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1. An agitated, confused female 3.

Nurse Joey is assigned to care hands


client arrives in the emergency for a C. Nervousness and tremors
department. Her history includes postoperative male client who D. Thyroid gland swelling
type 1 diabetes mellitus, has 6. A female client with
hypertension , and angina diabetes mellitus . During the hypothyroidism
pectoris . Assessment reveals assessment interview, the client ( myxedema ) is receiving
pallor, diaphoresis, headache, reports that he’s impotent and levothyroxine
and intense hunger. A stat blood says (Synthroid), 25 mcg P.O. daily.
glucose sample measures 42 he’s concerned about its effect Which
mg/dl, and the client is treated on his finding should nurse Hans
for an acute hypoglycemic marriage. In planning this recognize as an adverse drug
reaction. After recovery, the client’s effect?
nurse care, the most appropriate A. Dysuria
teaches the client to treat intervention would be to: B. Leg cramps
hypoglycemia by ingesting: A. Encourage the client to ask C. Tachycardia
A. 2 to 5 g of a simple questions about personal D. Blurred vision
carbohydrate. sexuality. 7. A 67-year-old male client has
B. 10 to 15 g of a simple B. Provide time for privacy. been
carbohydrate. C. Provide support for the spouse complaining of sleeping more,
C. 18 to 20 g of a simple or increased urination, anorexia,
carbohydrate. significant other. weakness, irritability,
D. 25 to 30 g of a simple D. Suggest referral to a sex depression, and
carbohydrate. counselor bone pain that interferes with
2. A female adult client with a or other appropriate her
history professional. going outdoors. Based on these
of chronic hyperparathyroidism 4. During a class on exercise for assessment findings, nurse
admits to being noncompliant. diabetic clients, a female client Richard
Based on initial assessment asks would suspect which of the
findings, the nurse formulates the nurse educator how often to following
the nursing diagnosis of Risk for exercise. The nurse educator disorders?
injury. To complete the nursing advises A. Diabetes mellitus
diagnosis statement for this the clients to exercise how often B. Diabetes insipidus
client, which “related-to” phrase to C. Hypoparathyroidism
should the nurse add? meet the goals of planned D. Hyperparathyroidism
A. Related to bone exercise? 8. When caring for a male client
demineralization A. At least once a week with
resulting in pathologic fractures B. At least three times a week diabetes insipidus, nurse Juliet
B. Related to exhaustion C. At least five times a week expects to administer:
secondary to an accelerated D. Every day A. vasopressin (Pitressin
metabolic rate 5. Nurse Oliver should expect a Synthetic).
C. Related to edema and dry skin client B. furosemide ( Lasix ).
secondary to fluid infiltration into with hypothyroidism to report C. regular insulin .
the which D. 10% dextrose.
interstitial spaces health concerns? 9. The nurse is aware that the
D. Related to tetany secondary A. Increased appetite and weight following is the most common
to a loss cause
decreased serum calcium level B. Puffiness of the face and of hyperaldosteronism?

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A. Excessive sodium intake 13. Early this morning, a female intervention is appropriate?
B. A pituitary adenoma client A. Infusing I.V. fluids rapidly as
C. Deficient potassium intake had a subtotal thyroidectomy. ordered
D. An adrenal adenoma During B. Encouraging increased oral
10. A male client with type 1 evening rounds, nurse Tina intake
diabetes assesses C. Restricting fluids
mellitus has a highly elevated the client, who now has nausea, D. Administering glucose-
glycosylated hemoglobin (Hb) a containing
test temperature of 105° F (40.5° C), I.V. fluids as ordered
result. In discussing the result tachycardia, and extreme 17. A female client has a serum
with the client, nurse Sharmaine restlessness. What is the most calcium level of 7.2 mg/dl.
would be most accurate in likely cause of these signs? During the
stating: A. Diabetic ketoacidosis physical examination, nurse
A. “The test needs to be B. Thyroid crisis Noah
repeated C. Hypoglycemia expects to assess:
following a 12-hour fast.” D. Tetany A. Trousseau’s sign.
B. “It looks like you aren’t 14. For a male client with B. Homans’ sign.
following the prescribed diabetic hyperglycemia , which C. Hegar’s sign.
diet.” assessment D. Goodell’s sign.
C. “It tells us about your sugar finding best supports a nursing 18. Which outcome indicates
control for the last 3 months.” diagnosis of Deficient fluid that
D. “Your insulin regimen needs volume ? treatment of a male client with
to be A. Cool, clammy skin diabetes insipidus has been
altered significantly.” B. Distended neck veins effective?
11. Following a unilateral C. Increased urine osmolarity A. Fluid intake is less than 2,500
adrenalectomy, nurse Betty D. Decreased serum sodium ml/
would level day.
assess for hyperkalemia shown 15. When assessing a male B. Urine output measures more
by client with than
which of the following? pheochromocytoma, a tumor of 200 ml/hour.
A. Muscle weakness the C. Blood pressure is 90/50 mm
B. Tremors adrenal medulla that secretes Hg.
C. Diaphoresis excessive catecholamine, nurse D. The heart rate is 126
D. Constipation April beats/minute.
12. Nurse Louie is developing a is most likely to detect: 19. Jemma, who weighs 210 lb
teaching plan for a male client A. a blood pressure of 130/70 (95 kg) and has been diagnosed
diagnosed with diabetes mm Hg. with
insipidus. The nurse should B. a blood glucose level of 130 hyperglycemia tells the nurse
include information about which mg/dl. that her husband sleeps in
hormone lacking in clients with C. bradycardia. another room
diabetes insipidus? D. a blood pressure of 176/88 because her snoring keeps him
A. antidiuretic hormone (ADH). mm Hg. awake. The nurse notices that
B. thyroid-stimulating hormone 16. A male client is admitted for she has large hands and a
(TSH). treatment of the syndrome of hoarse voice. Which of the
C. follicle-stimulating hormone inappropriate antidiuretic following would the nurse
(FSH). hormone suspect as a possible cause of
D. luteinizing hormone (LH). (SIADH). Which nursing the client’s hyperglycemia?

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A. Acromegaly these medications are only breathing
B. Type 1 diabetes mellitus effective if the client: and coughing after surgery.”
C. Hypothyroidism A. prefers to take insulin orally. C. “You won’t be able to swallow
D. Deficient growth hormone B. has type 2 diabetes. for
20. Nurse Kate is providing C. has type 1 diabetes. the first day or two.”
dietary D. is pregnant and has type 2 D. “You must avoid
instructions to a male client with diabetes. hyperextending
hypoglycemia. To control 23. When caring for a female your neck after surgery.”
hypoglycemic episodes, the client 26. Nurse Ronn is assessing a
nurse should recommend: with a history of hypoglycemia, client
A. Increasing saturated fat intake nurse with possible Cushing’s
and Ruby should avoid administering syndrome. In a client with
fasting in the afternoon. a Cushing’s syndrome, the
B. Increasing intake of vitamins drug that may potentiate nurse would expect to find:
B and hypoglycemia. Which drug fits A. Hypotension.
D and taking iron supplements. this B. Thick, coarse skin.
C. Eating a candy bar if description? C. Deposits of adipose tissue in
lightheadedness occurs. A. sulfisoxazole (Gantrisin) the
D. Consuming a low- B. mexiletine (Mexitil) trunk and dorsocervical area.
carbohydrate, high protein diet C. prednisone (Orasone) D. Weight gain in arms and legs.
and avoiding fasting. D. lithium carbonate (Lithobid) 27. A male client with primary
21. An incoherent female client 24. After taking glipizide diabetes insipidus is ready for
with a history of hypothyroidism (Glucotrol) discharge on desmopressin
is brought to the emergency for 9 months, a male client (DDAVP).
department by the rescue experiences secondary failure. Which instruction should nurse
squad. Physical and laboratory Which Lina
findings reveal hypothermia, of the following would the nurse provide?
hypoventilation, respiratory expect the physician to do? A. “Administer desmopressin
acidosis, A. Initiate insulin therapy. while the suspension is cold.”
bradycardia, hypotension , and B. Switch the client to a different B. “Your condition isn’t chronic,
nonpitting edema of the face oral so you won’t need to wear a
and antidiabetic agent. medical
pretibial area. Knowing that C. Prescribe an additional oral identification bracelet.”
these antidiabetic agent. C. “You may not be able to use
findings suggest severe D. Restrict carbohydrate intake desmopressin nasally if you have
hypothyroidism, nurse Libby to less nasal discharge or blockage.”
prepares to take emergency than 30% of the total caloric D. “You won’t need to monitor
action to prevent the potential intake. your
complication of: 25. During preoperative teaching fluid intake and output after you
A. Thyroid storm. for a female client who will start
B. Cretinism . undergo subtotal thyroidectomy, taking desmopressin.”
C. myxedema coma. the nurse should include which 28. Nurse Wayne is aware that a
D. Hashimoto’s thyroiditis. statement? positive Chvostek’s sign
22. A male client with type 1 A. “The head of your bed must indicate?
diabetes mellitus asks the nurse remain A. Hypocalcemia
about taking an oral antidiabetic flat for 24 hours after surgery.” B. Hyponatremia
agent. Nurse Jack explains that B. “You should avoid deep C. Hypokalemia

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D. Hypermagnesemia according to glucose results. At 2 D. Laryngeal nerve damage
29. In a 29-year-old female client p.m., the client has a capillary 34. After undergoing a subtotal
who is being successfully treated glucose level of 250 mg/dl for thyroidectomy, a female client
for which he receives 8 U of regular develops hypothyroidism. Dr.
Cushing’s syndrome, nurse insulin. Nurse Vince should Smith
Lyzette expect the dose’s: prescribes levothyroxine
would expect a decline in: A. Onset to be at 2 p.m. and its (Levothroid),
A. Serum glucose level. peak 25 mcg P.O. daily. For which
B. Hair loss. to be at 3 p.m. condition is levothyroxine the
C. Bone mineralization. B. Onset to be at 2:15 p.m. and preferred agent?
D. Menstrual flow. its A. Primary hypothyroidism
30. A male client has recently peak to be at 3 p.m. B. Graves’ disease
undergone surgical removal of a C. Onset to be at 2:30 p.m. and C. Thyrotoxicosis
pituitary tumor. Dr. Wong its D. Euthyroidism
prescribes peak to be at 4 p.m. 35. Which of these signs
corticotropin (Acthar), 20 units D. Onset to be at 4 p.m. and its suggests that a male client with
I.M. peak the syndrome of inappropriate
q.i.d. as a replacement therapy. to be at 6 p.m. antidiuretic hormone (SIADH)
What 32. A female client with secretion is experiencing
is the mechanism of action of Cushing’s complications?
corticotropin? syndrome is admitted to the A. Tetanic contractions
A. It decreases cyclic adenosine medical- B. Neck vein distention
monophosphate (cAMP) surgical unit. During the C. Weight loss
production and affects the admission D. Polyuria
metabolic rate of target organs. assessment, nurse Tyzz notes 36. A female client with a history
B. It interacts with plasma that the client is agitated and of
membrane irritable, has poor memory, pheochromocytoma is admitted
receptors to inhibit enzymatic reports loss of appetite, and to the hospital in an acute
actions. appears disheveled. These hypertensive
C. It interacts with plasma findings are consistent with crisis. To reverse hypertensive
membrane which problem? crisis
receptors to produce enzymatic A. Depression caused by pheochromocytoma,
actions that affect protein, fat, B. Neuropathy nurse Lyka expects to
and C. Hypoglycemia administer:
carbohydrate metabolism. D. Hyperthyroidism A. phentolamine (Regitine).
D. It regulates the threshold for 33. Nurse Ruth is assessing a B. methyldopa (Aldomet).
water client C. mannitol ( Osmitrol ).
resorption in the kidneys. after a thyroidectomy. The D. felodipine (Plendil).
31. Capillary glucose monitoring assessment reveals muscle 37. A male client with a history
is twitching and tingling, along of
being performed every 4 hours with numbness in the fingers, hypertension is diagnosed with
for a toes, and mouth area. The nurse primary hyperaldosteronism.
female client diagnosed with should suspect which This diagnosis indicates that the
diabetic complication? client’s hypertension is caused
ketoacidosis. Insulin is A. Tetany by excessive hormone secretion
administered B. Hemorrhage from which of the following
using a scale of regular insulin C. Thyroid storm glands?

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A. Adrenal cortex postoperative instruction should bedtime. Why are wet-to-dry
B. Pancreas the nurse emphasize? dressings used for this client?
C. Adrenal medulla A. “You must lie flat for 24 hours A. They contain exudate and
D. Parathyroid after surgery.” provide a moist wound
38. Nurse Troy is aware that the B. “You must avoid coughing, environment.
most sneezing, and blowing your B. They protect the wound from
appropriate for a client with nose.” mechanical trauma and promote
Addison’s disease? C. “You must restrict your fluid healing.
A. Risk for infection intake.” C. They debride the wound and
B. Excessive fluid volume D. “You must report ringing in promote healing by secondary
C. Urinary retention your intention.
D. Hypothermia ears immediately.” D. They prevent the entrance of
39. Acarbose (Precose), an 41. Dr. Kennedy prescribes microorganisms and minimize
alpha- glipizide wound
glucosidase inhibitor, is (Glucotrol), an oral antidiabetic discomfort.
prescribed for a female client agent, for a male client with type 43. When instructing the female
with type 2 diabetes mellitus. 2 diabetes client diagnosed with
During discharge planning, nurse mellitus who has been having hyperparathyroidism about diet,
Pauleen would be aware of the trouble nurse Gina should stress
client’s need for additional controlling the blood glucose the importance of which of the
teaching when the client states: level following?
A. “If I have hypoglycemia, I through diet and exercise. Which A. Restricting fluids
should eat some sugar, not medication instruction should B. Restricting sodium
dextrose.” the C. Forcing fluids
B. “The drug makes my pancreas nurse provide? D. Restricting potassium
release more insulin.” A. “Be sure to take glipizide 30 44. Which nursing diagnosis
C. “I should never take insulin minutes before meals.” takes
while B. “Glipizide may cause a low highest priority for a female
I’m taking this drug.” serum client with hyperthyroidism?
D. “It’s best if I take the drug sodium level, so make sure you A. Risk for imbalanced nutrition:
with the have More than body requirements
first bite of a meal.” your sodium level checked related to thyroid hormone
40. A female client whose monthly.” excess
physical C. “You won’t need to check your B. Risk for impaired skin integrity
findings suggest a hyperpituitary blood glucose level after you related to edema, skin fragility,
condition undergoes an start and
extensive taking glipizide.” poor wound healing
diagnostic workup. Test results D. “Take glipizide after a meal to C. Body image disturbance
reveal prevent heartburn.” related to
a pituitary tumor, which 42. For a diabetic male client weight gain and edema
necessitates with a D. Imbalanced nutrition: Less
a transsphenoidal foot ulcer , the physician orders than
hypophysectomy. bed body requirements related to
The evening before the surgery, rest, a wet-to-dry dressing thyroid
nurse Jacob reviews preoperative change hormone excess
and postoperative instructions every shift, and blood glucose 45. A male client with a tentative
given to the client earlier. Which monitoring before meals and diagnosis of hyperosmolar

5
hyperglycemic nonketotic 48. Which instruction about D. Hyperkalemia
syndrome insulin
(HHNS) has a history of type 2 administration should nurse Kate
diabetes that is being controlled give 1. Knowing that gluconeogenesis
with to a client? helps to maintain blood levels, a
an oral diabetic agent, A. “Always follow the same order nurse should:
tolazamide when drawing the different 1. Document weight changes
(Tolinase). Which of the following insulins into the syringe.” because of fatty acid
is B. “Shake the vials before mobilization
the most important laboratory withdrawing the insulin.” 2. Evaluate the patient’s
test for confirming this disorder? C. “Store unopened vials of sensitivity to
A. Serum potassium level insulin in low room temperatures because
B. Serum sodium level the freezer at temperatures well of
C. Arterial blood gas (ABG) below freezing.” decreased adipose tissue
values D. “Discard the intermediate- insulation
D. Serum osmolarity acting 3. Protect the patient from
46. A male client has just been insulin if it appears cloudy.” sources of
diagnosed with type 1 diabetes 49. Nurse Perry is caring for a infection because of decreased
mellitus. When teaching the female cellular protein deposits
client and family how diet and client with type 1 diabetes 4. Do all of the above
exercise affect insulin mellitus 2. Clinical manifestations
requirements, Nurse Joy should who exhibits confusion, light- associated
include which guideline? headedness, and aberrant with a diagnosis of type 1 DM
A. “You’ll need more insulin behavior. include
when you exercise or increase The client is still conscious. The all of the following except:
your food intake.” nurse 1. Hypoglycemia
B. “You’ll need less insulin when should first administer: 2. Hyponatremia
you A. I.M. or subcutaneous 3. Ketonuria
exercise or reduce your food glucagon. 4. Polyphagia
intake.” B. I.V. bolus of dextrose 50%. 3. The lowest fasting plasma
C. “You’ll need less insulin when C. 15 to 20 g of a fast-acting glucose
you carbohydrate such as orange level suggestive of a diagnosis of
increase your food intake.” juice. DM
D. “You’ll need more insulin D. 10 U of fast-acting insulin. is:
when you exercise or decrease 50. For the first 72 hours after 1. 90mg/dl
your food intake.” thyroidectomy surgery, nurse 2. 115mg/dl
47. Nurse Noemi administers Jamie 3. 126mg/dl
glucagon to her diabetic client, would assess the female client 4. 180mg/dl
then monitors the client for for 4. Rotation sites for insulin
adverse drug reactions and Chvostek’s sign and Trousseau’s injection
interactions. Which type of drug sign should be separated from one
interacts adversely with because they indicate which of another by 2.5 cm (1 inch) and
glucagon? the should be used only every:
A. Oral anticoagulants following? 1. Third day
B. Anabolic steroids A. Hypocalcemia 2. Week
C. Beta-adrenergic blockers B. Hypercalcemia 3. 2-3 weeks
D. Thiazide diuretics C. Hypokalemia 4. 2-4 weeks

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5. A clinical feature that insulin at 0730. Meals are served 3. 16-18 hours after
distinguishes at 0830, 1230, and 1830. The administration
a hypoglycemic reaction from a nurse expects that the NPH 4. 18-24 hours after
ketoacidosis reaction is: insulin will reach its maximum administration
1. Blurred vision effect (peak) between the hours 12. An external insulin pump is
2. Diaphoresis of: prescribed for a client with DM.
3. Nausea 1. 1130 and 1330 The
4. Weakness 2. 1330 and 1930 client asks the nurse about the
6. Clinical nursing assessment 3. 1530 and 2130 functioning of the pump. The
for a 4. 1730 and 2330 nurse
patient with microangiopathy 9. A bedtime snack is provided bases the response on the
who has manifested impaired for information that the pump:
peripheral arterial circulation Albert. This is based on the 1. Gives small continuous dose
includes all of the following knowledge of
except: that intermediate-acting insulins regular insulin subcutaneously,
1. Integumentary inspection for are and the client can self-
the effective for an approximate administer a bolus with an
presence of brown spots on the duration additional dosage from the pump
lower extremities of: before each meal.
2. Observation for paleness of 1. 6-8 hours 2. Is timed to release
the 2. 10-14 hours programmed
lower extremities 3. 16-20 hours doses of regular or NPH insulin
3. Observation for blanching of 4. 24-28 hours into
the feet 10. Albert refuses his bedtime the bloodstream at specific
after the legs are elevated for 60 snack. intervals.
seconds This should alert the nurse to 3. Is surgically attached to the
4. Palpation for increased pulse assess pancreas and infuses regular
volume in the arteries of the for: insulin
lower extremities 1. Elevated serum bicarbonate into the pancreas, which in turn
7. The nurse expects that a type and a releases the insulin into the
1 decreased blood pH. bloodstream.
diabetic may receive ____ of his 2. Signs of hypoglycemia earlier 4. Continuously infuses small
or her morning dose of insulin than amounts of NPH insulin into the
preoperatively: expected. bloodstream
1. 10-20% 3. Symptoms of hyperglycemia while regularly monitoring blood
2. 25-40% during glucose levels.
3. 50-60% the peak time of NPH insulin. 13. A client with a diagnosis of
4. 85-90% 4. Sugar in the urine diabetic ketoacidosis (DKA) is
8. Albert, a 35-year-old insulin 11. A client is taking NPH insulin being
dependent diabetic, is admitted daily treated in the ER. Which finding
to the hospital with a diagnosis every morning. The nurse would a nurse expect to note as
of instructs the client that the most confirming this diagnosis?
pneumonia . He has been febrile likely time for a hypoglycemic 1. Elevated blood glucose level
since admission. His daily insulin reaction to occur is: and a
requirement is 24 units of NPH. 1. 2-4 hours after administration low plasma bicarbonate
Every 2. 6-14 hours after 2. Decreased urine output
morning Albert is given NPH administration 3. Increased respirations and an

7
increase in pH monitor. blood glucose has been running
4. Comatose state 17. A nurse performs a physical 180-200mg/dl. Which
14. A client with DM assessment on a client with type medication, if
demonstrates 2 DM. Findings include a fasting added to the clients regimen,
acute anxiety when first blood may
admitted for glucose of 120mg/dl, have contributed to the
the treatment of hyperglycemia. temperature of hyperglycemia?
The 101, pulse of 88, respirations of 1. Prednisone (Deltasone)
most appropriate intervention to 22, 2. Atenolol (Tenormin)
decrease the client’s anxiety and a bp of 140/84. Which 3. Phenelzine (Nardil)
would be to: finding 4. Allopurinol (Zyloprim)
1. Administer a sedative would be of most concern of the 20. Glucose is an important
2. Make sure the client knows all nurse? molecule
the 1. Pulse in a cell because this molecule is
correct medical terms to 2. BP primarily used for:
understand 3. Respiration 1. Extraction of energy
what is happening. 4. Temperature 2. Synthesis of protein
3. Ignore the signs and 18. A client with type 1 DM calls 3. Building of genetic material
symptoms of the 4. Formation of cell membranes.
anxiety so that they will soon nurse to report recurrent 21. When a client is first
disappear episodes of admitted with hyperglycemic
4. Convey empathy, trust, and hypoglycemia with exercise. hyperosmolar nonketotic
respect toward the client. Which syndrome (HHNS), the nurse’s
15. A nurse is preparing a plan of statement by the client indicated priority is to provide:
care for a client with DM who has an 1. Oxygen
hyperglycemia. The priority inadequate understanding of the 2. Carbohydrates
nursing peak action of NPH insulin and 3. Fluid replacement
diagnosis would be: exercise? 4. Dietary instruction
1. High risk for deficient fluid 1. “The best time for me to 22. The nurse is admitting a
volume exercise is every afternoon.” client with hypoglycemia.
2. Deficient knowledge: disease 2. “The best time for me to Identify the signs and symptoms
process and treatment exercise is right after I eat.” the nurse should expect.
3. Imbalanced nutrition: less 3. “The best time for me to Select all that apply.
than body requirements exercise is after breakfast.” 1. Thirst
4. Disabled family coping: 4. “The best time for me to 2. Palpitations
compromised. exercise is after my morning 3. Diaphoresis
16. A nurse is caring for a client snack.” 4. Slurred speech
admitted to the ER with DKA. In 19. A client with diabetes 5. Hyperventilation
the mellitus 23. When a client is in diabetic
acute phase the priority nursing visits a health care clinic. The ketoacidosis, the insulin that
action is to prepare to: client’s would be administered is:
1. Administer regular insulin diabetes previously had been 1. Human NPH insulin
intravenously well 2. Human regular insulin
2. Administer 5% dextrose controlled with glyburide 3. Insulin lispro injection
intravenously (Diabeta), 5 4. Insulin glargine injection
3. Correct the acidosis mg PO daily, but recently the 24. The nurse recognizes that
4. Apply an electrocardiogram fasting additional teaching is necessary

8
when the client who is learning fingerstick glucose level of control
alternative site testing (AST) for 258mg/dl 2. Salt and sugar restriction is
glucose monitoring says: at bedtime. An order for sliding the
1. “I need to rub my forearm scale main concern
vigorously until warm before insulin exists. The nurse should: 3. Small, frequent meals are
testing at this site.” 1. Call the physician better for digestion
2. “The fingertip is preferred for 2. Encourage the intake of fluids 4. Large meals can contribute to
glucose monitoring if 3. Administer the insulin as a
hyperglycemia is suspected.” ordered weight problem
3. “I have to make sure that my 4. Give the client ½ c. of orange 32. A client with DM has an
current glucose monitor can be juice above-
used at an alternate site.” 29. The physician orders 36 units knee amputation because of
4. “Alternate site testing is of severe
unsafe if I NPH and 12 units of regular peripheral vascular disease, Two
am experiencing a rapid change insulin. days
in The nurse plans to administer following surgery, when
glucose levels.” these preparing the client for dinner, it
25. Which adaptations should drugs in 1 syringe. Identify the is the nurse’s
the steps primary responsibility to:
nurse caring for a client with in this procedure by listing them 1. Check the client’s serum
diabetic in glucose
ketoacidosis expect the client to priority order. level
exhibit? Select all that apply: 1. Inject air equal to NPH dose 2. Assist the client out of bed to
1. Sweating into the
2. Low PCO2 NPH vial chair
3. Retinopathy 2. Invert regular insulin bottle 3. Place the client in a high-
4. Acetone breath and Fowlers
5. Elevated serum bicarbonate withdraw regular insulin dose position
26. A client’s blood gases reflect 3. Inject air equal to regular dose 4. Ensure that the client’s
diabetic acidosis. The nurse into residual limb is elevated.
should regular dose 33. Which of the following
expect: 4. Invert NPH vial and withdraw nursing
1. Increased pH NPH interventions should be taken for
2. Decreased PO2 dose. a
3. Increased PCO2 30. The insulin that has the most client who complains of nausea
4. Decreased HCO3 rapid onset of action would be: and
27. The nurse knows that 1. Lente vomits one hour after taking his
glucagon 2. Lispro glyburide (DiaBeta)?
may be given in the treatment of 3. Ultralente 1. Give glyburide again
hypoglycemia because it: 4. Humulin N 2. Give subcutaneous insulin and
1. Inhibits gluconeogenesis 31. A client with DM states, “I monitor blood glucose
2. Stimulates the release of cannot 3. Monitor blood glucose closely,
insulin eat big meals; I prefer to snack and
3. Increases blood glucose levels throughout the day.” The nurse look for signs of hypoglycemia.
4. Provides more storage of should carefully explain that the: 4. Monitor blood glucose, and
glucose. 1. Regulated food intake is basic assess
28. A client with type 1 DM has a to for signs of hyperglycemia.

9
34. Which of the following 3. Undiagnosed, untreated D. “The endocrine function of
chronic hyperpituitarism your
complications is associated with 4. Undiagnosed, untreated pancreas is to secrete insulin.”
diabetes? diabetes E. “It means your pancreas
1. Dizziness, dyspnea on mellitus cannot
exertion, and coronary artery 39. A client is in DKA, secondary secrete insulin.”
disease. to 2. Dr. Shrunk orders intravenous
2. Retinopathy, neuropathy, and infection. As the condition (IV)
coronary artery disease progresses, which of the insulin for Rita, a client with a
3. Leg ulcers, cerebral ischemic following symptoms might the blood
events, and pulmonary infarcts nurse see? sugar of 563. Nurse AJ
4. Fatigue , nausea, vomiting, 1. Kussmaul’s respirations and a administers
muscle fruity odor on the breath insulin lispro ( Humalog)
weakness, and cardiac 2. Shallow respirations and intravenously
arrhythmia’s severe (IV). What does the best
35. Rotating injection sites when abdominal pain evaluation of the nurse reveal?
administering insulin prevents 3. Decreased respirations and Select all that apply.
which of the following increased urine output. A. The nurse could have given
complications? 4. Cheyne-stokes respirations the
1. Insulin edema and foul- smelling urine insulin subcutaneously.
2. Insulin lipodystrophy 40. Clients with type 1 diabetes B. The nurse should have
3. Insulin resistance may contacted
4. Systemic allergic reactions require which of the following the physician.
36. Which of the following changes to their daily routine C. The nurse should have used
methods of insulin during periods of infection? regular insulin (Humulin R).
administration would be used in 1. No changes D. The nurse used the correct
the initial treatment of 2. Less insulin insulin.
hyperglycemia in a client with 3. More insulin 3. Ben injects his insulin as
diabetic ketoacidosis? 4. Oral antidiabetic prescribed, but then gets busy
1. Subcutaneous and
2. Intramuscular forgets to eat. What will the best
3. IV bolus only 1. Marlisa has been diagnosed assessment of the nurse reveal?
4. IV bolus, followed by with A. The client will be very thirsty.
continuous diabetes mellitus type 1. She B. The client will complain of
infusion. asks nausea.
37. Insulin forces which of the Nurse Errol what this means. C. The client will need to urinate.
following electrolytes out of the What is D. The client will have moist
plasma and into the cells? the best response by the nurse? skin.
1. Calcium Select all that apply. 4. A clinical instructor teaches a
2. Magnesium A. “Your alpha cells should be class
3. Phosphorus able to for the public about diabetes
4. Potassium secrete insulin , but cannot.” mellitus . Which individual does
38. Which of the following B. “The exocrine function of your the nurse assess as being at
causes of pancreas is to secrete insulin.” highest risk for developing
HHNS is most common? C. “Without insulin, you will diabetes?
1. Insulin overdose develop A. The 50-year-old client who
2. Removal of the adrenal gland ketoacidosis (DKA).” does not get any physical

10
exercise 4. Call a code. mellitus how to
B. The 56-year-old client who A. 1, 2, 3, 4 administer insulin. He evaluates
drinks B. 1, 3, 2, 4 the
three glasses of wine each C. 3, 1, 2, 4 learning has occurred when the
evening D. 4, 3, 2, 1 client makes which statement?
C. The 42-year-old client who is 8. Serge who has diabetes A. “I should check my blood
50 mellitus is sugar
pounds overweight taking oral agents, and is immediately prior to the
D. The 38-year-old client who scheduled administration.”
smokes for a diagnostic test that B. “I should provide direct
one pack of cigarettes per day requires him pressure
5. Steven John has type 1 to be NPO. What is the best plan over the site following the
diabetes of injection.”
mellitus and receives insulin. the nurse with regard to giving C. “I should use the abdominal
Which the area
laboratory test will the nurse client his oral medications? only for insulin injections.”
assess? A. Administer the oral agents D. “I should only use calibrated
A. Potassium immediately after the test. insulin
B. AST (aspartate B. Notify the the diagnostic syringe for the injections.”
aminotransferase) department and request orders. 11. Genevieve has diabetes type
C. Serum amylase C. Notify the physician and 1 and receives insulin for
D. Sodium request glycemic control. She tells the
6. Jansen is receiving metformin orders. nurse that she likes to have a
( Glucophage ). What will be the D. Administer the oral agents glass of wine with dinner. What
best with a will the best plan of the nurse for
plan of the nurse with regard to sip of water before the test. client education include?
patient education with this drug? 9. A client diagnosed with type 1 A. The alcohol could cause
Select all that apply. diabetes receives insulin. He pancreatic
A. It stimulates the pancreas to asks the disease.
produce more insulin. nurse why he can’t just take pills B. The alcohol could cause
B. It must be taken with meals. instead. What is the best serious
C. It decreases sugar production response by liver disease.
in the liver . the nurse? C. The alcohol could predispose
D. It inhibits absorption of A. “Insulin must be injected you to hypoglycemia.
carbohydrates. because it needs to work D. The alcohol could predispose
E. It reduces insulin resistance. quickly.” you to hyperglycemia.
7. Serafica who has diabetes B. “Insulin can’t be in a pill 12. Dr. Wijangco orders insulin
mellitus because it lispro
type 1 is found unresponsive in is destroyed in stomach acid.” (Humalog) 10 units for Alicia, a
the C. “Have you talked to your client
clinical setting. Which nursing doctor with diabetes mellitus. When will
action is a priority? arrange from about taking pills instead?” the
1 to 4. D. “I know it is tough, but you nurse administer this
1. Treat the client for will get medication?
hypoglycemia . used to the shots soon.” A. When the client is eating
2. Call the physician STAT. 10. Nurse Andy has finished B. Thirty minutes before meals
3. Assess the vital signs. teaching a client with diabetes C. fifteen minutes before meals

11
D. When the meal trays arrive on receptors, but there is enough C. Brittle diabetes
the insulin.” D. Diabetes insipidus
floor B. “My peripheral cells have 19. Dr. Hugo has prescribed
13. Nurse Matt makes a home increased sensitivity to insulin.” sulfonylureas for Rebecca in the
visit to C. “My beta cells cannot produce management of diabetes
the client with diabetes mellitus. enough insulin for my cells.” mellitus type 2. As a nurse, you
During the visit, Nurse Matt D. “My cells cannot use the know that the
notes the client’s additional insulin my pancreas makes.” primary purpose of
insulin vials are not refrigerated. 16. The principal goals of sulfonylureas, such as long-
What is the best action by the therapy for acting glyburide (Micronase), is
nurse at this time? older patients who have poor to:
A. Instruct the client to label glycemic control are: A. Induce hypoglycemia by
each vial with the date when A. Enhancing quality of life. decreasing insulin sensitivity.
opened. B. Decreasing the chance of B. Improve insulin sensitivity and
B. Tell the client there is no need complications. decrease hyperglycemia.
to C. Improving self-care through C. Stimulate the beta cells of the
keep additional vials. education. pancreas to secrete insulin.
C. Have the client place the D. All of the above. D. Decrease insulin sensitivity by
insulin 17. Which of the following is enhancing glucose uptake.
vials in the refrigerator. accurate pertaining to physical 20. Rosemary has been taking
D. Have the client discard the exercise and type 1 diabetes Glargine (Lantus) to treat her
vials. mellitus? condition. One of the benefits of
14. During the morning rounds, A. Physical exercise can slow the Glargine (Lantus)
Nurse AJ accompanied the progression of diabetes mellitus. insulin is its ability to:
physician in every patient’s B. Strenuous exercise is A. Release insulin rapidly
room. The physician writes beneficial throughout
orders for the client with when the blood glucose is high. the day to help control basal
diabetes mellitus. Which order C. Patients who take insulin and glucose.
would the nurse validate with engage in strenuous physical B. Release insulin evenly
the physician? exercise throughout
A. Use Humalog insulin for might experience the day and control basal
sliding hyperglycemia. glucose
scale coverage. D. Adjusting insulin regimen levels.
B. Metformin (Glucophage) 1000 allows for safe participation in all C. Simplify the dosing and better
mg forms of control blood glucose levels
per day in divided doses. exercise. during the day.
C. Administer regular insulin 30 18. Harry is a diabetic patient D. Cause hypoglycemia with
minutes prior to meals. who is other
D. Lantus insulin 20U BID. experiencing a reaction of manifestation of other adverse
15. Gary has diabetes type 2. alternating reactions.
Nurse periods of nocturnal 21. A 50-year-old widower is
Martha has taught him about the hypoglycemia and admitted to the hospital with a
illness and evaluates learning hyperglycemia. The patient diagnosis of diabetes mellitus
has might be manifesting which of and complaints of rapid-onset
occurred when the client makes the following? weight loss, elevated blood
which statement? A. Uncontrolled diabetes glucose levels, and polyphagia,
A. “My cells have increased their B. Somogyi phenomenon the gerontology nurse should

12
anticipate which of the following B. Overweight with a waist/hip 28. Which of the following
secondary medical diagnoses? ratio >1 medications are most likely to
A. Impaired glucose tolerance C. Having a consistent HDL level cause
B. Gestational diabetes mellitus above 40 mg/dl hypothyroidism? (Select all that
C. Pituitary tumor D. Maintaining a sedentary apply.)
D. Pancreatic tumor lifestyle A. Acetylsalicylic acid ( aspirin )
22. An older woman with 25. During a visit in the hospital, B. Furosemide (Lasix)
diabetes the C. Docusate sodium (Colace)
mellitus visits the clinic student nurses are asked which D. Rifampin (Rifadin)
concerning of the following persons would 29. After visiting the physician,
her condition. Of which of the most likely be diagnosed with Angela found out that she has a
following symptoms might an diabetes mellitus. They are thyroid problem. In line with her
older correct if they answered a 44- condition, which of the following
woman with diabetes mellitus year- old: diagnostic studies is done to
complain? A. Caucasian woman. determine the size and
A. Anorexia B. Asian woman. composition of the thyroid
B. Pain intolerance C. African-American woman. gland?
C. Weight loss D. Hispanic male. A. Thyroid scan with RAI 123I
D. Perineal itching 26. An ailing 70-year-old woman B. Electrocardiography
23. Gregory is a 52-year-old man with a diagnosis of type 2 C. Ultrasonography
identified as high-risk for diabetes mellitus has been ill D. Venous duplex Doppler study
diabetes with pneumonia . The client’s 30. Nurse Gil is caring for a
mellitus. Which laboratory test intake has been very poor, and patient
should a nurse anticipate a she is admitted to the hospital with a diagnosis of
physician would order for him? for observation and hypothyroidism.
(Select all that apply.) management as Which nursing diagnosis should
A. Fasting Plasma Glucose (FPG) needed. What is the most likely the
B. Two-hour Oral Glucose problem with this patient? nurse most seriously consider
Tolerance A. Insulin resistance has when
Test (OGTT) developed. analyzing the needs of the
C. Glycosylated hemoglobin B. Diabetic ketoacidosis is patient?
(HbA1C) occurring. A. High risk for aspiration related
D. Finger stick glucose three C. Hypoglycemia unawareness is to
times developing. severe vomiting
daily D. Hyperglycemic hyperosmolar B. Diarrhea related to increased
24. According to the National non- peristalsis
Diabetes Statistics Report, ketotic coma. C. Hypothermia related to
diabetes remains as one of the 27. Daniel is diagnosed of having slowed
leading causes of death in the hyperthyroidism (Graves’ metabolic rate
United States since 2010. Which disease). D. Oral mucous membrane,
of Which of the following is a drug altered
the following factors are risks for of related to disease process
the choice for his condition?
development of diabetes A. Furosemide ( Lasix )
mellitus? B. Digoxin (Lanoxin)
(Select all that apply.) C. Propranolol (Inderal) 1. During lecture, the clinical
A. Age over 45 years D. Propylthiouracil (PTU) instructor

13
tells the students that 50% to recommendations would the B. Gestational diabetes increases
60% of nurse the
daily calories should come from make to help the client increase risk that the mother will develop
carbohydrates. What should the calorie consumption to offset diabetes later in life.
nurse absorption problems? C. Gestational diabetes usually
say about the types of A. Eat small meals with two or resolves after the baby is born.
carbohydrates three D. Insulin injections may be
that can be eaten? snacks throughout the day to necessary.
A. Try to limit simple sugars to keep E. The baby will likely be born
between 10% and 20% of daily blood glucose levels steady with
calories. B. Increase consumption of diabetes
B. Simple carbohydrates are simple F. The mother should strive to
absorbed carbohydrates gain no
more rapidly than complex C. Eating small meals with two more weight during the
carbohydrates. or three pregnancy.
C. Simple sugars cause rapid snacks may be more helpful in 6. The goal for pre-prandial
spike in maintaining blood glucose levels blood
glucose levels and should be than glucose for those with Type 1
avoided. three large meals. diabetes
D. Simple sugars should never D. Skip meals to help lose weight mellitus is:
be 4. Billy is being asked A. <80 mg/dl
consumed by someone with concerning his B. <130 mg/dl
diabetes. health in the emergency C. <180 mg/dl
2. At the time Cherrie Ann found department. D. <6%
out When obtaining a health history 7. The guidelines for
that the symptoms of diabetes from a Carbohydrate
were patient with acute pancreatitis , Counting as medical nutrition
caused by high levels of blood the therapy
glucose, she decided to break nurse asks the patient for diabetes mellitus includes all
the specifically of
habit of eating carbohydrates. about a history of the following EXCEPT:
With A. alcohol use. A. Flexibility in types and
this, the nurse would be aware B. cigarette smoking. amounts of
that C. diabetes mellitus . foods consumed
the client might develop what D. high-protein diet. B. Unlimited intake of total fat,
complication? 5. Nurse Shey is educating a saturated fat and cholesterol
A. retinopathy pregnant C. Including adequate servings
B. atherosclerosis client who has gestational of
C. glycosuria diabetes. fruits, vegetables and the dairy
D. acidosis Which of the following group
3. Joko has recently been statements D. Applicable to with either Type
diagnosed should the nurse make to the 1 or
with Type I diabetes and asks client? Type 2 diabetes mellitus
Nurse Select all that apply. 8. The nurse working in the
Jessica for help formulating a A. Cakes, candies, cookies, and physician’s office is reviewing
nutrition regular lab
plan. Which of the following soft drinks should be avoided. results on the clients seen that

14
day. overweight client who has a needs to be screened for
One of the clients who has high- diabetes
classic stress job and smokes. This based on the seven risk criteria?
diabetic symptoms had an eight- client has A. A client with an HDL
hour just received a diagnosis of Type cholesterol
fasting plasma glucose (FPG) II level of 40 mg/dl and a
test Diabetes and has just been triglyceride
done. The nurse realizes that started on level of 300 mg/dl
diagnostic criteria developed by an oral hypoglycemic agent. B. A woman who is at 90% of
the Which of standard
American Diabetes Association the following goals for the client body weight after delivering an
for which eight-
diabetes include classic diabetic if met, would be most likely to pound baby
symptoms plus which of the lead to C. A middle-aged Caucasian
following an improvement in insulin male
fasting plasma glucose levels? efficiency to D. An older client who is
A. Higher than 106 mg/dl the point the client would no hypotensive
B. Higher than 126 mg/dl longer 12. During the admission of a
C. Higher than 140 mg/dl require oral hypoglycemic client
D. Higher than 160 mg/dl agents? with diabetic ketoacidosis, Nurse
9. When taking a health history, A. Comply with medication Kendra will anticipate the
the regimen physician
nurse screens for manifestations 100% for 6 months ordering which of the following
suggestive of Diabetes Type I. B. Quit the use of any tobacco types
Which products by the end of three of intravenous solution if the
of the following manifestations months client
are C. Lose a pound a week until cannot take fluids orally?
considered the primary weight is A. Lactated Ringer’s solution
manifestations in normal range for height and B. 0.9 normal saline solution
of Diabetes Type I and would be exercise C. 5% dextrose in water ( D5W )
most 30 minutes daily D. 0.45% normal saline solution
suggestive and require follow-up D. Practice relaxation techniques 13. You are doing some teaching
investigation? for at with
A. Excessive intake of calories, least five minutes five times a a client who is starting on a
rapid day for sulfonylurea antidiabetic agent.
weight gain, and difficulty losing at least five months The
weight 11. During a visit in a client mentions that he usually
B. An increase in three areas: community, the has a
thirst, nurse will recommend routine couple of beers each night and
intake of fluids, and hunger screening for diabetes when the takes
C. Poor circulation, wound person an aspirin each day to prevent
healing, and has one or more of seven risk heart
leg ulcers, criteria. attack and/or strokes. Which of
D. Lack of energy, weight gain, Which of the following persons the
and that following responses would be
depression the nurse comes in contact with best on
10. The nurse is working with an most the part of the nurse?

15
A. As long as you only drink two injecting the insulin I.V.
beers D. Warm the skin with a warmed C. Give 4 to 6 oz (118 to 177 mL)
and take one aspirin, this should towel of
not be or washcloth prior to the orange juice.
a problem injection D. Give the client four to six
B. The aspirin is alright but you 16. Nurse Pira is explaining to glucose
need the tablets.
to give up drinking any alcoholic client about Type II Diabetes. 20. An external insulin pump is
beverages Risk prescribed for a client with
C. Taking alcohol and/or aspirin factors of such condition include diabetes
with a all of mellitus and the client asks the
sulfonylurea drug can cause the following except: nurse
development of hypoglycemia A. Advanced age about the functioning of the
D. Aspirin and alcohol will cause B. Physical inactivity pump. The
the C. Obesity nurse bases the response on the
stomach to bleed more when on D. Smoking information that the pump:
a 17. Blood sugar is well controlled A. is timed to release
sulfonylurea drug when programmed
14. Which of the following if Hemoglobin A1C is: doses of regular or NPH insulin
stated by A. Below 5.7% into
the nurse is correct about B. Between 12%-15% the bloodstream at specific
Hyperglycemic Hyperosmolar C. Less than 180 mg/dL intervals
Nonketotic Syndrome (HHNS)? D. Between 90 and 130 mg/dL B. gives a small continuously
A. This syndrome occurs mainly 18. Which of the following dose of
in diabetes regular insulin subcutaneously,
people with Type I Diabetes drugs acts by decreasing the and the
B. It has a higher mortality rate amount client can self-administer a bolus
than of glucose produced by the liver? with
Diabetic Ketoacidosis A. Alpha-glucosidase inhibitors an additional dose from the
C. The client with HHNS is in a B. Biguanides pump
state C. Meglitinides before each meal
of overhydration D. Sulfonylureas C. continuously infuses small
D. This condition develops very 19. A 39-year-old company amounts
rapidly driver of NPH insulin into the
15. Nurse Robedee is teaching a presents with shakiness, bloodstream
thin sweating, while regularly monitoring blood
client about the proper methods/ anxiety , and palpitations and glucose levels
techniques when giving insulin. tells the D. is surgically attached to the
Which nurse he has Type I Diabetes pancreas and infuses regular
one of the following is proper? Mellitus. insulin
A. Pinch the skin up and use a 90 Which of the follow actions into the pancreas, which in turn
degree angle should the releases the insulin into the
B. Use a 45 degree angle with nurse do first? bloodstream
the skin A. Inject 1 mg of glucagon 21. Which of the following
pinched up subcutaneously. persons
C. Massage the area of injection B. Administer 50 mL of 50% would most likely be diagnosed
after glucose with

16
Diabetes Mellitus? A 44-year-old: B. anorexia and lethargy
A. Caucasian woman. C. diaphoresis and trembling
B. Asian woman. D. headache and polyuria
C. African-American woman. 25. Mr. Wesley is newly
D. Hispanic male. diagnosed with
22. Which of the following Type I DM and is being seen by
factors are the
risks for the development of home health nurse. The doctors
Diabetes orders
Mellitus? Select all that apply. include: 1200 calorie ADA diet,
A. Age over 45 years 15
B. Overweight with a waist/hip units NPH insulin before
ratio >1 breakfast,
C. Having a consistent HDL level and check blood sugar qid.
above When the
40 mg/dl nurse visits the patient at 5 pm,
D. Maintaining a sedentary the
lifestyle nurse observes the man
23. Anton brought his performing
grandfather to blood sugar analysis. The result
the clinic to confirm his blood is 50
sugar mg/dL. The nurse would expect
levels. Which laboratory test the
should a patient to be
nurse anticipate a physician A. confused with cold, clammy
would skin
order when an older person is and pulse of 110
identified as high-risk for B. lethargic with hot dry skin and
Diabetes rapid
Mellitus? Select all that apply. deep respirations
A. Fasting Plasma Glucose (FPG) C. alert and cooperative with BP
B. Two-hour Oral Glucose of
Tolerance 130/80 and respirations of 12
Test (OGTT) D. short of breath, with
C. Glycosylated hemoglobin distended neck
(HbA1C) veins and bounding pulse of 96.
D. Finger stick glucose three
times
daily
24. A patient received 6 units of
regular insulin 3 hours ago. The
nurse
would be MOST concerned if
which of
the following was observed?
A. kussmaul respirations and
diaphoresis

17