NUR 221 exam 2
The nurse is reviewing the results of patient's recent hemoglobin A1c level drawn to evaluate type 1 diabetes management. Which result indicates that treatment has been successful? A. > or = 8% B. < or = 6.5% C. > 110 mg/dL D. > 140 mg/dL
B. < or = 6.5%
Which children admitted to the pediatric unit would the nurse monitor closely for development of SIADH? Select all who apply. A. A newly diagnosed preschooler with type 1 diabetes B. A school-age child returning from surgery for removal of a brain tumor C. An infant with suspected meningitis D. An adolescent with blunt abdominal trauma following a car accident E. A school-age child with head trauma
B. A school-age child returning from surgery for removal of a brain tumor C. An infant with suspected meningitis E. A school-age child with head trauma
A patient with type 1 diabetes mellitus has not taken insulin for several days. Which observation indicates that diabetic ketoacidosis (DKA) could be developing? A. Slow heart rate B. Deep rapid respirations C. Decreased urine output D. Increased blood pressure
B. Deep rapid respirations
The nurse is caring for a patient who underwent pituitary surgery 12 hours ago. The nurse will give priority to monitoring the patient carefully for which possible complication? A. Congestive heart failure B. Hypovolemic shock C. Infection D. Volume overload
B. Hypovolemic shock (Profound diuresis that accompanies diabetes insipidus may result in hypovolemic shock.)
A patient has a serum sodium level of 126 mEq/L. What action should the nurse take to ensure for this patient's safety? A. Apply wrist restraints B. Implement seizure precautions C. Prepare for nasogastric tube insertion D. Plan for intermittent urinary catheterization
B. Implement seizure precautions
The nurse is evaluating teaching provided to a patient with type 1 diabetes mellitus. Which patient observation indicates that medication teaching has been effective? A. Uses a 1 mL syringe to measure insulin dose B. Places a new injection an inch away from previous injection site C. Inserts the needle at a 25-degree angle prior to injecting the medication D. Provides an injection in the thigh after an abdominal injection in the morning
B. Places a new injection an inch away from previous injection site
Diabetes insipidus is a disorder of the A. Anterior pituitary B. Posterior pituitary C. Adrenal cortex D. Adrenal medulla
B. Posterior pituitary
What should a nurse advise the parents of a child with type 1 diabetes mellitus who is not eating as a result of a minor illness? A. Give the child half his regular morning dose of insulin. B. Substitute simple carbohydrates or calorie-containing liquids for solid foods. C. Give the child plenty of unsweetened, clear liquids to prevent dehydration. D. Take the child directly to the emergency department.
B. Substitute simple carbohydrates or calorie-containing liquids for solid foods.
What is the most important factor in determining the rate of fluid replacement in the dehydrated child? A. The child's weight B. The type of dehydration C. Urine output D. Serum potassium level
B. The type of dehydration
Which is the nurse's best response to the parents of a 10-year-old child newly diagnosed with type 1 diabetes mellitus who are concerned about the child's continued participation in soccer? A. "Consider the swim team as an alternative to soccer." B. "Encourage intellectual activity rather than participation in sports." C. "It is okay to play sports such as soccer unless the weather is too hot." D. "Give the child an extra 15 to 30 g of carbohydrate snack before soccer practice."
D. "Give the child an extra 15 to 30 g of carbohydrate snack before soccer practice."
Mechanisms for development of diabetes insipidus include which of the following? (Select all that apply.) A. ADH deficiency B. ADH excess C. ADH insensitivity D. ADH replacement therapy E. Water deprivation
A. ADH deficiency C. ADH insensitivity
A 20-year-old with a history of type 1 diabetes and an eating disorder is found unconscious. In the emergency department, the following lab values are obtained: Glucose648 mg/dL pH6.88 P a CO 2 20 mm Hg P a O 2 95 mm Hg HCO 3 - undetectable Anion gap>31 Na + 127 mEq/L K + 3.5 mEq/L Creatinine1.8 mg/dL After the patient's airway and ventilation have been established, what is the next priority intervention for this patient? A. Administration of a 1-L normal saline fluid bolus. B. Administration of 0.1 unit of regular insulin IV push followed by an insulin infusion. C. Administration of 20 mEq KCl in 100 mL. D. IV push administration of 1 amp of sodium bicarbonate.
A. Administration of a 1-L normal saline fluid bolus.
What psychosocial factors may potentially contribute to the development of diabetic ketoacidosis? (Select all that apply.) A. Altered sleep/rest patterns B. Eating disorder C. Exposure to influenza D. High levels of stress E. Lack of financial resources
A. Altered sleep/rest patterns B. Eating disorder D. High levels of stress E. Lack of financial resources
The nurse is caring for a 27-year-old patient with a diagnosis of head trauma. The nurse notes that the patient's urine output has increased tremendously over the past 18 hours. The nurse suspects that the patient may be developing what complication of the injury? A. Diabetes insipidus B. Diabetic ketoacidosis C. Hyperosmolar hyperglycemic syndrome D. Syndrome of inappropriate secretion of antidiuretic hormone
A. Diabetes insipidus
When would a child diagnosed with type 1 diabetes mellitus most likely demonstrate a decreased need for insulin? A. During the "honeymoon" phase B. During adolescence C. During growth spurts D. During minor illnesses
A. During the "honeymoon" phase
The nurse is preparing to assess a patient with diabetes insipidus (DI). Which manifestations should the nurse expect? Select all that apply. A. Fatigue B. Extreme thirst C. Extreme hunger D. Large amounts of urine output E. Waking up to urinate during the night
A. Fatigue B. Extreme thirst D. Large amounts of urine output E. Waking up to urinate during the night
Factors associated with the development of nephrogenic diabetes insipidus include which of the following? (Select all that apply.) A. Heredity B. Medications, including phenytoin and lithium carbonate C. Meningitis D. Pituitary tumors E. Sickle cell disease
A. Heredity B. Medications, including phenytoin and lithium carbonate E. Sickle cell disease
A patient is having testing to diagnose type 1 diabetes mellitus. Which diagnostic tests might be prescribed for this patient? Select all that apply. A. Hemoglobin A1c B. 2-hr postprandial C. Serum albumin level D. Fasting blood glucose E. Random blood glucose
A. Hemoglobin A1c B. 2-hr postprandial D. Fasting blood glucose E. Random blood glucose
The nurse is reviewing orders written for a patient with syndrome of inappropriate antidiuretic hormone (SIADH). Which order should the nurse clarify? A. No added salt diet B. Fluid restriction 1L/day C. IV fluids 0.9% normal saline 125 mL/hr D. Furosemide (Lasix) 20 mg by mouth every day
A. No added salt diet
A patient with syndrome of inappropriate antidiuretic hormone (SIADH) is experiencing a headache and confusion. Which laboratory test would best explain the reason for this patient's symptoms? A. Sodium B. Calcium C. Potassium D. Hematocrit
A. Sodium
What is the primary concern for a 7 year-old child with type 1 diabetes mellitus who asks his mother not to tell anyone at school that he has diabetes? A. The child's safety B. The privacy of the child C. Development of a sense of industry D. Peer group acceptance
A. The child's safety
The parents of a child with acid-base imbalance ask the nurse about mechanisms that regulate acid-base balance. Which statement by the nurse accurately explains the mechanisms regulating acid-base balance in children? A. The respiratory, renal, and chemical-buffering systems B. The kidneys balance acid; the lungs balance base C. The cardiovascular and integumentary systems D. The skin, kidney, and endocrine systems
A. The respiratory, renal, and chemical-buffering systems
What is the best time for the nurse to assess the peak effectiveness of subcutaneously administered Regular insulin? A. Two hours after administration B. Four hours after administration C. Immediately after administration D. Thirty minutes after administration
A. Two hours after administration
A patient diagnosed with type 1 diabetes is receiving a continuous subcutaneous insulin infusion via an insulin pump contacts the clinic to report mechanical failure of the infusion pump. The nurse instructs the patient to begin monitoring for signs of what possible complication? A. Adrenal insufficiency B. Diabetic ketoacidosis C. Hyperosmolar, hyperglycemic state D. Hypoglycemia
B. Diabetic ketoacidosis
A continuous insulin intravenous infusion is started, and hourly bedside glucose monitoring is ordered for a patient who presented to the emergency department experiencing diabetic ketoacidosis. What is the targeted blood glucose value after the first hour of therapy? A. 70 to 120 mg/dL B. A decrease of 25 to 50 mg/dL compared with admitting values C. A decrease of 50 to 75 mg/dL compared with admitting values D. Less than 200 mg/dL
C. A decrease of 50 to 75 mg/dL compared with admitting values
What is the best nursing action when a child with type 1 diabetes mellitus is sweating, trembling, and pale? A. Offer the child a glass of water. B. Give the child 5 units of regular insulin subcutaneously. C. Give the child a glass of orange juice. D. Give the child glucagon subcutaneously.
C. Give the child a glass of orange juice.
Which of the following laboratory values would be found in a patient with syndrome of inappropriate secretion of antidiuretic hormone? A. Fasting blood glucose 156 mg/dL B. Serum potassium 5.8 mEq/L C. Serum sodium 115 mEq/L D. Serum sodium 152 mEq/L
C. Serum sodium 115 mEq/L
The nurse notices that a patient who has been drinking large volumes of water and eating large meals throughout the day continues to lose weight. Which health problem should the nurse suspect this patient is experiencing? A. Hypercortisolism B. Hyperaldosteronism C. Type 1 diabetes mellitus D. Type 2 diabetes mellitus
C. Type 1 diabetes mellitus
A patient is being treated for diabetes insipidus (DI). Which medication should the nurse prepare to administer? A. Calcium B. Synthroid C. Vitamin D D. Desmopressin (DDAVP)
D. Desmopressin (DDAVP)
A patient experiencing diabetic ketoacidosis (DKA) is receiving a normal saline infusion and intravenous insulin. What additional medication should the nurse expect to be prescribed for this patient? A. Diuretic B. Laxative C. Antibiotic D. Potassium
D. Potassium
A patient is prescribed Regular insulin 5 units subcutaneous injection now. Which syringe should the nurse use for this dose if all are readily available? A. U-30 B. U-50 C. U-100 D. U-500
A. U-30
The nurse is reviewing type 1 diabetes mellitus with a group of patients newly diagnosed with the disorder. What should the nurse explain as the major cause for the disorder? A. Autoimmune process B. Cancer of the pancreas C. Alteration in lipid and protein utilization D. Malfunction of carbohydrate metabolism
A. Autoimmune process
A medication regimen is being planned for a patient newly diagnosed with type 1 diabetes mellitus. For which reasons should the nurse instruct the patient to self administer doses of insulin? Select all that apply. A. Basal B. Prandial C. Deficient D. Excessive E. Correctional
A. Basal B. Prandial E. Correctional
The nurse notes that patient with diabetes insipidus (DI) has a loss of free water. Which nursing diagnosis should the nurse use to guide care for this patient? A. Fluid Volume Deficit B. Alteration in Comfort C. Body Image Disturbance D. Sensory Perceptual Alteration
A. Fluid Volume Deficit
Laboratory results have been posted for a male patient experiencing manifestations of diabetes insipidus (DI). Which results would confirm the diagnosis? Select all that apply. A. Hematocrit 52% B. White blood cells 8000 C. Serum sodium 150 mEq/L D. Urine specific gravity 1.002 E. Serum potassium 5.5 mEq/L
A. Hematocrit 52% C. Serum sodium 150 mEq/L D. Urine specific gravity 1.002
Which nursing intervention is appropriate for a child with type 1 diabetes who is experiencing deficient fluid volume related to abnormal fluid losses through diuresis and emesis? Select all that apply. A. Initiate IV access. B. Begin IV fluid replacement with normal saline. C. Begin IV fluid replacement with D5 1/2NS. D. Weigh on arrival to the unit and then every other day. E. Maintain strict intake and output monitoring.
A. Initiate IV access. B. Begin IV fluid replacement with normal saline. E. Maintain strict intake and output monitoring.
Which assessment findings indicate to the nurse that a child has excess fluid volume? Select all that apply. A. Weight gain B. Decreased blood pressure C. Moist breath sounds D. Poor skin turgor E. Rapid bounding pulse
A. Weight gain C. Moist breath sounds E. Rapid bounding pulse
A patient with newly diagnosed type 1 diabetes is being transitioned from an infusion of intravenous (IV) regular insulin to an intensive insulin therapy regimen of insulin glargine and insulin aspart. How should the nurse manage this transition in insulin delivery? A. Administer the insulin glargine and continue the IV insulin infusion for 24 hours. B. Administer the insulin glargine and discontinue the IV infusion in several hours. C. Discontinue the IV infusion and administer the insulin aspart with the next meal. D. Discontinue the IV infusion and administer the glargine insulin at bedtime.
B. Administer the insulin glargine and discontinue the IV infusion in several hours.
A college student was admitted to the emergency department after being found unconscious by a roommate. The roommate informs emergency medical personnel that the student has diabetes and has been experiencing flulike symptoms, including vomiting, since yesterday. The patient had been up all night studying for exams. The patient used the last diabetes testing supplies 3 days ago and has not had time to go to the pharmacy to refill prescription supplies. Based upon the history, which laboratory findings would be anticipated in this client? (Select all that apply.) A. Blood glucose 43 mg/dL B. Blood glucose 524 mg/dL C. HCO 3 - 10 mEq/L D. PaCO 2 37 mm Hg E. pH 7.23
B. Blood glucose 524 mg/dL C. HCO 3 - 10 mEq/L E. pH 7.23
Which nursing diagnosis is a high-priority for both diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome? A. Activity intolerance B. Fluid volume deficient C. Hyperthermia D. Impaired nutrition, more than body requirements
B. Fluid volume deficient
A patient with type 1 diabetes mellitus is scheduled for a hemoglobin A1c level. What should the nurse emphasize to the patient to prepare for this test? A. Schedule the test for first thing in the morning B. Have the test drawn at any time during the day C. Avoid eating and drinking anything after midnight the day before the test D. Restrict the intake of red meat for three days before having the test
B. Have the test drawn at any time during the day
Which laboratory finding confirms that a child with type 1 diabetes is experiencing diabetic ketoacidosis? A. No urinary ketones B. Low arterial pH C. Elevated serum carbon dioxide D. Elevated serum phosphorus
B. Low arterial pH
A patient with type 1 diabetes mellitus is preparing to play tennis. What should be done first before engaging in this physical activity? A. Drink 1 liter of fluid B. Measure blood glucose level C. Eat one serving of carbohydrate D. Take a dose of prescribed medication
B. Measure blood glucose level
The nurse is reviewing discharge instructions with a patient being treated for diabetes insipidus (DI). What should the nurse direct the patient to do regarding changes in body weight? A. Restrict fluids for a day B. Notify the health-care provider C. Increase the intake of salty foods D. Take an extra dose of medication
B. Notify the health-care provider
A patient with a history of syndrome of inappropriate antidiuretic hormone (SIADH) reports a low urine output for several days. What should the nurse respond to this patient? A. "Drink more fluids." B. "Avoid eating salty foods." C. "Go to the emergency room now." D. "Take an over-the-counter NSAID."
C. "Go to the emergency room now."
Which comment by a 12-year-old child with type 1 diabetes indicates deficient knowledge? A. "I rotate my insulin injection sites every time I give myself an injection." B. "I keep records of my glucose levels and insulin sites and amounts." C. "I'll be glad when I can take a pill for my diabetes like my uncle does." D. "I keep Lifesavers in my school bag in case I have a low-sugar reaction."
C. "I'll be glad when I can take a pill for my diabetes like my uncle does."
A middle-aged patient is surprised to learn of the diagnosis of type 1 diabetes mellitus. What should the nurse respond? A. "It is odd since it is usually a disease of childhood." B. "You probably developed it because of an infection." C. "Type 1 diabetes mellitus can occur at any stage of life." D. "It usually means that another disease process is present."
C. "Type 1 diabetes mellitus can occur at any stage of life."
A patient with type 1 diabetes mellitus will be self-monitoring blood glucose levels at home. What is the minimum number of measurements that this patient should make each day? A. 1 B. 3 C. 4 D. 8
C. 4
A parent asks the nurse why self-monitoring of blood glucose is being recommended for her child with diabetes. The nurse should base the explanation on the knowledge that A. It is a less expensive method of testing. B. It is not as accurate as laboratory testing. C. Children are better able to manage the diabetes. D. The parents are better able to manage the disease.
C. Children are better able to manage the diabetes.
The nurse suspects that a patient has undiagnosed type 1 diabetes mellitus. What findings did the nurse use to make this clinical decision? Select all that apply. A. Weight gain B. Blurred vision C. Extreme hunger D. Excessive thirst E. Voluminous urine output
C. Extreme hunger D. Excessive thirst E. Voluminous urine output
A patient diagnosed with pancreatic cancer has been admitted to the critical care unit with clinical signs consistent with syndrome of inappropriate secretion of antidiuretic hormone. The nurse anticipates that clinical management of this condition will include what intervention? A. Administration of 3% normal saline B. Administration of exogenous vasopressin C. Fluid restriction D. Low sodium diet
C. Fluid restriction
Which assessment is most relevant to the care of an infant with dehydration? A. Temperature, heart rate, and blood pressure. B. Respiratory rate, oxygen saturation, and lung sounds. C. Heart rate, sensorium, and skin color. D. Diet tolerance, bowel function, and abdominal girth.
C. Heart rate, sensorium, and skin color.
Which sign, when exhibited by a hospitalized child, should the nurse recognize as a characteristic of diabetes insipidus? A. Weight gain B. Increased urine specific gravity C. Increased urination D. Serum sodium level of 130 mEq/L
C. Increased urination
A patient with type 1 diabetes mellitus is experiencing elevated blood glucose levels in the morning. Which action should be taken to determine the reason for this elevation? A. Check urine for glucose level B. Restrict oral fluids after 1800 hours C. Measure blood glucose at 0200 hours D. Limit carbohydrate intake to 45 grams with evening meal
C. Measure blood glucose at 0200 hours
A 32-year-old patient is admitted to the critical care unit with a diagnosis of diabetic ketoacidosis. Following aggressive fluid resuscitation and intravenous (IV) insulin administration, the blood glucose begins to normalize. In addition to glucose monitoring, which of the following electrolytes requires close monitoring? A. Calcium B. Chloride C. Potassium D. Sodium.
C. Potassium
What should the nurse include in the teaching plan for parents of a child with diabetes insipidus who is receiving DDAVP? A. Increase the dosage of DDAVP as the urine specific gravity (SG) increases. B. Give DDAVP only if urine output decreases. C. The child should have free access to water and toilet facilities at school. D. Cleanse skin before administering the transdermal patch.
C. The child should have free access to water and toilet facilities at school.
What assessment should the nurse make before initiating an intravenous (IV) infusion of dextrose 5% in 0.9% normal saline solution with 10 mEq of potassium chloride for a child hospitalized with dehydration? A. Fluid intake B. Number of stools C. Urine output D. Capillary refill
C. Urine output
The nurse is reviewing laboratory values for a female patient who has had minimal urine output over the last shift. Which finding suggests that this patient may be experiencing syndrome of inappropriate antidiuretic hormone (SIADH)? A. Hematocrit 40% B. Serum sodium 136 mEq/L C. Urine specific gravity 1.035 D. Serum potassium 3.9 mEq/L
C. Urine specific gravity 1.035
A patient with osteoarthritis develops the syndrome of inappropriate antidiuretic hormone (SIADH). What information in the patient's history should the nurse identify as being the best reason for the development of this disorder? A. Male gender B. Age 70 years C. Use of NSAIDs D. African American
C. Use of NSAIDs
An older patient with type 1 diabetes mellitus has poor oral intake. What should be considered to ensure adequate blood glucose control? A. Hold all prandial doses B. Consider increasing longer-acting insulin C. Increase the frequency of correctional doses D. Administer prandial and correctional insulin together
D. Administer prandial and correctional insulin together
Type 1 diabetes mellitus is suspected in an adolescent. Which clinical manifestation may be present? A. Moist skin B. Weight gain C. Fluid overload D. Blurred vision
D. Blurred vision
The nurse is preparing medications for a patient with syndrome of inappropriate antidiuretic hormone (SIADH). Which medication would most likely be prescribed for this patient? A. Ampicillin B. Tetracycline C. Vancomycin D. Demeclocycline
D. Demeclocycline
What differences would you expect to see in patients experiencing hyperosmolar hyperglycemic syndrome rather than diabetic ketoacidosis? A. Lower serum glucose, lower osmolality, and greater ketosis B. Lower serum glucose, lower osmolality, and milder ketosis C. Higher serum glucose, higher osmolality, and greater ketosis D. Higher serum glucose, higher osmolality, and no ketosis
D. Higher serum glucose, higher osmolality, and no ketosis
Which statement best describes why infants are at greater risk for dehydration than older children? A. Infants have an increased ability to concentrate urine. B. Infants have a greater volume of intracellular fluid. C. Infants have a smaller body surface area. D. Infants have an increased extracellular fluid volume.
D. Infants have an increased extracellular fluid volume.
A patient with diabetes insipidus (DI) is experiencing extreme dehydration. What should be used to guide intravenous fluid replacement therapy for this patient? A. Skin turgor B. Urine output total C. Hemoglobin level D. Serum sodium level
D. Serum sodium level
A patient is admitted to the oncology unit with a small cell lung carcinoma. During the admission, the patient is noted to have a significant decrease in urine output accompanied by shortness of breath, edema, and mental status changes. The nurse is aware that this clinical presentation is consistent with what diagnosis? A. Adrenal crisis B. Diabetes insipidus C. Myxedema coma D. Syndrome of inappropriate secretion of antidiuretic hormone (SIADH)
D. Syndrome of inappropriate secretion of antidiuretic hormone (SIADH)
A patient who experienced head trauma was admitted to the surgical intensive care unit following a motorcycle crash. What assessment that will assist the nurse in early identification of an endocrine disorder commonly associated with this condition? A. Daily weight B. Fingerstick glucose C. Lung sound auscultation D. Urine osmolality
D. Urine osmolality
Which of the following statements is true about the medical management of diabetic ketoacidosis? A. Serum lactate levels are used to guide insulin administration. B. Sodium bicarbonate is a first-line medication for treatment. C. The degree of acidosis is assessed through continuous pulse oximetry. D. Volume replacement and insulin infusion often correct the acidosis.
D. Volume replacement and insulin infusion often correct the acidosis.
In the management of diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome, when is an intravenous (IV) solution that contains dextrose started? A. Never; normal saline is the only appropriate solution in diabetes management B. When the blood sugar reaches 70 mg/dL C. When the blood sugar reaches 150 mg/dL D. When the blood glucose reaches 250 mg/dL
D. When the blood glucose reaches 250 mg/dL
Which laboratory values would be more common in patients with diabetic ketoacidosis? A. Blood glucose >1000 mg/dL B. Negative ketones in the urine C. Normal anion gap D. pH 7.24
D. pH 7.24
