ENDOCRINE PHARM
6) A client with diabetes presents to the emergency department with a 3-hour history of profound weakness and nervousness. According to the spouse, the client became confused shortly after self-administering the morning dose of 10 units of regular insulin and 25 units of NPH insulin. The client had a light breakfast and no additional intake since that time. Which condition would the nurse identify as the likely cause of the client's signs and symptoms? A. Hyperglycemia B. Hyperinsulinemia C. Hypoglycemia D. Hypoinsulinemia
C. Hypoglycemia
2) Which insulin will the nurse prepare for the emergency treatment of ketoacidosis? A. Glargine B. NPH insulin C. Insulin aspart D. Insulin detemir
C. Insulin aspart
12) Which complication of diabetes would the nurse suspect when a health care provider prescribes one tube of glucose gel for a client with type 1 diabetes? A. Diabetic acidosis B. Hyperinsulin secretion C. Insulin-induced hypoglycemia D.Idiosyncratic reactions to insulin
C. Insulin-induced hypoglycemia
1) A client who receives NPH insulin every morning reports feeling nervous at 4:30 PM. The nurse observes that the client's skin is moist and cool. Which condition is the client likely experiencing? A. Hyperosmolar hyperglycemic nonketotic state B. Ketoacidosis C. Glycogenesis D. Hypoglycemia
D. Hypoglycemia
1) Which medication will the nurse expect the health care provider to prescribe to a client who had a thyroidectomy and is pale with spasms of the hand when taking the blood pressure? A. Calcium B. Magnesium C. Bicarbonate D. Potassium chloride
A. Calcium
4) Which insulin would the nurse conclude has the fastest onset of action? A. NPH insulin B. Insulin lispro C. Regular insulin D.Insulin glargine
B. Insulin lispro
5) A client with diabetes mellitus is scheduled to receive an intravenous (IV) administration of 25 units of insulin in 250 mL normal saline. Which type of insulin would the nurse recognize as compatible with IV solutions? A. NPH insulin B. Insulin lispro C. Insulin detemir D.Insulin glargine
B. Insulin lispro
2) The nurse administers a tube of glucose gel to a client who is hypoglycemic. Which explanation would the nurse share regarding the reversal of hypoglycemia? A. It liberates glucose from hepatic stores of glycogen. B. It provides a glucose source that is rapidly absorbed. C. Insulin action is blocked as it competes for tissue sites. D. Glycogen is supplied to the brain as well as other vital organs.
B. It provides a glucose source that is rapidly absorbed.
6) The nurse is caring for a client with diabetes mellitus. The client reports feeling hungry and thirsty. The client's most recent blood glucose level was 175 mg/dL. Which type of insulin should the nurse anticipate being prescribed for this client? A. Glucagon B. Lispro C. Exenatide D. Sitagliptin
B. Lispro
2) Which purpose is served by an evening snack of milk, crackers, and cheese for a client who is receiving NPH insulin? A. Encouragement to stay on the diet B. Food to counteract late insulin activity C. Added calories to promote weight gain D. High carbohydrates to provide nourishment for immediate use
B. Food to counteract late insulin activity
13) The nurse is caring for a client who reports sweating, tachycardia, and tremors. The laboratory report of the client reveals serum cortisol less than normal and a blood glucose level of 60 mg/dL. Which medication would be administered to this client? A. Glucagon B. Kayexalate C. Hydrocortisone D. Insulin with dextrose in normal saline
A. Glucagon
5) Intravenous fluids and insulin are prescribed to treat a client's diabetic ketoacidosis. The client develops peripheral paresthesias and shortness of breath. The cardiac monitor shows the appearance of a U wave. Which complication would the nurse suspect? A. Hypokalemia B. Hypoglycemia C. Hypernatremia D.Hypercalcemia
A. Hypokalemia
3) Which statement by the nurse is most appropriate regarding the greatest advantage of using an insulin pump? A. 'Independence is fostered.' B. 'Fear of daily injections is allayed.' C. 'Dietary restrictions are minimized.' D. 'Blood glucose monitoring can be eliminated.'
A. 'Independence is fostered.'
9) A nurse is educating a client on insulin administration. Which statement made by the client indicates further teaching is required? A. I will inject the insulin in the same site every day B. The best injection area is around my abdomen C. I will squeeze my skin together to inject the medication D. Gentle pressure should be applied to the site after injection
A. I will inject the insulin in the same site every day
7) The nurse plans to teach a client with type 1 diabetes about the use of an insulin pump. Which information will the nurse include in client teaching? A. Insulin pumps mimic the way a healthy pancreas works. B. The insulin pump's needle should be changed every day. C. Pumps are implanted in a subcutaneous pocket near the abdomen. D. The insulin pump's advantage is that it only requires glucose monitoring once a day.
A. Insulin pumps mimic the way a healthy pancreas works.
4) In addition to clients who are receiving insulin for type 1 diabetes, the nurse will assess for signs and symptoms of hypoglycemia in clients who have which diagnosis? A. Liver failure B. Anemia C. Hyperthyroidism D. Stage 3 hypertension
A. Liver failure
1) Which independent nursing action would be included in the plan of care for a client after an episode of ketoacidosis? A. Monitoring for signs of hypoglycemia resulting from treatment B. Withholding glucose in any form until the situation is corrected C. Giving fruit juices, broth, and milk as soon as the client is able to take fluids orally D. Regulating insulin dosage according to the client's urinary ketone levels
A. Monitoring for signs of hypoglycemia resulting from treatment
1) Which mechanism of action explains how glyburide decreases serum glucose levels? A. Stimulates the pancreas to produce insulin B. Accelerates the liver's release of stored glycogen C. Increases glucose transport across the cell membrane D. Decreases absorption of glucose from the gastrointestinal system
A. Stimulates the pancreas to produce insulin
8) A client is diagnosed with acute kidney failure secondary to dehydration. An intravenous (IV) infusion of 50% glucose with regular insulin is prescribed to address which purpose? A. To correct hyperkalemia B. To increase urinary output C. To prevent respiratory acidosis D.To increase serum calcium levels
A. To correct hyperkalemia
3) When would the nurse plan to administer pancrelipase to a child with cystic fibrosis? A. With meals and snacks B. In the morning and at bedtime C. On awakening and every 3 hours while the child is awake D. After each bowel movement and after postural drainage is performed
A. With meals and snacks
1) Which information would the nurse provide to a client with type 1 diabetes who requests information about the differences between penlike insulin delivery devices and syringes? A. "The penlike devices have a shorter injection time." B. "Penlike devices provide a more accurate dose delivery." C. "The penlike delivery system uses a smaller-gauge needle." D. "Penlike devices cost less by having reusable insulin cartridges."
B. "Penlike devices provide a more accurate dose delivery."
3) At the client's request, the nurse performs a fingerstick to test the client's blood glucose and the results are 322 mg/dL (17.9 mmol/L). Following the insulin sliding scale orders, the nurse administers 3 units of insulin lispro at 11:00 AM. When does the nurse anticipate the insulin lispro will begin to act? A. 3:00 pm B. 11:15 am C. 1:00 pm D.12:00 PM
B. 11:15 am
1) At 9 am, the nurse administers 10 units of insulin aspart subcutaneously to a client with a blood sugar of 322 mg/dL. At approximately what time should the nurse expect the insulin to peak? A. At 9:30 am B. At 10:00 am C. At noon D. This insulin does not peak because it acts over 24 hours.
B. At 10:00 am
4) The nurse teaches an adolescent about administration of intermediate-acting insulin and regular insulin. Which response indicates the adolescent understands when to administer the second dose of NPH insulin? A. At lunch B. At dinnertime C. 1 hour after lunch D. 1 hour after dinner
B. At dinnertime
3) Which mineral deficiency would a nurse suspect in a client who reports tingling in the fingers and around the mouth and exhibits carpopedal spasm and tremors after a surgical thyroidectomy ? A. Potassium B. Calcium C. Magnesium D.Sodium
B. Calcium
6) A client is experiencing both tingling of the extremities and tetany. The nurse will review the client's laboratory report to check for which electrolyte abnormality? A. Hypokalemia B. Hypocalcemia C.Hyponatremia
B. Hypocalcemia
6) A child with type 1 diabetes is receiving 15 units of regular insulin and 20 units of NPH insulin at 7:00 AM each day. Which time would the nurse anticipate a hypoglycemic reaction from the NPH insulin to occur? A. Before noon B. In the afternoon C. Within 30 minutes D.During the evening
B. In the afternoon
5) Which advice will the nurse give the client to avoid lipodystrophy when self-administering insulin therapy? A. Exercise regularly. B. Rotate injection sites. C. Use the Z-track technique. D. Vigorously massage the injection site.
B. Rotate injection sites.
4) A client with thyroid cancer is scheduled for a thyroidectomy. Which information will the nurse teach the client? A. The dietary intake of carbohydrates must be restricted. B. Thyroxine replacement therapy will be required indefinitely. C. Chemotherapy will be used in conjunction with the surgery. D. A tracheostomy is required for clients having this procedure.
B. Thyroxine replacement therapy will be required indefinitely.
1) Which time for medication scheduling would a nurse teach to a client prescribed the oral pancreatic enzymes pancrelipase? A. At bedtime B. With meals C. One hour before meals D. On arising each morning
B. With meals
6) The nurse evaluates that teaching for the oral pancreatic enzymes pancrelipase is understood when the client identifies which time for medication scheduling? A. At bedtime B. With meals C. One hour before meals D. On arising each morning
B. With meals
2) A client asks the nurse if glipizide (Glucotrol) is an oral insulin. Which response should the nurse provide? A. "Yes, it is an oral insulin and has the same actions and properties as intermediate insulin." B. "Yes, it is an oral insulin and is distributed, metabolized, and excreted in the same manner as insulin." C. "No, it is not an oral insulin and can be used only when some beta cell function is present." D. "No, it is not an oral insulin, but it is effective for those who are resistant to injectable insulins."
C. "No, it is not an oral insulin and can be used only when some beta cell function is present."
2) Which is the priority short-term goal when teaching a client with type 1 diabetes who is placed on an insulin pump to control the diabetes? A. "The client will adhere to the medical regimen." B. "The client will remain normoglycemic for 3 weeks." C. "The client will demonstrate correct use of the insulin pump." D. "The client will list three self-care activities that are necessary to control the diabetes."
C. "The client will demonstrate correct use of the insulin pump."
7) A client with type 1 diabetes experiences tremors, pallor, and diaphoresis. These signs and symptoms are manifestations of which cause? A. Overeating B. Viral infection C. Aerobic exercise D. Missed insulin dose
C. Aerobic exercise
19) The nurse is caring for a client with diabetes type I who received a prescribed dose of regular insulin 30 minutes prior to the meal. The client reports nausea and vomiting. Which action should the nurse take? A. Administer another dose of regular insulin B. Encourage the client to eat a small amount of carbohydrates C. Assess blood glucose level D.Notify the healthcare provider
C. Assess blood glucose level
17) The health care provider prescribes an oral hypoglycemic medication for the client with type 2 diabetes. Which statement will the nurse need to consider when developing the teaching plan? A. Oral hypoglycemics work by decreasing absorption of carbohydrates. B. Oral hypoglycemics work by stimulating the pancreas to produce insulin. C. Clients taking oral hypoglycemics may subconsciously relax dietary rules to gain a sense of control. D. Serious adverse effects are not a problem for oral hypoglycemics.
C. Clients taking oral hypoglycemics may subconsciously relax dietary rules to gain a sense of control.
16) A client with diabetes asks how exercise will affect insulin and dietary needs. Which effects of exercise would the nurse share? A. Increases the amount of insulin needed and increases the need for carbohydrates B. Increases the amount of insulin needed and decreases the need for carbohydrates C. Decreases the amount of insulin needed and increases the need for carbohydrates D. Decreases the amount of insulin needed and decreases the need for carbohydrates
C. Decreases the amount of insulin needed and increases the need for carbohydrates
4) A 12-year-old child with cystic fibrosis is prescribed four pancrelipase capsules five times a day. The nurse explains to the child they would take the medication with meals and snacks to accomplish which goal? A. Enhance oxygenation B. Limit excretion of fats C. Facilitate nutrient utilization D.Prevent iron-deficiency anemia
C. Facilitate nutrient utilization
3) The health care provider prescribes metformin as monotherapy for the client with type 2 diabetes. The nurse will teach the client to monitor for which adverse effect? A. Weight gain B. Constipation C. Lactic acidosis D.Hypoglycemia
C. Lactic acidosis
3) A client with type 1 diabetes self-administers neutral protamine Hagedorn (NPH) insulin every morning at 8:00 AM. The nurse evaluates that the client understands the action of the insulin when the client identifies which time range as the highest risk for hypoglycemia? A. 9:00 AM to 10:00 AM B. 10:00 AM to 11:00 AM C. Noon to 8:00 PM D.8:00 PM to midnight
C. Noon to 8:00 PM
7) The nurse adds 20 mEq of potassium chloride to the intravenous solution of a client with diabetic ketoacidosis. Which purpose would this medication serve? A. Treats hyperpnea B. Prevents flaccid paralysis C. Prevents hypokalemia D.Treats cardiac dysrhythmias
C. Prevents hypokalemia
4) The nurse is teaching a school-age child how to use an insulin pump. Which instruction by the nurse is most important for the child to understand? A. The needle must be changed every day. B. A blood glucose check is necessary once a day. C. The pump is an attempt to mimic the way a healthy pancreas works. D. Subcutaneous pockets near the abdomen are used to implant the pump.
C. The pump is an attempt to mimic the way a healthy pancreas works.
1) Which statement made by a client prescribed metformin extended release to control type 2 diabetes mellitus indicates the need for further education? A. "I will take the medication with food." B. "I must swallow my medication whole and not crush or chew it." C. "I will notify my doctor if I develop muscular or abdominal discomfort." D."I will stop taking metformin for 24 hours before and after having a test involving dye."
D. "I will stop taking metformin for 24 hours before and after having a test involving dye."
5) A client is admitted to the hospital for a subtotal thyroidectomy. When discussing postoperative medication therapy with the client, which advice will the nurse include in the teaching? A. 'You will be taking iodine daily to increase the formation of thyroid hormone.' B. 'After your body adjusts to postsurgical status, you will be weaned off this medication.' C. 'The propylthiouracil that is prescribed will stimulate the secretion of thyroid-stimulating hormone.' D.'If you develop palpitations, nervousness, or tremors, the dose of thyroid hormone may need to be decreased.'
D. 'If you develop palpitations, nervousness, or tremors, the dose of thyroid hormone may need to be decreased.'
2) Which alteration is the likely cause of thyrotoxic crisis (thyroid storm) in a client who has had treatment with propylthiouracil for hyperthyroidism followed by thyroid ablation with 131I? A. Deficiency of iodine B. Decreased serum calcium C. Increased sodium retention D.Excessive hormone replacement
D. Excessive hormone replacement
3) A nurse is reviewing prescribed medications for a client diagnosed with diabetic ketoacidosis. Which medication will the nurse clarify with the healthcare provider? A. Regular insulin Your Answer B. Potassium C. 0.9% sodium chloride D.Glipizide
D. Glipizide
3) A client with type 1 diabetes receives 30 units of neutral protamine Hagedorn (NPH) insulin at 7:00 AM. At 3:30 PM, the client becomes diaphoretic, weak, and pale. With which condition would the nurse determine that these physiological responses are associated? A. Diabetic coma B. Hyperosmolar hyperglycemic nonketotic syndrome C. Diabetic ketoacidosis D. Hypoglycemic reaction
D. Hypoglycemic reaction
3) Which purpose of insulin would a nurse identify when caring for a client prescribed insulin added to a solution of 10% dextrose in water after an intravenous solution containing potassium inadvertently was infused too rapidly? A. Glucose with insulin increases metabolism, which accelerates potassium excretion. B. Increased potassium causes a temporary slowing of the pancreatic production of insulin. C. Increased insulin accelerates the excretion of glucose and potassium, thereby decreasing the serum potassium level. D. Potassium follows glucose into the cells of the body, thereby raising the intracellular potassium level.
D. Potassium follows glucose into the cells of the body, thereby raising the intracellular potassium level.
6) Which rationale explain why intravenous (IV) potassium is prescribed in addition to regular insulin for clients in diabetic ketosis? A. Potassium loss occurs rapidly from diaphoresis present during coma. B. Potassium is carried with glucose to the kidneys to be excreted in the urine in increased amounts. C. Potassium is quickly used up during the rapid series of catabolic reactions stimulated by insulin and glucose. D.Serum potassium levels will decrease as potassium ions shift from the extracellular fluid to the intracellular fluid compartment.
D. Serum potassium levels will decrease as potassium ions shift from the extracellular fluid to the intracellular fluid compartment.
9) An adolescent with type 1 diabetes mellitus is admitted to the intensive care unit in ketoacidosis with a blood glucose level of 170 mg/dL (9.4 mmol/L). A continuous insulin infusion is started. Which adverse reaction to the infusion is most important for the nurse to monitor? A. Hypokalemia B. Hypovolemia C. Hypernatremia D.Hypercalcemia
A. Hypokalemia
4) A nurse is educating a client with diabetes type 2 about newly prescribed glipizide. Which statement by the nurse best describes the action of glipizide? A. "This medication absorbs the excess carbohydrates from your intestinal tract." B. "This medication will inhibit the release of glucose stored in the liver." C. "This medication will stimulate your pancreas to release insulin." D. "This medication works by increasing the ability of the cells to uptake glucose."
C. "This medication will stimulate your pancreas to release insulin."
6) The nurse identifies a nontender 5-cm indurated region on the upper arm of a client with type 1 diabetes. The client says to the nurse, 'That is where I give myself insulin shots.' The nurse concludes that the nodule is a result of which condition? A. Callus B. An allergy C. An infection D.Lipodystrophy
D. Lipodystrophy
7) An adolescent with diabetes had a 6:30 AM fasting blood glucose level of 180 mg/dL (10.0 mmol/L). Which nursing action is a priority? A. Encourage the adolescent to start exercising. B. Ask the adolescent to obtain an immediate glucometer reading. C. Inform the adolescent that a complex carbohydrate such as cheese should be eaten. D. Tell the adolescent that the prescribed dose of rapid-acting insulin should be administered.
D. Tell the adolescent that the prescribed dose of rapid-acting insulin should be administered.
5) The nurse is giving instructions to the parents of a child who has cystic fibrosis. Which information should the nurse emphasize about administration of pancreatic enzymes? A. Administer each time a high-carbohydrate meal is eaten B. Crush the tablet and sprinkle on food three times a day C. Dispense once daily with breakfast D.They are to be taken with every meal or snack
D. They are to be taken with every meal or snack
5) The nurse teaches an adolescent with type 1 diabetes about peak action of NPH insulin and the risk for hypoglycemia. The nurse determines teaching has been effective when the adolescent identifies insulin peak action within which time frame? A. 1 to 2 hours B. 2 to 4 hours C. 5 to 10 hours D.4 to 12 hours
D.4 to 12 hours
1) The nurse is planning an evening snack for a child receiving NPH insulin. The nurse offers a snack for which reason? It encourages the child to stay on the diet. Energy is needed for immediate utilization. Extra calories will help the child gain weight. Nourishment helps counteract late insulin activity.
Nourishment helps counteract late insulin activity.
8) A nurse receives a prescription to administer regular insulin U-500 to a client with diabetes mellitus. How will the nurse administer this medication? A. Intravenously using an infusion pump B. Subcutaneously using an insulin pump C. Intramuscularly using a U-100 syringe D. Subcutaneously using a U-500 syringe
D. Subcutaneously using a U-500 syringe
2) The nurse is reviewing discharge instructions with the parent of an infant with cystic fibrosis. Which statement indicates the parents know how to administer the pancreatic enzyme replacement? A. 'We should give the medication with feedings.' B. 'We should put crushed enteric-coated pills in the formula.' C. 'We need to give the medication every 6 hours, even during the night.' D. 'We should feed the granules from the capsule in applesauce every morning.'
A. 'We should give the medication with feedings.'
10) Which response would a nurse give to a client taking an oral hypoglycemic tablet daily who asks if an extra tablet should be taken before exercise? A. "You will need to decrease your exercise." B. "An extra tablet will help your body use glucose correctly." C. "When taking medicine, your diet will not be affected by exercise." D. "No, but you should observe for signs of hypoglycemia while exercising."
D. "No, but you should observe for signs of hypoglycemia while exercising."
14) A client with type 2 diabetes takes one glyburide tablet daily. The client asks whether an extra tablet should be taken before exercise. Which response will the nurse provide? A. 'You will need to decrease how much you are exercising.' B. 'An extra pill will help your body use glucose when exercising.' C. 'The amount of medication you need to take is not related to exercising.' D. 'Do not take an extra pill because you may become hypoglycemic when exercising.'
D. 'Do not take an extra pill because you may become hypoglycemic when exercising.'
9) A nurse is assessing a client diagnosed with diabetic ketoacidosis. The client is on a prescribed regular insulin infusion at 0.1 units/kg/hr. The client appears restless and verbalizes tingling to the extremities. Which action does the nurse perform next? A. Check the client capillary blood glucose B. Stop the regular insulin infusion C. Increase the infusion to 0.15 units/kg/hr D. Give the client 4 oz of fruit juice
A. Check the client capillary blood glucose
4) Which rationale accurately explains why insulin is prescribed for clients in acute renal failure? A. It promotes transfer of potassium into cells to lower serum potassium levels. B. Insulin is required because the alpha cells of the pancreas cease to function with renal failure. C. It is necessary to manage the elevated blood glucose levels that accompany renal failure. D. Insulin reduces the accumulated toxins by lowering the metabolic rate.
A. It promotes transfer of potassium into cells to lower serum potassium levels.
18) The nurse is teaching a 10-year-old child with type 1 diabetes about insulin requirements. Which statement by the nurse correctly identifies when insulin needs decrease? A. 'Insulin needs often decrease when puberty is reached.' B. 'When there is an infection is present, the body requires less insulin.' C. 'Emotional stress can cause insulin needs to decrease.' D. 'Increased muscle activity such as exercise, cause insulin needs to decrease.'
D. 'Increased muscle activity such as exercise, cause insulin needs to decrease.'
2) The nurse prepares to administer extended-release metformin to an older adult who has asked that it be crushed because it is difficult to swallow. Which rationale will prompt the nurse to ask the provider for a different form of metformin? A. This medication has a wax matrix frame that is difficult to crush. B. The medication has an unpleasant taste, which most clients find intolerable if crushed. C. If crushed, this medication irritates mucosal tissue and can cause oral and esophageal ulcer formation. D. Extended-release formulations are designed to be released slowly and crushing the tablet will prevent this from occurring.
D. Extended-release formulations are designed to be released slowly and crushing the tablet will prevent this from occurring.