Diabetes

A client with hyperaldosteronism is being treated with spironolactone (Aldactone) before surgery. Which precautions does the nurse teach this client? a. Read the label before using salt substitutes. b. Do not add salt to your food when you eat. c. Avoid exposure to sunlight. d. Take Tylenol instead of aspirin for pain.

A ~ Spironolactone is a potassium-sparing diuretic used to control potassium levels. Its use can lead to hyperkalemia. Although the goal is to increase the client's potassium, unknowingly adding potassium can cause complications. Some salt substitutes are composed of potassium chloride and should be avoided by clients on spironolactone therapy. Depending on the client, he or she may benefit from a low-sodium diet before surgery, but this may not be necessary. Avoiding sunlight and Tylenol is not necessary.

7. A diabetes nurse educator is teaching a group of patients with type 1 diabetes about sick day rules. What guideline applies to periods of illness in a diabetic patient? A) Do not eliminate insulin when nauseated and vomiting. B) Report elevated glucose levels greater than 150 mg/dL. C) Eat three substantial meals a day, if possible. D) Reduce food intake and insulin doses in times of illness.

A) Do not eliminate insulin when nauseated and vomiting. Feedback: The most important issue to teach patients with diabetes who become ill is not to eliminate insulin doses when nausea and vomiting occur. Rather, they should take their usual insulin or oral hypoglycemic agent dose, then attempt to consume frequent, small portions of carbohydrates. In general, blood sugar levels will rise but should be reported if they are greater than 300 mg/dL.

18. A diabetic educator is discussing sick day rules with a newly diagnosed type 1 diabetic. The educator is aware that the patient will require further teaching when the patient states what? A) I will not take my insulin on the days when I am sick, but I will certainly check my blood sugar every 2 hours. B) If I cannot eat a meal, I will eat a soft food such as soup, gelatin, or pudding six to eight times a day. C) I will call the doctor if I am not able to keep liquids in my body due to vomiting or diarrhea. D) I will call the doctor if my blood sugar is over 300 mg/dL or if I have ketones in my urine.

A) I will not take my insulin on the days when I am sick, but I will certainly check my blood sugar every 2 hours. Feedback: The nurse must explanation the sick day rules again to the patient who plans to stop taking insulin when sick. The nurse should emphasize that the patient should take insulin agents as usual and test ones blood sugar and urine ketones every 3 to 4 hours. In fact, insulin-requiring patients may need supplemental doses of regular insulin every 3 to 4 hours. The patient should report elevated glucose levels (greater than 300 mg/dL or as otherwise instructed) or urine ketones to the physician. If the patient is not able to eat normally, the patient should be instructed to substitute soft foods such a gelatin, soup, and pudding. If vomiting, diarrhea, or fever persists, the patient should have an intake of liquids every 30 to 60 minutes to prevent dehydration.

26. A patient with a longstanding diagnosis of type 1 diabetes has a history of poor glycemic control. The nurse recognizes the need to assess the patient for signs and symptoms of peripheral neuropathy. Peripheral neuropathy constitutes a risk for what nursing diagnosis? A) Infection B) Acute pain C) Acute confusion D) Impaired urinary elimination

A) Infection Feedback: Decreased sensations of pain and temperature place patients with neuropathy at increased risk for injury and undetected foot infections. The neurologic changes associated with peripheral neuropathy do not normally result in pain, confusion, or impairments in urinary function. Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 971

10. A 15-year-old child is brought to the emergency department with symptoms of hyperglycemia and is subsequently diagnosed with diabetes. Based on the fact that the childs pancreatic beta cells are being destroyed, the patient would be diagnosed with what type of diabetes? A) Type 1 diabetes B) Type 2 diabetes C) Noninsulin-dependent diabetes D) Prediabetes

A) Type 1 diabetes Feedback: Beta cell destruction is the hallmark of type 1 diabetes. Noninsulin-dependent diabetes is synonymous with type 2 diabetes, which involves insulin resistance and impaired insulin secretion, but not beta cell destruction. Prediabetes is characterized by normal glucose metabolism, but a previous history of hyperglycemia, often during illness or pregnancy.

A nurse assesses a client with Cushing's disease. Which assessment findings should the nurse correlate with this disorder? (SATA) a. Moon face b. Weight loss c. Hypotension d. Petechiae e. Muscle atrophy

A, D, E ~ Clinical manifestations of Cushing's disease include moon face, weight gain, hypertension, petechiae, and muscle atrophy.

6. Which patient is most at risk for developing Syndrome of Inappropriate Anti-diuretic Hormone (SIADH)? A. A patient diagnosed with small cell lung cancer. B. A patient whose kidney tubules are failing to reabsorb water. C. A patient with a tumor on the anterior pituitary gland. D. A patient taking Declomycin.

A. A patient diagnosed with small cell lung cancer.

A client with severe diabetes insipidus is receiving desmopressin acetate, which is administered intranasally in a metered spray. During the follow-up visits, the client reports chest tightness to the primary healthcare provider. Which intervention would effectively reduce complications in the client? Select all that apply. A. Administration of desmopressin acetate orally B. Administration of lithium carbonate intranasally C. Administration of antidiuretic hormone intravenously D. Administration of antidiuretic hormone intramuscularly E. Administration of desmopressin acetate subcutaneously

A. Administration of desmopressin acetate orally E. Administration of desmopressin acetate subcutaneously

2. A patient is found to have a blood glucose of 375 mg/dL, positive ketones in the urine, and blood pH of 7.25. Which condition is this?

A. Diabetic Ketoacidosis

The physical examination of a client reveals moon face, buffalo hump, and truncal obesity. The laboratory report reveals salivary cortisol level of 3.0 ng/mL (9.54 nmol/L). Which other manifestations would be present in the client? Select all that apply. A. Edema B. Osteoporosis C. Hypogonadism D. Muscle atrophy E. Barrel-shaped chest

A. Edema B. Osteoporosis D. Muscle atrophy

A client with a brain tumor develops a urine output of 300 mL/hr, dry skin, and dry mucous membranes. Which nursing intervention is the most appropriate to perform for this client? A. Evaluate urine specific gravity. B. Implement fluid restrictions. C. Provide emollients to the skin to prevent breakdown. D. Slow down the intravenous (IV) fluids and notify the primary healthcare provider.

A. Evaluate urine specific gravity.

4. You are developing a care plan for a patient with SIADH. Which of the following would be a potential nursing diagnosis for this patient? A. Fluid volume overload B. Fluid volume deficient C. Acute pain D. Impaired skin integrity

A. Fluid volume overload

4. This condition happens gradually and is more likely to affect older adults? A. HHNS B. DKA

A. HHNS

5. A patient has an infection and reports not checking their blood glucose or regularly taking Metformin. What condition is this patient MOST at risk for? A. HHNS B. DKA C. Metabolic alkalosis D. Metabolic acidosis

A. HHNS

The laboratory reports of a client with adrenal adenoma show high urine aldosterone levels and a low specific gravity of urine. The serum potassium is found to be 2.8 mEq/L (2.8 mmol/L). Which other findings will be present upon assessment? Select all that apply. A. Hypernatremia B. Hypertension C. Hypoglycemia D. Hypercalcemia E. Metabolic alkalosis

A. Hypernatremia B. Hypertension E. Metabolic alkalosis

10. You are providing care to a patient experiencing diabetic ketoacidosis. The patient is on an insulin drip and their current glucose level is 300. In addition, to the insulin drip the patient also has 5% Dextrose 0.45% NS infusing in the right antecubital vein. Which of the following patient signs/symptoms causes concern? A. Patient has a potassium level of 2.3 B. Patient complains of thirst. C. Patient is nauseous. D. Patient's skin and mucous membranes are dry.

A. Patient has a potassium level of 2.3

What interventions should the nurse implement in caring for a client with diabetes insipidus (DI) following a head injury? Select all that apply. A. Providing adequate fluids within easy reach B. Reporting an increasing urine specific gravity C. Administering prescribed erythromycin D. Assessing for and reporting changes in neurological status E. Monitoring for constipation, weight loss, hypotension, and tachycardia

A. Providing adequate fluids within easy reach D. Assessing for and reporting changes in neurological status E. Monitoring for constipation, weight loss, hypotension, and tachycardia

1. A patient arrives to the ER and is unable to give you a health history due to altered mental status. The family reports the patient has gained over 10 lbs in 1 week and says it is mainly "water" weight. In addition, they report the patient hasn't been able to urinate or eat within the past week as well and was recently diagnosed with small cell lung cancer. On assessment, you note the patient's HR is 115 and BP 180/92. Patient sodium level is 90. Which of the following conditions do you suspect the patient is most likely presenting with? A. SIADH B. Diabetes Insipidus C. Addison's Disease D. Fluid Volume Deficient

A. SIADH

5. A patient with a mild case of diabetes insipidus is started on Diabinese. What would you include in your patient teaching with this patient? A. Signs and symptoms of hypoglycemia B. Restricting foods containing caffeine C. Taking the medication on an empty stomach D. Drinking 16 oz of water when taking the medication

A. Signs and symptoms of hypoglycemia

Type 1 diabetics typically have the following clinical characteristics: A. Thin, young with ketones present in the urine B. Overweight, young with no ketones present in the urine C. Thin, older adult with glycosuria D. Overweight, adult-aged with ketones present in the urine

A. Thin, young with ketones present in the urine

A nurse is caring for a client who was prescribed high-dose corticosteroid therapy for 1 month to treat a severe inflammatory condition. The client's symptoms have now resolved and the client asks, "When can I stop taking these medications?" How should the nurse respond? a. It is possible for the inflammation to recur if you stop the medication. b. Once you start corticosteroids, you have to be weaned off them. c. You must decrease the dose slowly so your hormones will work again. d. The drug suppresses your immune system, which must be built back up.

B ~ One of the most common causes of adrenal insufficiency, a life-threatening problem, is the sudden cessation of long-term, high-dose corticosteroid therapy. This therapy suppresses the hypothalamic-pituitary-adrenal axis and must be withdrawn gradually to allow for pituitary production of adrenocorticotropic hormone and adrenal production of cortisol. Decreasing hormone therapy slowly ensures self-production of hormone, not hormone effectiveness. Building the client's immune system and rebound inflammation are not concerns related to stopping high-dose corticosteroids.

A nurse teaches a client with a cortisol deficiency who is prescribed prednisone (Deltasone). Which statement should the nurse include in this client's instructions? a. You will need to learn how to rotate the injection sites. b. If you work outside in the heat, you may need another drug. c. You need to follow a diet with strict sodium restrictions. d. Take one tablet in the morning and two tablets at night.

B ~ Steroid dosage adjustment may be needed if the client works outdoors and might be difficult, especially in hot weather, when the client is sweating a great deal more than normal. Clients take prednisone orally, have no need for a salt restriction, and usually start the regimen with two tablets in the morning and one at night.

A nurse cares for a client who possibly has syndrome of inappropriate antidiuretic hormone (SIADH). The client's serum sodium level is 114 mEq/L. Which action should the nurse take first? a. Consult with the dietitian about increased dietary sodium. b. Restrict the client's fluid intake to 600 mL/day. c. Handle the client gently by using turn sheets for re-positioning. d. Instruct unlicensed assistive personnel to measure intake and output.

B ~ With SIADH, clients often have dilutional hyponatremia. The client needs a fluid restriction, sometimes to as little as 500 to 600 mL/24 hr. Adding sodium to the client's diet will not help if she is retaining fluid and diluting the sodium. The client is not at increased risk for fracture, so gentle handling is not an issue. The client should be on intake and output; however, this will monitor only the client's intake, so it is not the best answer. Reducing intake will help increase the client's sodium.

40. A patient is brought to the emergency department by the paramedics. The patient is a type 2 diabetic and is experiencing HHS. The nurse should identify what components of HHS? Select all that apply. A) Leukocytosis B) Glycosuria C) Dehydration D) Hypernatremia E) Hyperglycemia

B) Glycosuria C) Dehydration D) Hypernatremia E) Hyperglycemia Feedback: Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 977 In HHS, persistent hyperglycemia causes osmotic diuresis, which results in losses of water and electrolytes. To maintain osmotic equilibrium, water shifts from the intracellular fluid space to the extracellular fluid space. With glycosuria and dehydration, hypernatremia and increased osmolarity occur. Leukocytosis does not take place.

12. An occupational health nurse is screening a group of workers for diabetes. What statement should the nurse interpret as suggestive of diabetes? A) Ive always been a fan of sweet foods, but lately Im turned off by them. B) Lately, I drink and drink and cant seem to quench my thirst. C) No matter how much sleep I get, it seems to take me hours to wake up. D) When I went to the washroom the last few days, my urine smelled odd.

B) Lately, I drink and drink and cant seem to quench my thirst. Feedback: Classic clinical manifestations of diabetes include the three Ps: polyuria, polydipsia, and polyphagia. Lack of interest in sweet foods, fatigue, and foul-smelling urine are not suggestive of diabetes.

33. A patient with a history of type 1 diabetes has just been admitted to the critical care unit (CCU) for diabetic ketoacidosis. The CCU nurse should prioritize what assessment during the patients initial phase of treatment? A) Monitoring the patient for dysrhythmias B) Maintaining and monitoring the patients fluid balance C) Assessing the patients level of consciousness D) Assessing the patient for signs and symptoms of venous thromboembolism

B) Maintaining and monitoring the patients fluid balance Feedback: In addition to treating hyperglycemia, management of DKA is aimed at correcting dehydration, electrolyte loss, and acidosis before correcting the hyperglycemia with insulin. The nurse should monitor the patient for dysrhythmias, decreased LOC and VTE, but restoration and maintenance of fluid balance is the highest priority. Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 974

23. A patient with type 2 diabetes achieves adequate glycemic control through diet and exercise. Upon being admitted to the hospital for a cholecystectomy, however, the patient has required insulin injections on two occasions. The nurse would identify what likely cause for this short-term change in treatment? A) Alterations in bile metabolism and release have likely caused hyperglycemia. B) Stress has likely caused an increase in the patients blood sugar levels. C) The patient has likely overestimated her ability to control her diabetes using nonpharmacologic measures. D) The patients volatile fluid balance surrounding surgery has likely caused unstable blood sugars.

B) Stress has likely caused an increase in the patients blood sugar levels. Feedback: During periods of physiologic stress, such as surgery, blood glucose levels tend to increase, because levels of stress hormones (epinephrine, norepinephrine, glucagon, cortisol, and growth hormone) increase. The patients need for insulin is unrelated to the action of bile, the patients overestimation of previous blood sugar control, or fluid imbalance.

A nurse cares for a client who is prescribed vasopressin (DDAVP) for diabetes insipidus. Which assessment findings indicate a therapeutic response to this therapy? (SATA) a. Urine output is increased. b. Urine output is decreased. c. Specific gravity is increased. d. Specific gravity is decreased. e. Urine osmolality is increased. f. Urine osmolality is decreased.

B, C, E ~ Diabetes insipidus causes urine output to be greatly increased, with a low urine osmolality, as evidenced by a low specific gravity. Effective treatment results in decreased urine output that is more concentrated, as evidenced by an increased specific gravity.

A nurse teaches a client with Cushing's disease. Which dietary requirements should the nurse include in this client's teaching? (SATA) a. Low calcium b. Low carbohydrate c. Low protein d. Low calories e. Low sodium

B, D, E ~ The client with Cushing's disease has weight gain, muscle loss, hyperglycemia, and sodium retention. Dietary modifications need to include reduction of carbohydrates and total calories to prevent or reduce the degree of hyperglycemia. Sodium retention causes water retention and hypertension. Clients are encouraged to restrict their sodium intake moderately. Clients often have bone density loss and need more calcium. Increased protein intake will help decrease muscle loss.

The nurse evaluates the statements of a client after teaching about hydrocortisone therapy. Which statement made by the client indicates effective learning? A. "I should report if I experience two to three episodes of vomiting." B. "I should report if there is swelling in the hands or legs." C. "I should immediately report if my body temperature crosses 37°C (98.6 °F)." D. "I should immediately report if I experience diarrhea."

B. "I should report if there is swelling in the hands or legs."

1. A patient is being discharged home after recovering from HHNS. Which statement by the patient requires patient re-education about this condition? A. "I will monitor my blood glucose levels regularly." B. "This condition happens suddenly without any warning signs." C. "If I become sick I will monitor my blood glucose more frequently and drink lots of fluids." D. "It is important I take my medication as prescribed."

B. "This condition happens suddenly without any warning signs." The answer is B. HHNS tends to happen GRADUALLY rather than suddenly. DKA tends to occurs suddenly. Therefore, the patient should be re-educated about how signs and symptoms will appear gradually and how to detect them before the disease process advances.

2. In the scenario above what drug do you anticipate the patient will be started on per doctor's order? A. Desmopressin (DDAVP) IV B. Declomycin C. Diabinese D. Stimate

B. Declomycin

1. This complication is found mainly in Type 2 diabetics?

B. Hyperglycemic Hyperosmolar Nonketotic Syndrome

Which of the following statements are true regarding Type 2 diabetes treatment? A. Insulin and oral diabetic medications are administered routinely in the treatment of Type 2 diabetes. B. Insulin may be needed during times of surgery or illness. C. Insulin is never taken by the Type 2 diabetic. D. Oral medications are the first line of treatment for newly diagnosed Type 2 diabetics.

B. Insulin may be needed during times of surgery or illness.

A Type 2 diabetic may have all the following signs or symptoms EXCEPT: A. Blurry vision B. Ketones present in the urine C. Glycosuria D. Poor wound healing

B. Ketones present in the urine

A patient with diabetes is experiencing a blood glucose of 275 when waking. What is a typical treatment for this phenomenon? A. None, this is a normal blood glucose reading. B. The patient may need a night time dose of an intermediate-acting insulin to counteract the morning hyperglycemia. C. A bedtime snack may prevent this phenomenon. D. This is known as the Somogyi effect and requires decreasing the bedtime dose of insulin.

B. The patient may need a night time dose of an intermediate-acting insulin to counteract the morning hyperglycemia.

A client is admitted with a diagnosis of Cushing syndrome. Which clinical manifestations should the nurse expect the client to exhibit? Select all that apply. A. Emaciation B. Weakness C. Hypertension D. Truncal obesity E. Intermittent tonic spasms

B. Weakness C. Hypertension D. Truncal obesity

A nurse plans care for a client with Cushing's disease. Which action should the nurse include in this client's plan of care to prevent injury? a. Pad the side rails of the client's bed. b. Assist the client to change positions slowly. c. Use a lift sheet to change the client's position. d. Keep suctioning equipment at the clients bedside.

C ~ Cushing's syndrome or disease greatly increases the serum levels of cortisol, which contributes to excessive bone demineralization and increases the risk for pathologic bone fracture. Padding the side rails and assisting the client to change position may be effective, but these measures will not protect her as much as using a lift sheet. The client should not require suctioning.

1. A patient with type 1 diabetes has told the nurse that his most recent urine test for ketones was positive. What is the nurses most plausible conclusion based on this assessment finding? A) The patient should withhold his next scheduled dose of insulin. B) The patient should promptly eat some protein and carbohydrates. C) The patients insulin levels are inadequate. D) The patient would benefit from a dose of metformin (Glucophage).

C) The patients insulin levels are inadequate. Feedback: Ketones in the urine signal that there is a deficiency of insulin and that control of type 1 diabetes is deteriorating. Withholding insulin or eating food would exacerbate the patients ketonuria. Metformin will not cause short-term resolution of hyperglycemia.

A nurse is caring for a client admitted to the hospital for diabetic ketoacidosis. Which clinical findings related to this event should the nurse document in the client's clinical record? Select all that apply. A. Diaphoresis B. Retinopathy C. Acetone breath D. Increased arterial bicarbonate level E. Decreased arterial carbon dioxide level

C. Acetone breath E. Decreased arterial carbon dioxide level

8. Which of the following is NOT a medical treatment for DKA and HHNS? A. IV regular insulin B. Isotonic fluids C. Bicarbonate D. IV potassium Solution

C. Bicarbonate

Which treatment intervention should be provided to a client diagnosed with Cushing's disease? A. Increase cortisol levels B. Increase sodium levels C. Decrease blood glucose levels D. Decrease serum calcium levels

C. Decrease blood glucose levels

A client with addisonian crisis exhibits severe manifestations of glucocorticoid and mineralocorticoid deficiencies. Which responses should the nurse expect the client to exhibit? Select all that apply. A. Bradycardia B. Hypertension C. Hyperkalemia D. Hyponatremia E. Postural hypotension

C. Hyperkalemia D. Hyponatremia E. Postural hypotension

. Where is the anti-diuretic hormone PRODUCED in the body? A. Anterior pituitary gland B. Posterior pituitary gland C. Hypothalamus D. Medulla

C. Hypothalamus

6. Which patient population is most at risk for DKA? A. Middle-aged adults who are obese B. Older-adults with Type 2 diabetes C. Newly diagnosed diabetes D. None of the options

C. Newly diagnosed diabetes

9. Which of the following is not a sign or symptom of Diabetic Ketoacidosis? A. Positive Ketones in the urine B. Polydipsia C. Oliguria D. Abdominal Pain

C. Oliguria The answer is C. Oliguria means low urinary output...in DKA there is POLYURIA (high urinary output)

3. Which of the following signs and symptoms is NOT expected with Diabetes Insipidus? A. Polyuria B. Polydipsia C. Polyphagia D. Extreme thirst

C. Polyphagia

10. Where is the anti-diuretic hormone SECRETED in the body? A. Hypothalamus B. Thyroid C. Posterior Pituitary gland D. Anterior pituitary gland

C. Posterior Pituitary gland

8. The anti-diuretic hormone is __________ in Diabetes Insipidus and _________ in SIADH. A. high, low B. absent, absent C. low, high D. low, low

C. low, high

11. A newly admitted patient with type 1 diabetes asks the nurse what caused her diabetes. When the nurse is explaining to the patient the etiology of type 1 diabetes, what process should the nurse describe? A) The tissues in your body are resistant to the action of insulin, making the glucose levels in your blood increase. B) Damage to your pancreas causes an increase in the amount of glucose that it releases, and there is not enough insulin to control it. C) The amount of glucose that your body makes overwhelms your pancreas and decreases your production of insulin. D) Destruction of special cells in the pancreas causes a decrease in insulin production. Glucose levels rise because insulin normally breaks it down.

D) Destruction of special cells in the pancreas causes a decrease in insulin production. Glucose levels rise because insulin normally breaks it down. Feedback: Type 1 diabetes is characterized by the destruction of pancreatic beta cells, resulting in decreased insulin production, unchecked glucose production by the liver, and fasting hyperglycemia. Also, glucose derived from food cannot be stored in the liver and remains circulating in the blood, which leads to postprandial hyperglycemia. Type 2 diabetes involves insulin resistance and impaired insulin secretion. The body does not make glucose.

15. An older adult patient with type 2 diabetes is brought to the emergency department by his daughter. The patient is found to have a blood glucose level of 623 mg/dL. The patients daughter reports that the patient recently had a gastrointestinal virus and has been confused for the last 3 hours. The diagnosis of hyperglycemic hyperosmolar syndrome (HHS) is made. What nursing action would be a priority? A) Administration of antihypertensive medications B) Administering sodium bicarbonate intravenously C) Reversing acidosis by administering insulin D) Fluid and electrolyte replacement

D) Fluid and electrolyte replacement Feedback: The overall approach to HHS includes fluid replacement, correction of electrolyte imbalances, and insulin administration. Antihypertensive medications are not indicated, as hypotension generally accompanies HHS due to dehydration. Sodium bicarbonate is not administered to patients with HHS, as their plasma bicarbonate level is usually normal. Insulin administration plays a less important role in the treatment of HHS because it is not needed for reversal of acidosis, as in diabetic ketoacidosis (DKA).

21. A medical nurse is aware of the need to screen specific patients for their risk of hyperglycemic hyperosmolar syndrome (HHS). In what patient population does hyperosmolar nonketotic syndrome most often occur? A) Patients who are obese and who have no known history of diabetes B) Patients with type 1 diabetes and poor dietary control C) Adolescents with type 2 diabetes and sporadic use of antihyperglycemics D) Middle-aged or older people with either type 2 diabetes or no known history of diabetes

D) Middle-aged or older people with either type 2 diabetes or no known history of diabetes Feedback: HHS occurs most often in older people (50 to 70 years of age) who have no known history of diabetes or who have type 2 diabetes.

7. A patient with SIADH is undergoing IV treatment of a hypertonic IV solution of 3% saline and IV Lasix. Which of the following nursing findings requires intervention? A. Sodium level of 136. B. Patient reports urinating more frequently. C. Potassium level of 5.0. D. Assessment finding of crackles throughout the lung fields.

D. Assessment finding of crackles throughout the lung fields. The answer is D: Assessment finding of crackles throughout the lung fields. Remember that when administering a hypertonic solution you have to do this very slowly and watch for volume overload. Hypertonic solutions pull fluid from the cell (which is already water intoxicated) and place it back into the vascular system...therefore, crackles in the lungs are a sign there is too much fluid in the body and the heart can not compensate so the fluid is backing up into the lungs. This would require intervention.

The _____ ______ secrete insulin which are located in the _______. A. Alpha cells, liver B. Alpha cells, pancreas C. Beta cells, liver D. Beta cells, pancreas

D. Beta cells, pancreas

A client's blood gases reflect diabetic ketoacidosis. Which clinical indicator should the nurse identify when monitoring this client's laboratory values? A. Increased pH B. Decreased PO2 C. Increased PCO2 D. Decreased HCO3

D. Decreased HCO3

Hyperglycemic Hyperosmolar Nonketotic Syndrome would have all of the following signs and symptoms EXCEPT? A. Dry mucous membranes B. Polyuria C. Blood glucose >600 mg/dL D. Kussmaul breathing

D. Kussmaul breathing The answer is D. Kussmaul breathing is found in DKA due to the compensatory mechanism of the respiratory system. Remember that in DKA there are excessive ketones (none are present in HHNS) which are acids and this causes metabolic acidosis. Therefore, the respiratory system tries to "blow off" extra acid (carbon dioxide) to try to make the blood more alkalotic.

A patient has a blood glucose of 400. Which of the following medications could be the cause of this? A. Glyburide B. Atenolol C. Bactrim D. Prednisone

D. Prednisone

A nurse is developing a discharge plan for a client hospitalized with severe cirrhosis of the liver. What should be included in this plan? A. The need for a high-protein diet B. The use of a sedative for relaxation C. The need to increase fluids D. The importance of reporting personality changes to the primary healthcare provider

D. The importance of reporting personality changes to the primary healthcare provider

What statement or statements are INCORRECT regarding Diabetic Ketoacidosis? A. DKA occurs mainly in Type 1 diabetics. B. Ketones are present in the urine in DKA. C. Cheyne-stokes breathing can present in DKA. D. Severe hypoglycemia is a hallmark sign in DKA. E. Options C & D

E. Options C & D

7. True or False: Osmotic diuresis is present in HHNS and DKA due to the kidney's inability to reabsorb the excessive glucose which causes glucose to leak into the urine which in turn causes extra water and electrolytes to be excreted.

True