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The client newly diagnosed with Type 1 diabetes asks the nurse, "Why should I get an external portable insulin pump?" Which statement is the nurse's best response? 1. "It will cause you to have fewer hypoglycemic reactions and it will control blood glucose levels better." 2. "Insulin pumps provide an automatic memory of the date and time of the last 24 boluses." 3. "The pump injects intermediate-acting insulin automatically into the vein to maintain a normal blood glucose level." 4. "The portable pump is the easiest way to administer insulin to someone with Type 1 diabetes and is highly recommended."

1. A portable insulin pump is a batteryoperated device that uses rapid-acting insulin—Lispro, Humalog, or NovoLog. It delivers both basal insulin infusion (continuous release of a small amount of insulin) and bolus doses with meals. This provides fewer hypoglycemic reactions and better blood glucose levels.

The overweight client diagnosed with Type 2 diabetes reports to the clinic nurse that he has lost 35 pounds in the last 4 months. Which action should the nurse implement first? 1. Determine if the client has had an increase in hypoglycemic reactions. 2. Instruct the client to make an appointment with the health-care provider. 3. Ask the client if he has been trying to lose weight or has it happened naturally. 4. Check the client's last weight in the chart with the weight obtained in the clinic.

1. Changes in weight will affect the amount of medication needed to control blood glucose. The nurse should determine if the client's medication dose is too high by determining if the client has had an increase in hypoglycemic reactions. This is the nurse's first intervention

The nurse is preparing to administer liothyronine (Cytomel), a thyroid hormone, to a client diagnosed with hypothyroidism. Which data would cause the nurse to question administering the medication? 1. The client is complaining of being nervous. 2. The client's oral temperature is 98.9F. 3. The client's blood pressure is 110/70. 4. The client is complaining of being tired.

1. Nervousness, jitteriness, and irritability are signs or symptoms of hyperthyroidism; therefore, the nurse should question administering thyroid hormone.

The nurse administered 12 units of regular insulin to the patient with Type 1 diabetes at 0700. Which meal would prevent the client from experiencing hypoglycemia? 1. Breakfast. 2. Lunch. 3. Supper. 4. HS snack.

1. Regular insulin peaks in 2-4 hours; therefore, the breakfast meal would prevent the client from developing hypoglycemia.

Which complication should the nurse assess for in the elderly client newly diagnosed with hypothyroidism who has been prescribed levothyroxine (Synthroid)? 1. Cardiac dysrhythmias. 2. Respiratory depression. 3. Paralytic ileus. 4. Thyroid storm

1. Synthroid increases the basal metabolic rate, which can precipitate cardiac dysrhythmias in clients with undiagnosed heart disease, especially in elderly clients. Synthroid can also cause cardiovascular collapse. Therefore the client's cardiovascular function should be assessed by the nurse.

The nurse is teaching the client with Type 1 diabetes how to use an insulin pen injector. Which information should the nurse discuss with the client? 1. Instruct the client to dial in the number of insulin units needed to inject. 2. Demonstrate the proper way to draw up the insulin in an insulin syringe. 3. Discuss that the insulin pen injector must be used in the abdominal area only. 4. Explain that the traditional insulin syringe is less painful than the injector pen.

1. The insulin pen injector resembles a fountain pen. It contains a disposable needle and insulin-filled cartridge. When the client operates the insulin pen, the correct dose is obtained by turning the dial to the number of insulin units needed.

The nurse is discussing the oral hypoglycemic medication Micronase with the client diagnosed with Type 2 diabetes. Which information should the nurse discuss with the client? 1. Instruct the client to take the oral hypoglycemic medication with food. 2. Explain that hypoglycemia will not occur with oral medications. 3. Tell the client to notify the HCP if a headache, nervousness, or sweating occurs. 4. Recommend the client check the ketones in the urine every morning.

1. The oral hypoglycemic medication should be administered with food to decrease gastric upset.

The nurse is discussing storage of insulin vials with the client. Which statement indicates the client understands the teaching concerning the storage of insulin? 1. "I will keep my unopened vials of insulin in the refrigerator." 2. "I can keep my insulin in the trunk of my car so I will have it at all times." 3. "It is all right to put my unopened insulin vials in the freezer." 4. "If I prefill my insulin syringes, I must use them within 1-2 days."

1. This statement indicates the client understands the medication teaching. Keeping the insulin in the refrigerator will maintain the insulin's strength and potency. Once the insulin vial is opened it may be kept at room temperature for 1 month.

The client diagnosed with hyperthyroidism is prescribed an antithyroid medication. Which interventions should the nurse implement? Select all that apply. 1. Monitor the client's thyroid function tests. 2. Monitor the client's weight weekly. 3. Monitor the client for gastrointestinal distress. 4. Monitor the client's vital signs. 5. Monitor the client for activity intolerance.

1. Thyroid function tests are used to determine the effectiveness of drug therapy. 2. Weight gain is expected as a result of a slower metabolism. 3. Antithyroid medication may cause nausea or vomiting. 4. Changes in metabolic rate will be manifested as changes in blood pressure, pulse, and body temperature. 5. Hyperthyroidism results in protein catabolism, overactivity, and increased metabolism, which lead to exhaustion; therefore, the nurse should monitor for activity intolerance.

The client diagnosed with hyperthyroidism is prescribed the antithyroid medication propylthiouracil (PTU). Which statement by the client warrants immediate intervention by the nurse? 1. "I seem to be drowsy and sleepy all the time." 2. "I have a sore throat and have had a fever." 3. "I have gained 2 pounds since I started taking PTU." 4. "Since taking PTU I am not as hot as I used to be."

2. The antithyroid medication may affect the body's ability to defend itself against bacteria and viruses; therefore, the nurse should intervene if the client has any type of sore throat, fever, chills, malaise, or weakness.

The nurse is caring for the client diagnosed with Type 2 diabetes. The client is complaining of a headache, jitteriness, and nervousness. Which action should the nurse implement first? 1. Check the client's serum blood glucose level. 2. Give the client a glass of orange juice. 3. Determine when the last antidiabetic medication was administered. 4. Assess the client's blood pressure and apical pulse.

2. The client is experiencing signs of a hypoglycemic reaction and the nurse must treat the client by administering some type of simple-acting glucose. This is the first intervention.

The client with hyperthyroidism is administered radioactive iodine (I-131). Which intervention should the nurse implement? 1. Explain that the medication will destroy the thyroid gland completely. 2. Instruct the client to avoid close contact with children for 1 week. 3. Discuss the need to take the medication at night for 7 days. 4. Administer the radioactive iodine in 8 ounces of cold orange juice.

2. The client should not be in close contact with children or pregnant women for 1 week following administration of the medication because the client will be emitting small amounts of radiation.

The client diagnosed with Type 1 diabetes is complaining of a dry mouth, extreme thirst, and increased urination. Which action should the nurse implement? 1. Administer one amp of intravenous 50% glucose. 2. Prepare to administer intravenous regular insulin. 3. Inject Humulin N subcutaneously in the abdomen. 4. Hang an intravenous infusion of D5W at a keep open rate.

2. The client's signs and symptoms indicate the client is experiencing diabetic ketoacidosis (DKA), which is treated with intravenous regular insulin.

The nurse administered 25 units of Humulin N to a client with Type 1 diabetes at 1600. Which intervention should the nurse implement? 1. Assess the client for hypoglycemia around 1800. 2. Ensure the client eats the nighttime snack. 3. Check the client's serum blood glucose level. 4. Serve the client the supper tray.

2. The nurse needs to ensure the client eats the nighttime (HS) snack to help prevent nighttime hypoglycemia.

Which assessment data best indicate the client with Type 1 diabetes is adhering to the medical treatment regimen? 1. The client's fasting blood glucose is 100 mg/dL. 2. The client's urine specimen has no ketones. 3. The client's glycosylated hemoglobin is 5.8%. 4. The client's glucometer reading is 120 mg/dL

3. A glycosylated hemoglobin (A1C) gives the average of the blood glucose level over the last 3 months and indicates adherence to the medical treatment regimen. A glycosylated hemoglobin level of 5.8% is close to normal and indicates that the client is adhering to the treatment regimen.

The client diagnosed with Type 2 diabetes is prescribed the sulfonylurea glipizide (Glucotrol). Which statement by the client would warrant intervention by the nurse? 1. "I have to eat my diabetic diet even if I am taking this medication." 2. "I will need to check my blood glucose level at least once a day." 3. "I usually have one glass of wine with my evening meal." 4. "I do not like to walk every day, but I will if it will help my diabetes."

3. Sulfonylureas and biguanides may cause an Antabuse-like reaction when taken with alcohol, causing the client to become nauseated and vomit. Advise the client to abstain from alcohol and to avoid liquid over-the-counter (OTC) medications that may contain alcohol. Alcohol also increases the half-life of the medication and can cause a hypoglycemic reaction.

. The client diagnosed with hyperthyroidism who received radioactive iodine, I-131, tells the nurse, "I don't think the medication is working. I don't feel any different." Which statement would be the nurse's best response? 1. "You should notify your health-care provider immediately." 2. "You may need to have two or three more doses of the medication." 3. "It may take up to several months to get the full benefits of the treatment." 4. "You don't feel any different. Would you like to sit down and talk about it?"

3. The goal of radioactive therapy for hyperthyroidism is to destroy just enough of the thyroid gland so that levels of thyroid function return to normal. Full benefits may take several months

The nurse is discussing the thyroid hormone levothyroxine (Synthroid) with a client diagnosed with hypothyroidism. Which intervention should be included in the client teaching? 1. Discuss the importance of not using iodized salt. 2. Explain the importance of not taking medication with grapefruit juice. 3. Instruct the client to take the medication in the morning. 4. Teach the client to monitor daily glucose levels.

3. The medication should be taken in the morning to decrease the incidence of drug-related insomnia.

The school nurse is teaching a class about Type 2 diabetes to elementary school teachers. Which information is most important for the nurse to discuss with the teachers? 1. The importance of not allowing students to eat candy in the classroom. 2. The increase in the number of students developing Type 2 diabetes. 3. The signs and symptoms of hypoglycemia and the immediate treatment. 4. The need to have the students run or walk for 20 minutes during the recess period.

3. The most important information for the teachers to know is how to treat potentially life-threatening complications secondary to the medications used to treat Type 2 diabetes. The school nurse should discuss issues that keep the students safe.

. Which statement best describes the scientific rationale for prescribing the biguanide metformin (Glucophage)? 1. This medication decreases insulin resistance, improving blood glucose control. 2. This medication allows the carbohydrates to pass slowly through the large intestine. 3. This medication will decrease the hepatic production of glucose from stored glycogen. 4. This medication stimulates the beta cells to release more insulin into the bloodstream.

3. The scientific rationale for administering metformin (Glucophage) is that it diminishes the increase in serum glucose following a meal and blunts the degree of postprandial hyperglycemia by preventing gluconeogenesis.

The client diagnosed with Type 2 diabetes is receiving the combination oral antidiabetic medication glyburide/metformin (Glucovance). Which data indicate the medication is effective? 1. The client's skin turgor is elastic. 2. The client's urine ketones are negative. 3. The serum blood glucose level is 118 mg/dL. 4. The client's glucometer level is 170 mg/dL.

3. The serum blood glucose level should be within normal limits, which is 70-110 mg/dL. A level of 118 mg/dL is close to normal; therefore, the medication can be considered effective.

. The client with Type 2 diabetes is admitted into the medical department with a wound on the left leg that will not heal. The HCP prescribes sliding-scale insulin. The client tells the nurse, "I don't want to have to take shots. I take pills at home." Which statement would be the nurse's best response? 1. "If you can't keep your glucose under control with pills, you must take insulin." 2. "You should discuss the insulin order with your HCP because you don't want to take it." 3. "You are worried about having to take insulin. I will sit down and we can talk." 4. "During illness you may need to take insulin to keep your blood glucose level down."

4. Blood glucose levels elevate during times of stress, surgery, or serious infection. The client with Type 2 diabetes may need to be given insulin temporarily to help keep the blood glucose level with normal limits.

51 The client diagnosed with hypothyroidism is prescribed levothyroxine (Synthroid). Which assessment data would support that the client is not taking enough medication? 1. The client has a 2-kg weight loss. 2. The client complains of being too hot. 3. The client's radial pulse rate is 110 bpm. 4. The client complains of being constipated.

4. Decreased metabolism and constipation indicate that the client is not taking enough of the thyroid hormone.

The nurse in the medical department is preparing to administer Humalog, a rapidacting insulin, to a client diagnosed with Type 1 diabetes. Which intervention should the nurse implement? 1. Ensure the client is wearing a MedicAlert bracelet. 2. Administer the dose according to the regular insulin sliding scale. 3. Assess the client for hyperosmolar, hyperglycemic, nonketotic coma. 4. Make sure the client eats the food on the meal tray that is at the bedside.

4. Humalog peaks in 30 minutes to 1 hour; therefore, the client needs to eat when or shortly after the medication is administered to prevent hypoglycemia.

The client newly diagnosed with Type 2 diabetes who has been prescribed an oral hypoglycemic medication calls the clinic and tells the nurse that the sclera has a yellow color. Which action should the clinic nurse implement? 1. Ask the client if he or she has been exposed to someone with hepatitis. 2. Determine if the client has a history of alcohol use or is currently drinking alcohol. 3. Check to see if the client is taking the cardiac glycoside digoxin. 4. Make an appointment for the client to come to the health-care provider's office.

4. Oral hypoglycemics are metabolized in the liver and may cause elevations in liver enzymes; the client should be instructed to report the first signs of yellow skin, sclera, pale stools, or dark urine to the HCP.

The client with hyperthyroidism is prescribed the thioamide propylthiouracil (PTU). Which laboratory data should the nurse monitor? 1. The client's arterial blood gases. 2. The client's serum potassium level. 3. The client's red blood cell count (RBC). 4. The client's white blood cell count (WBC).

4. The client receiving PTU is at risk for agranulocytosis; therefore, the client's white blood cell count should be checked periodically. Because agranulocytosis puts the client at greater risk for infection, efforts to control invasion of microbes should be strictly observed.

The nurse is discussing the thyroid hormone levothyroxine (Synthroid) with the client diagnosed with hypothyroidism. Which intervention should the nurse discuss with the client? 1. Encourage the client to decrease the fiber in the diet. 2. Discuss the need to monitor the T3, T4 levels daily. 3. Tell the client to take the medication with food only. 4. Instruct the client to report any significant weight changes.

4. The client's weight should be monitored weekly. Weight loss is expected as a result of the increased metabolic rate, and weight changes help to determine the effectiveness of the drug therapy.

The female client diagnosed with Type 2 diabetes tells the clinic nurse that she started taking ginseng to help increase her memory. Which action should the clinic nurse take? 1. Take no action because ginseng does not affect Type 2 diabetes. 2. Determine what type of memory deficits the client is experiencing. 3. Explain that herbs are dangerous and she should not be taking them. 4. Determine if the client is currently taking any type of antidiabetic medication.

4. The nurse should determine if the client is taking any medication because many oral hypoglycemics interact with herbs. Ginseng and garlic may increase the hypoglycemic effects of oral hypoglycemics.

Which statement best describes the pharmacodynamics of insulin? 1. Insulin causes the pancreas to secrete glucose into the bloodstream. 2. Insulin is metabolized by the liver and muscle and excreted in the urine. 3. Insulin is needed to maintain colloidal osmotic pressure in the bloodstream. 4. Insulin lowers blood glucose by promoting use of glucose in the body cells.

4. This is the statement that explains the pharmacodynamics, which is the drug's mechanism of action or way that insulin is utilized by the body. Over time, elevated glucose levels in the bloodstream can cause long-term complications, including nephropathy, retinopathy, and neuropathy. Insulin lowers blood glucose by promoting the use of glucose in body cells.

The nurse is teaching a client with newly diagnosed Type 1 diabetes about insulin therapy. Which statement indicates the client needs more teaching concerning insulin therapy? 1. "If I have a headache or start getting nervous, I will drink some orange juice." 2. "If I pass out at home, a family member should give me a glucagon injection." 3. "Because I am taking my insulin daily I do not have to adhere to a diabetic diet." 4. "I will check my blood glucose with my glucometer at least once a day."

Even with insulin therapy the client should adhere to the American Diabetic Association diet, which recommends "carbohydrate counting." This statement indicates the client needs more teaching