Endocrine Review

A nurse is teaching a client with diabetes mellitus who requires insulin about methods of preventing diabetic ketoacidosis (DKA) when the client is ill. The nurse tells the client to: Refrain from eating or drinking during periods of vomiting Take the prescribed insulin dose even if he is unable to eat Contact the physician if a fever over 102° F occurs Contact the physician when the premeal blood glucose value is greater than 350 mg/dL

B Rationale: Insulin should never be independently stopped or decreased, and the client is instructed to take prescribed insulin even if he or she is vomiting or unable to eat. Acute illness may cause a counterregulatory hormone response, resulting in hyperglycemia. During times of illness, the client should monitor the blood glucose level and notify the physician if it exceeds 250 mg/dL. Adequate fluids and carbohydrates are essential during illness. The client should eat 10 to 15 g of carbohydrate every 1 to 2 hours and drink a small quantity of fluid every 15 to 30 minutes to help prevent dehydration and ketoacidosis. The client should notify the physician of a fever over 100° F.

A nurse is monitoring a client with a head injury for signs of diabetes insipidus (DI). Which finding would cause the nurse to suspect that this complication is developing? Urine specific gravity 1.030 Serum sodium level 155 mEq/L Serum osmolarity 200 mOsm/kg Urine output 30 mL/hr for past 4 hours

B Rationale: One complication of head injury is diabetes insipidus (DI), which may occur with insult to the hypothalamus, the antidiuretic hormone storage vesicles, or the posterior pituitary gland. In DI the urine specific gravity ranges from 1.001 to 1.005 and the serum osmolarity and serum sodium level are high. Large quantities of very dilute urine are excreted, putting the client at risk for severe dehydration. Normal osmolarity ranges from 275 to 295 mOsm/kg. The normal sodium range is 135 to 145 mEq/L. The other options are signs of syndrome of inappropriate antidiuretic hormone, which is a complication of intracranial surgery.

A nurse is transcribing a physician's prescription for oral prednisone 5 mg/day that was written in the chart of a client with type 2 diabetes mellitus who is already taking an oral hypoglycemic medication. The nurse contacts the physician to ask about the prescription because: A. Prednisone can lower the blood glucose level B. Prednisone can increase the blood glucose level C. Prednisone is contraindicated with the use of oral hypoglycemic medications D.For prednisone to be effective in a client taking an oral hypoglycemic agent, a higher dosage of prednisone is required

B Correct Aswer Feedback Rationale: Prednisone is a glucocorticoid. Glucocorticoids can increase the blood glucose level. Prednisone is not contraindicated in the client taking an oral hypoglycemic agent; however, diabetic clients may require increased dosages of insulin or oral hypoglycemic medications during glucocorticoid therapy.

A licensed practical nurse is reinforcing instruction about insulin therapy and its administration to an adolescent client who has just been found to have diabetes mellitus. Which statement by the client indicates a need for further instruction? A. "It's important to rotate injection sites." B. "I need to store the insulin in a cool, dry place." C. "I need to keep any unopened bottles of insulin in the freezer." D. "I need to check the expiration date on the insulin before I use it."

C Correct Answer Feedback Rationale: Insulin is stored in a cool, dry place. It should not be placed in the freezer or exposed to excess heat or agitation. Injection sites should be rotated to ensure adequate insulin absorption and to prevent complications of insulin administration. Once a bottle of insulin has been opened, it is dated and discarded as recommended. The client should check the expiration date on the insulin vial before using it.

A home care nurse prefills syringes containing NPH (Humulin N) and regular (Humulin R) insulin for a client with diabetes mellitus who will be administering his own insulin but has difficulty seeing and accurately preparing doses. The nurse places the medication in the client's refrigerator with the syringes: A. Lying flat B. In a horizontal position C. In a vertical position with the needles pointing up D. In a vertical position with the needles pointing down

C Correct Answer Feedback Rationale: Mixtures of insulin in prefilled syringes may be stored in a refrigerator, where they will be stable for at least 1 to 2 weeks. The syringes should be stored vertically, with the needles pointing up to prevent clogging of the needle with the insulin. Before administration of the medication, the syringe should be agitated gently to resuspend the insulin.

A nurse is providing information on the glycosylated hemoglobin assay (HgbA1C) and its purpose to a client with diabetes mellitus. The nurse reinforces information to the client that this blood test: A. Is a measure of the client's hematocrit level B. Is a measure of the client's hemoglobin level C. Helps predict the risk for the development of chronic complications of diabetes mellitus D. Provides a determination of short-term glycemic control in the client with diabetes mellitus

C Rationale: Glycosylated hemoglobin is the best indicator of the average blood glucose level. Because glucose attaches itself to the hemoglobin molecule, measurement of glycosylated hemoglobin indicates the average blood glucose level during the previous 120 days, the lifespan of the red blood cell. The test is used to assess long-term glycemic control, as well as to predict the risk for the development of chronic complications.

A nurse is teaching a client with newly diagnosed diabetes mellitus how to perform fingerstick blood glucose measurements. The nurse tells the client to: A. Puncture the tip of the finger in its center B. Clean the puncture site with alcohol but not allow the alcohol to dry C. Reuse the same lancet or bloodletting device for a full day before discarding it D. Hold the finger in a dependent position and massage the finger toward the puncture site

D Correct Answer Feedback Rationale: Before performing a fingerstick for blood glucose measurement, the client should wash the hands, using warm water to stimulate the circulation to the area. The finger is punctured near the side, not the center, because there are fewer nerve endings along the side of the finger. The puncture is only deep enough to obtain an adequate size of a drop of blood; an excessively deep puncture may result in pain and bruising. The arm should be allowed to hang dependently, and the finger may be massaged to promote obtaining a good-sized drop of blood. The site is cleaned with alcohol or an antiseptic swab and allowed to dry completely before puncture, because alcohol can cause hemolysis of blood. To help prevent infection, a lancet or blood-letting device is used once and then discarded.

A nurse instructs a client with diabetes mellitus and hypertension in illness management and lists carbohydrate-containing beverages that the client may consume when he cannot tolerate food orally. The nurse determines that the client needs additional instruction if he states that he should consume: Ginger ale Apple juice Regular cola Canned orange juice

D Rationale: A diabetic client who is unable to tolerate food because of illness should take in approximately 15 g of carbohydrate every 1 to 2 hours. Ginger ale, apple juice, and regular cola each provide 13 to 15 g of carbohydrate in a half-cup serving. Items that are canned are generally high in sodium and should not be used by the client with hypertension.

A client with a medical history of diabetes mellitus is found to have sarcoidosis, and oral prednisone is prescribed. The licensed practical nurse reinforces instructions to the client about the medication and tells the client to: A. Eat foods that are high in sodium B. Decrease the daily dose of insulin C. Eat foods that are low in potassium D. Closely monitor the blood glucose level

D Rationale: Sarcoidosis is a multisystem granulomatous disorder of unknown cause that can affect virtually any organ. Corticosteroids are the primary pharmacological therapy for sarcoidosis. When taken over an extensive period of time, prednisone may cause increased blood glucose and decreased potassium. It may also cause increased blood pressure and sodium retention. The client with diabetes mellitus would be instructed to closely monitor the blood glucose level. The physician may prescribe an increased dose of insulin while the client is taking this medication.

A client with type 1 diabetes mellitus is instructed by the physician to obtain glucagon hydrochloride (Glucagon) for emergency home use. The licensed practical nurse reinforces information to the client's wife about the medication. Which statement by the client's wife indicates that she understands the information? A. "I need to store this medication in the freezer." B. "I know that this is used to treat episodes of high blood sugar." C. "I can give this medication instead of insulin if his insulin runs out." D. "I need to give this if he has signs of low blood sugar and becomes unresponsive."

D Correct Answer Feedback Rationale: Glucagon is used to treat hypoglycemia resulting from insulin overdose. If hypoglycemic coma develops, glucagon is administered promptly. The family of the client is instructed in how to administer the medication. In an unconscious client, arousal usually occurs within 20 minutes of injection. Once consciousness has been produced, oral carbohydrates should be given. Insulin should never be stored in the freezer. Glucagon is not used to treat hyperglycemia or used in place of insulin; also, the client should be instructed to have additional vials of insulin on hand at home so that he will not run out. Glucagon is stored at room temperature.

A nurse is teaching a client with newly diagnosed diabetes mellitus how to perform fingerstick blood glucose measurements. The nurse tells the client to: A. Puncture the tip of the finger in its center B. Clean the puncture site with alcohol but not allow the alcohol to dry C. Reuse the same lancet or bloodletting device for a full day before discarding it D. Hold the finger in a dependent position and massage the finger toward the puncture site

D Rationale: Before performing a fingerstick for blood glucose measurement, the client should wash the hands, using warm water to stimulate the circulation to the area. The finger is punctured near the side, not the center, because there are fewer nerve endings along the side of the finger. The puncture is only deep enough to obtain an adequate size of a drop of blood; an excessively deep puncture may result in pain and bruising. The arm should be allowed to hang dependently, and the finger may be massaged to promote obtaining a good-sized drop of blood. The site is cleaned with alcohol or an antiseptic swab and allowed to dry completely before puncture, because alcohol can cause hemolysis of blood. To help prevent infection, a lancet or blood-letting device is used once and then discarded.

Vasopressin (Pitressin) is prescribed to a client with diabetes insipidus. For which sign, indicative of an adverse effect of the medication, does the nurse monitor the client? A. Chest pain B. Constipation C. Loss of appetite D. Decreased urine output

A Correct Answer Feedback Rationale: Because of its powerful vasoconstrictive action, vasopressin can cause adverse cardiovascular effects. By constricting arteries of the heart, vasopressin can cause angina pectoris and even myocardial infarction, especially if the medication is administered to a client with existing coronary artery disease. Vasopressin may also cause gangrene by decreasing blood flow in the periphery. Chest pain is a sign of an adverse effect, and if it occurs the physician is notified. Decreased urine output is an expected effect. Neither constipation nor loss of appetite is associated with this medication.

Glargine insulin (Lantus) is prescribed for a client with type 1 diabetes mellitus. What does the nurse tell the client about this type of insulin? Select all that apply. A. It does not have a peak effect. B. It is usually given once daily, at bedtime. C. It usually has a 24-hour duration of action. D. It may be mixed in a syringe with regular insulin. E. Its onset of action comes 4 hours after administration.

A B C Correct Answer Feedback Rationale: Glargine insulin, a long-acting basal insulin analog, has an onset of action of 1 to 2 hours, with no peak effect, and a duration of action of more than 24 hours. It is usually given once daily, preferably at bedtime. Glargine insulin may not be mixed in a syringe with other insulin.

A nurse is developing a plan of care for an older client with diabetic neuropathy of the lower extremities resulting from type 2 diabetes mellitus. Which problem does the nurse recognize as the highest priority for this client? A. Change in body image B. Increased risk for injury C. Increased risk of depression D. Lower level of physical activity

B Correct Answer Feedback Rationale: The client with diabetic neuropathy of the lower extremities has a diminished sensation in the legs and feet. This client is at risk for tissue injury and for falls as a result of this nervous system impairment. Therefore the highest priority nursing problem is increased risk for injury. Increased risk of depression and change in body image are more psychosocial in nature and, as such, are secondary needs. A lower level of physical activity may be a problem but is not the priority.

A nurse, providing information to a client who has just been found to have diabetes mellitus, gives the client a list of symptoms of hypoglycemia. Which of the following answers by the client, on being asked to list the symptoms, tells the nurse that the client understands the information? Select all that apply. A. Hunger B. Weakness C. Blurred vision D. Increased thirst E. Increased urine output

A B C Correct Answer Feedback Rationale: The manifestations of diabetes mellitus (hyperglycemia) include polydipsia, polyuria, and polyphagia. Symptoms of hypoglycemia include weakness, double vision, blurred vision, hunger, tachycardia, and palpitations.

The nurse is teaching client with newly diagnosed diabetes mellitus who has been prescribed NPH insulin how to recognize the signs of hypoglycemia. The client states that he must look for certain signs and symptoms in the late afternoon, indicating to the nurse that he has understood the instructions. What are these signs and symptoms? Select all that apply. A. Shakiness B. Drowsiness C. Blurred vision D. Increased thirst E. Feelings of hunger F. Nausea and vomiting

A C E Rationale: The client taking NPH insulin experiences peak medication effects 6 to 12 hours after administration. When the medication's action peaks, the client is at risk of hypoglycemia if food intake is insufficient. The nurse teaches the client to be alert for signs and symptoms of hypoglycemia, including anxiety, confusion, difficulty concentrating, blurred vision, cold sweats, headache, increased pulse, shakiness, and hunger. The other options are signs and symptoms of hyperglycemia.

A home care nurse visits a depressed older adult client in whom type 2 diabetes mellitus was recently diagnosed. As the nurse teaches him about insulin injections, the client says, "I don't think I'll ever learn to stick this needle in myself." Which response by the nurse is therapeutic? A. "With proper diet and exercise, you may be able to stop taking insulin." B. "Perhaps you could start by telling me what troubles you most about injecting yourself." C. "Injecting yourself with insulin seems odd at first. Let me show you how to assemble your insulin pen." D. "All of my clients tell me that when they first start to self-administer insulin, but they learn. You will, too."

B Rationale: In listening to the client's fears, the nurse allows the client to vent, establishes a one-on-one relationship, and identifies areas in which the client will require emotional support. It may not be possible for the client to discontinue insulin, regardless of his compliance with the prescribed diet and exercise. The nurse should not begin teaching until the client is able to accept the need for injections. Clichés and false reassurances are nontherapeutic responses that minimize the client's feelings and risk belittling the client. Test-Taking Strategy: Use your knowledge of therapeutic communication techniques. Focus on the client's feelings. This will direct you to the correct option. Review therapeutic communication techniques if you had difficulty with this question.

A nurse is providing information to a client with diabetes insipidus who will be taking desmopressin acetate (DDAVP) by way of the nasal route. For which of the following occurrences does the nurse tell the client to contact the physician? A. Abdominal cramps B. Stuffy or runny nose C. Headache and nausea D. Decreased urine output

C Correct Answer Feedback Rationale: Diabetes insipidus is a disorder of water metabolism caused by a deficiency of antidiuretic hormone (ADH). Desmopressin, a synthetic form of antidiuretic hormone, causes increased resorption of water and a resultant decrease in urine output (an expected outcome). One adverse effect of the medication is water intoxication. Early signs of water intoxication include headache, nausea, shortness of breath, drowsiness, and listlessness. The physician is notified if these signs occur. Abdominal cramping is a side effect, not an adverse effect, of the parenteral form of the medication. A runny or stuffy nose is a side effect, not an adverse effect, of the medication.

The wife of a client with diabetes mellitus calls the nurse and reports that her husband's blood glucose level is 60 mg/dL and that her husband is awake but groggy. The nurse tells the client's wife to immediately: A. Call the physician B. Administer glucagon hydrochloride (Glucagon) C. Call an ambulance to bring her husband to the emergency department D. Place some honey in her husband's mouth, between his gums and cheek

D Correct Answer Feedback Rationale: The client and his wife spouse should be educated about the signs of hypoglycemia (blood glucose level of 60 mg/dL or lower). If a client experiences hypoglycemia and is awake but groggy, corn syrup, honey, or cake icing may be placed in the client's mouth, between the gums and cheek. Once the sugar has been absorbed through the oral mucosa, the client can usually be aroused sufficiently to take a glass of juice, milk, or sugar-sweetened coffee or tea. There is no reason at this time to call the physician or to call an ambulance to bring the client to the emergency department. Glucagon hydrochloride is used to treat hypoglycemic coma.