NCLEX Quiz on Addison’s
High protein, carbs, and
Disease & Cushing’s
1. Which of the following
patients are at risk for
developing Cushing’s
Syndrome?
A. A patient with a tumor on
the pituitary gland, which is
causing too much ACTH to be
secreted.
B. A patient taking
glucocorticoids for several
weeks.
C. A patient with a
tuberculosis infection.
D. A patient who is post-opt
from an adrenalectomy
2. Addison’s Disease is:
A. Increased secretion of
cortisol
B. Increased secretion of
aldosterone and cortisol
C. Decreased secretion of
cortisol
D. Decreased secretion of
aldosterone and cortisol
3. A patient with Addison’s
Disease is being discharged
home on Prednisone. Which of
the following statements by the
patient warrants you to re-
educate the patient?
A. “I will notify the doctor if I
become sick or experience extra
stress.”
B. “I will take this medication
as needed when symptoms
present.”
C. “I will take this medication
at the same time every day.”
D. “My daughter has bought
me a Medic-Alert bracelet.”
4. A patient is admitted to the
ER. The patient is unconscious
on arrival. However, the
patient’s family is with the
patient and reports that before
the patient became unconscious
she was complaining of severe
pain in the abdomen, legs, and
back, and has been experiencing
worsening confusion. In
addition, they also report the
patient has not been taking any
medications. The patient was
recently discharged from the
hospital for treatment of low
cortisol and aldosterone levels.
On assessment, you note the
patient’s blood pressure is
70/45. What disorder is this
patient most likely
experiencing?
A. Addisonian Crisis
B. Cushing Syndrome
C. Thyroid crisis
D. Hashimoto thyroiditis
5. In the scenario above, what
medication do you expect the
patient to be started on?
A. IV Solu-Cortef
B. PO Prednisone
C. PO Declomycin
D. IV Insulin
6. A patient with Addison’s
Disease should consume which
of the following diets?
A. High fat and fiber
B. Low potassium and high
protein
C.
adequate sodium
D. Low carbs, high protein,
and increased sodium
7. In Cushing’s Disease and
Syndrome there are:
A. Increased cortisol
production
B. Low potassium and
glucose levels
C. Increased production of
aldosterone and cortisol
D. Decreased production of
cortisol and aldosterone
8. A patient with Cushing’s
syndrome will be undergoing an
adrenalectomy. Which of the
following will be included in the
patient’s discharge teaching
after the procedure?
A. Glucocorticoid
replacement therapy
B. Avoiding avocadoes and
pears
C. Declomycin therapy
D. Signs and symptoms of
Grave’s Disease
9. Which of the following is not
a typical sign and symptom of
Cushing’s Syndrome?
A. Hyperpigmentation of the
skin
B. Hirsutism
C. Purplish striae
D. Moon Face
10. In Cushing’s disease, the
_______is secreting too much
ACTH (Adrenocorticotropic
hormone) which is causing an
increase in cortisol production. Hashimoto's thyroiditis parathyroid glands

A. Adrenal cortex thyrotoxicosis

B. Pituitary gland 6. The most common cause of
Primary Addison's Disease is?
C. Thyroid gland 3. What is the occurance of
Addison's Disease worldwide?
D. Hypothalamus
tuberculosis (TB)
Answer Key

1. B 1 in 100,000 people adrenal tumors

2. D
3. B
4. A 1 in 1,000 drug abuse
5. A
6. C 1 in 10,000 people autoimmunity
7. A
8. A
9. A 1 in 1,000,000 ppeople
10. B 7. The mineralocorticoid
hormones regulate what critical
1. Which disease is the biochemical balance?
4. Which of the following is not
hyperfunction of the adrenal
a symptom of Addison's
glands?
Disease?

calcium and sodium

balance
goiter
weight gain
potassium and magnesium
adrenal crisis balance
craving for salty foods

Addison's Disease magnesium and calcium

weight loss
balance
Cushing's Syndrome
bronzing of the skin
sodium and potassium
balance
2. This polyendocrine disorder
5. Secondary adrenal
can include an underactive
insufficiency is related to what
thyroid gland, diabetes mellitus, 8. CAH stands for what?
other endocrine gland?
and hypoadrenal function.

congenital adrenal
islet cells
Type II diabetes hyperplasia

thyroid gland
Schmidt's Syndrome concentrated adrenal
hypofunction
pituitary gland
 Which would a person with
corrective adrenal Cushing's Syndrome prefer to
hormone eat?
contracted adrenal A. Fat Free Yogurt
hypertension
B. Salad
5.
Which of the following is NOT
another name for Cushing's
Syndrome?
A. Hypercorticism

C. Bacon Grease B. Hyperadrenocorticism

9. In Cushing's Disease, the
D. Fiber Bars C. Itsenko-Cushing syndrome
serum cortisol level will be high.
2. D. Fatty Disease

Cushing's Syndrome is
True a hormone disorder caused by
high levels of what?

False A. Y Chromosomes

B. Fiber in the digestive tract

10. Patients with one endocrine C. Cortisol in the blood 1C

disorder are at an increased risk
for another endocrine disorder. D. Unprotected sexual contact 2C

3A

3. 4A
True
Which gland does Cushing's 5
Syndrome originate in?
False Name a treatment for Addison's
A. Pituitary Disease?

B. Pineal
1D
C. Pancreas 2.
2B
D. Gonads In Addison's disease a person
3A will retain too much?
4A A. Sodium
4.
5C B. Chloride
Which is an obvious sign or
6D C. Potassium
sympton of Cushing's
7D Syndrome?
D. Normal Saline
8A A. Getting really, really fat.
3
9A B. Losing a lot of weight
What are some signs ans
C. Becoming constipated symptoms that Kimberly Wright
10A
presented with that are caused
1. D. Kidney Failure by Addison's disease?
A. Nausea/Vomiting
B. Dizziness/Syncope
C. Weight Gain
D. Irregular menstral cycle
4.
Adrenal glands are located
where?
5.
Which factors below are triggers
or will induce an adrenal crisis?
Select all that apply
A. Heat or cold
B. Stress
C. Surgery
D. Illness
E. Nursing school at Eastern
University
6.
The primary cause of Addison's
disease is overproduction of the
adrenalcortical hormone.
A. True
B. False
7.
Name 3 Nursing Interventions /
Management issues when
caring for a patient with
Addison's Disease?
8.
What are some important
medication teachings to cover
with Regina Wright? Select all
that apply
A. Don't take your medication if
you have a fever
B. Take your medication at the
prescribed times
C. Weight gain is a side effect
D. Good hand hygiene and
avoiding large crowds is
recommended to reduce
exposure to infection
E. This medication will cause
constipation and dry skin
9.
______________________
regulates the secretion of
sodium and potassium.
10 Regina Wright had skin
hyperpigmentation due to loss
of calcium.
A. True
B. False
11. Name 3 factors that
contributed to Regina's level of
stress and what are some non-
pharmacological treatment
options?
12.
Addison's disease is usually
diagnosed early and present
with sign and symptoms right
away.
A. True
B. False
13.
__________________________
____ fluid solution should be
used to replace fluid volume
and restore electrolyte
imbalance.
14.
The primary nursing diagnosis
for Regina Wright are which of
the following: select all that
apply
A. Ineffective Airway clearance
B. Altered nutrition: Less than
body requirements related to
anorexia, vomiting, and nausea
C. Risk for Infection
D. Altered Body Image
15.
Which famous person suffered
with Addison's Disease?
A. Henry Ford
B. John F. Kennedy
C. Martin Luther King Jr.
D. George Washington
1. Corticosteroid
Glucocorticoid
Mineralocorticoid
steroid hormone
2. C
3.ABD
4. ON top of kidney
5 ALL
6 FALSE
7 NOT EXPOSE TO COLD
8 BCD
9 ALDOSTERON
10 FALSE
11
12 FALSE
13 D5 NSS
14 BCD
15 B
1. Nurse Ronn is assessing a
client with possible Cushing’s
syndrome. In a client with
Cushing’s syndrome, the nurse
would expect to find:
A. Hypotension.
B. Thick, coarse skin.
C. Deposits of adipose tissue in
the trunk and dorsocervical
area.
D. Weight gain in arms and legs.
2. In a 29-year-old female client
who is being successfully
treated for Cushing’s syndrome,
nurse Lyzette would expect a
decline in:
A. Serum glucose level.
B. Hair loss.
C. Bone mineralization.
D. Menstrual flow.
3. A female client with Cushing’s
syndrome is admitted to the
medical-surgical unit. During the
admission assessment, nurse
Tyzz notes that the client is
agitated and irritable, has poor
memory, reports loss of
appetite, and appears
disheveled. These findings are
consistent with which problem?
A. Depression
B. Neuropathy
C. Hypoglycemia
D. Hyperthyroidism
4.Nurse Ruth is assessing a
client after a thyroidectomy.
The assessment reveals muscle
twitching and tingling, along
with numbness in the fingers,
toes, and mouth area. The nurse
should suspect which
complication?
A. Tetany
B.Hemorrhage
C. Thyroid storm
D. Laryngeal nerve damage
5.
Nurse Sugar is assessing a client
with Cushing's syndrome. Which
observation should the nurse
report to the physician
immediately?
A. Pitting edema of the legs
B. An irregular apical pulse
C. Dry mucous membranes
D. Frequent urination
6. The nurse is planning room
assignments for the day. Which
client should be assigned to a
private room if only one is
available?
A. The client with Cushing’s
disease
B.The client with diabetes
C. The client with acromegaly
D. The client with myxedema
7. Corticosteroids are potent
suppressors of the body’s
inflammatory response. Which
of the following conditions or
actions do they suppress?
ACushing
syndrome.
B.Pain receptors.
C. Immune response.
D. Neural transmission.
8. Which of the following
disorders is characterized by a
group of symptoms produced by
an excess of free circulating
cortisol from the adrenal
cortex?
A. Cushing’s syndrome
B. Addison’s disease
C. Graves’ disease
D. Hashimoto’s disease
9. The nurse is assessing a
postcraniotomy client and finds
the urine output from a
catheter is 1500 ml for the 1st
hour and the same for the 2nd
hour. The nurse should suspect:
A. Cushing’s syndrome
B. Diabetes mellitus
C. Adrenal crisis
D. Diabetes insipidus
10. As the shift begins, you are
assigned these patients. Which
patient should you assess first?
A. A 38-year-old patient with
Graves’ disease and a heart rate
of 94/minute
B. A 63-year-old patient with
type 2 diabetes and fingerstick
glucose of 137 mg/dL
C. A 58-year-old patient with
hypothyroidism and heart rate
of 48/minute
D. A 49-year-old patient with
Cushing’s disease and +1
dependent edema
11. You assess a patient with
Cushing’s disease. For which
finding will you notify the
physician immediately?
A. Purple striae present on
abdomen and thighs
B. Weight gain of 1 pound since
the previous day
C. +1 dependent edema in
ankles and calves
D. Crackles bilaterally in lower
lobes of lungs
12. The old woman told John
that she has osteoporosis;
Arthur knew that all of the
following factors would
contribute to osteoporosis
except
A. Hypothyroidism
B. End stage renal disease
C. Cushing’s Disease
D. Taking Furosemide and
Phenytoin.
13. Cushing's Syndrome is
a hormone disorder caused by
high levels of what?
A. Y Chromosomes
B. Fiber in the digestive tract
C. Cortisol in the blood
D. Unprotected sexual contact
14. Which would a person with
Cushing's Syndrome prefer to
eat?
A. Fat Free Yogurt
B. Salad
C. Bacon Grease
D. Fiber Bars
15.
Which gland does Cushing's
Syndrome originate in?
A. Pituitary
B. Pineal
C. Pancreas
D. Gonads
16. Which is an obvious sign or
sympton of Cushing's
Syndrome?
A. Getting really, really fat.
B. Losing a lot of weight
C. Becoming constipated
D. Kidney Failure
17. Which of the following is
NOT another name for Cushing's
Syndrome?
A.Hypercorticism
B.Hyperadrenocorticism
C.Itsenko-Cushing syndrome
D.Fatty Disease
18. The pituitary gland is also
known as the ____________.
A.
Hypophysis
B. Infundibulum
C. Hypothalamus
D. Neurohypophysis
19. Adrenocorticotropic
hormone (ACTH) from the
pituitary stimulates the
__________ glands to release
_________.
A. Pineal, cortisol
B. Adrenal, cortisol
C. Pineal, TSH
D. Adrenal, TSH
20. Signs and/or symptoms of
Cushing's Disease include:
(check correct boxes)
A. Moon face
B. Fatty limbs
C. Osteoporosis
D. Acne
E. Euphoria
21.Cushing's Disease and
Cushing's Sydrome have the
same cause.
A.True
B.False
22. The most common cause of
Cushing's Disease is
____________.
A.Alcohol abuse
B.Steroid use
C.Genetic disposition
D. Adenoma (benign tumor)
1. Acromegaly is most
frequently diagnosed in:
a. Middle-aged adults
b. Newborns
c. Children ages 2 to 5
d. Adults age 65 and older
2. Grave's disease is:
a. The most common cause of
hypothyroidism
b. The most common cause of
hyperparathyroidism
c. The most common cause of
hyperthyroidism
d. The most common cause of
adrenal insufficiency
3. Symptoms of Grave's
ophthalmopathy include all of
the following except:
a. Bulging eyeballs
b. Dry, irritated eyes and puffy
eyelids
c. Cataracts
d. Light sensitivity
4. An ACTH stimulation test is
commonly used to diagnose:
a. Grave's disease
b. Adrenal insufficiency and
Addison's disease
c. Cystic fibrosis
d. Hashimoto's disease
5. All of the following are
symptoms of Cushing's
syndrome except:
a. Severe fatigue and weakness
b. Hypertension and elevated
blood glucose
c. A protruding hump between
the shoulders
d. Hair loss
6. Which of the following
conditions is caused by long-
term exposure to high levels of
cortisol?
a. Addison's disease
b. Crohn's disease
c. Adrenal insufficiency
d. Cushing's syndrome
7. A "sweat test" or newborn
screening may be used to
detect:
a. Cystic fibrosis
b. Adrenal insufficiency
c. Grave's disease
d. Hypothyroidism
8. Hashimoto's disease is:
a. Chronic inflammation of the
thyroid gland
b. Diagnosed most frequently in
Asian-Americans and Pacific
Islanders
c. A form of hyperthyroidism
d. A rare form of
hypothyroidism
9. Persons at increased risk of
developing Hashimoto's
disease include all of the
following except:
a. Persons with vitiligo
b. Asian-Americans
c. Persons with rheumatoid
arthritis
d. Persons with Addison's
disease
10. All of the following
statements about Hashimoto's
disease are true except:
a. Many patients are entirely
asymptomatic
b. Not all patients become
hypothyroid
c. Most cases of obesity are
attributable to Hashimoto's
disease
d. Hypothyroidism may be
subclinical
11. The most common benign
tumor of the pituitary gland is
a:
a. Glioma
b Prolactinoma
c. Carcinoid tumor
d. Islet cell tumor
12. Symptoms of polycystic
ovarian syndrome (PCOS) may
include all of the following
except:
a. Pelvic pain
b. Acne, oily skin, and dandruff
c. Infertility
d. Weight Loss
13. Women with PCOS are at
increased risk for all of the
following except:
a. Pregnancy
b. Diabetes
c. Cardiovascular disease
d. Metabolic syndrome
14. All of the following organs
may be affected by multiple
endocrine neoplasia type 1
except:
a. Parathyroid glands
b. Kidneys
c. Pancreas and Duodenum
d. Pituitary gland
15. What is the treatment for
hyperparathyroidism?
a. Synthetic thyroid hormone
b. Desiccated thyroid hormone
c. Surgical removal of the glands
d. Calcium and phosphate
16. The most common causes
of death in people with cystic
fibrosis is:
a. Dehydration
b. Opportunistic infection
c. Lung cancer
d. Respiratory failure
17. Untreated hyperthyroidism
during pregnancy may result in
all of the following except:
a. Premature birth and
miscarriage
b. Low birthweight
c. Autism
d. Preeclampsia
18. Short stature and
undeveloped ovaries suggest
which of the following
disorders:
a. Polycystic ovarian syndrome
b. Prolactinoma
c. Grave's disease
d. Turner syndrome
19. Endocrine disorders may be
triggered by all of the following
except:
a. Stress
b. Infection
c. Chemicals in the food chain
and environment
d. Cell phone use
20. An analysis of data from the
Women's Health Initiative
questioned the use of which
therapy to prevent heart
disease?
a. Synthetic thyroid hormone
b. Oral contraceptives
c. Weight-loss drugs
d. Postmenopausal hormone
replacement therapy
Answers and Explanations
1. A: Acromegaly results from
benign tumors on the pituitary
gland that produce excessive
amounts of growth hormone.
Although symptoms may
present at any age, the
diagnosis generally occurs in
middle-aged persons.
Untreated, the consequences of
acromegaly include type 2
diabetes, hypertension and
increased risk of cardiovascular
disease, arthritis and colon
polyps.
2. C: Grave's disease is an
autoimmune disorder
characterized by an enlarged
thyroid gland and
overproduction of thyroid
hormones producing symptoms
of hyperthyroidism such as
rapid heartbeat, heat
intolerance, agitation or
irritability, weight loss, and
trouble sleeping. It usually
presents in persons age 20 to 40
and it is much more common in
women than in men.
3. C: Grave's ophthalmopathy is
an inflammation of tissue
behind the eye causing the
eyeballs to bulge. In addition to
the above-mentioned
symptoms, Grave's
ophthalmopathy may cause
pressure or pain in the eyes,
double vision, and trouble
moving the eyes. About one-
quarter of persons with Grave's
disease develop Grave's
ophthalmopathy. The condition
is frequently self-limiting,
resolving without treatment
over the course of a year or
two.
4. B: The ACTH stimulation test
measures blood and urine
cortisol before and after
injection of ACTH. Persons with
chronic adrenal insufficiency or
Addison's disease generally do
not respond with the expected
increase in cortisol levels. An
abnormal ACTH stimulation test
may be followed with a CRH
stimulation test to pinpoint the
cause of adrenal insufficiency.
5. D: Cushing's syndrome also
may cause fragile, thin skin
prone to bruises and stretch
marks on the abdomen and
thighs as well as excessive thirst
and urination and mood
changes such as depression and
anxiety. Women who suffer
from high levels of cortisol often
have irregular menstrual cycles
or amenorrhea and present
with hair on their faces, necks,
chests, abdomens, and thighs.
6. D: Cushing's syndrome is a
form of hypercortisolism. Risk
factors for Cushing's syndrome
are obesity, diabetes, and
hypertension. Cushing's
syndrome is most frequently
diagnosed in persons ages 20 to
50 who have characteristic
round faces, upper body
obesity, large necks, and
relatively thin limbs.
7. A: Cystic fibrosis is the most
common inherited fatal disease
of children and young adults in
the United States. Cystic fibrosis
is usually diagnosed by the time
an affected child is three years
old. Often, the only signs are a
persistent cough, a large
appetite but poor weight gain,
an extremely salty taste to the
skin, and large, foul-smelling
bowel movements. A simple
sweat test is currently the
standard diagnostic test. The
test measures the amount of
salt in the sweat; abnormally
high levels are the hallmark of
the disorder.
8. A: Hashimoto's disease is the
most common cause of
hypothyroidism. It is an
autoimmune disease that
produces chronic inflammation
of the thyroid gland. More
women are affected than men
and it is generally diagnosed in
persons ages 40 to 60. When
treatment is indicated, synthetic
T4 is administered.
9. B: Along with the above-
mentioned groups, persons with
type 1 diabetes and persons
suffering from pernicious
anemia (insufficient vitamin
b12) are at increased risk of
developing Hashimoto's
disease. Because it tends to run
in families, there is likely a
genetic susceptibility as well.
Environmental factors such as
excessive iodine consumption
and selected drugs also have
been implicated as potential risk
factors.
10. C: Although weight gain may
be a symptom of Hashimoto's
disease, the majority of obese
people have normal thyroid
function; rarely is thyroid
disorder the sole cause of
obesity. Other symptoms of
Hashimoto's disease include
fatigue, cold intolerance, joint
pain, myalgias, constipation, dry
hair, skin and nails, impaired
fertility, slow heart rate, and
depression.
11. B: Prolactinomas can cause
symptoms by releasing
excessive amounts of prolactin
into the blood or mechanically
by pressing on surrounding
tissues. In women, symptoms
may include menstrual
irregularities and infertility; in
men erectile dysfunction and
libido may be impaired.
12. D: In addition to the above-
mentioned symptoms, PCOS
may cause menstrual
irregularities, thinning hair or
male-pattern baldness, thick
skin or dark patches of skin and
excessive hair growth on the
face, chest, abdomen, thumbs
and toes.
13. A: Women with PCOS
produce excessive amounts of
androgens and do not release
ova during ovulation, which
seriously compromises their
ability to conceive. Although
women with PCOS can become
pregnant, often by using
assistive reproductive
technology, they are at
increased risk for miscarriage.
14. B: Multiple endocrine
neoplasia type 1, also known as
Werner's syndrome, is a
heritable disorder that causes
tumors in endocrine glands and
the duodenum. Although the
tumors associated with multiple
endocrine neoplasia type 1 are
generally benign, they can
produce symptoms chemically
by releasing excessive amounts
of hormones or mechanically by
pressing on adjacent tissue.
15. C: When
hyperparathyroidism requires
treatment, surgery is the
treatment of choice and is
considered curative for 95% of
cases. Because untreated
hyperparathyroidism may
elevate blood and urine levels of
calcium and deplete
phosphorus, bones and teeth
may lose the minerals needed
to remain strong.
16. D: Declining pulmonary
function is a hallmark of cystic
fibrosis. Drugs such as
Pulmozyme (dornase alfa) and
Zithromax (azithromycin) can
slow the progression of lung
disease and mechanical physical
therapy devices help CF patients
to breathe more easily by
loosening and dislodging mucus.
For some patients with severe
lung damage, lung
transplantation is a treatment
option.
17. C: In addition to the above-
mentioned complications of
uncontrolled hyperthyroidism in
pregnancy, expectant mothers
may suffer congestive heart
failure and thyroid storm, which
is life-threatening thyrotoxicosis
with symptoms that include
agitation, confusion,
tachycardia, shaking, sweating,
diarrhea, fever, and
restlessness.
18. D: Turner syndrome results
from a chromosomal
abnormality and occurs in an
estimated 1 in 2,500 female
births. It occurs more frequently
in preterm pregnancies.
Affected women are shorter
than average and are infertile
because they lack ovarian
function. They also may have
webbed necks, broad chests,
arms that turn out from the
elbow, lymphedema of the
hands and feet and skeletal,
cardiac, and renal problems.
19. D: Endocrine function may
be influenced by myriad factors.
In addition to the above-
mentioned, there is evidence
that exposure to naturally
occurring and man-made
endocrine disruptors such as
tributyltin, certain
bioaccumulating chlorinated
compounds, and
phytoestrogens is widespread
and in susceptible individuals,
may trigger endocrine
disorders.
20. D: The results of the
Women's Health Initiative study
prompted the U.S. Food and
Drug Administration (FDA) to
advise against using hormone
therapy (estrogen-alone or
estrogen-plus-progestin) to
prevent heart disease. When
hormone replacement therapy
is used to treat moderate to
severe hot flashes and
symptoms of vulvar and vaginal
atrophy it should used at the
lowest doses for the shortest
duration needed to achieve
treatment objectives.
1. Clinical manifestations of
Addison's Disease include:
(select all that apply)
A. Weight gain
B. Progressive weakness
C. Skin hyperpigmentation
D. Hypertension
E. Decreased axillary and pubic
hair
2. A patient with Addison's
disease asks a nurse for
nutrition and diet advice. Which
of the following diet
modification is NOT
recommended?
A. A diet high in grains
B. A diet with adequate caloric
intake
C. A high protein diet
D. A restricted sodium diet
3. Cushing's Syndrome may be
caused by which of the
following?
A. Destruction of more than
90% of the adrenal gland
B. Thyroid hormone
overproduction
C. Glucocorticoid excess
D. Insufficient antidiuretic
hormone
Correct answers:
1. B, C, E
2. D
3. C
Which of the following patients
is MOST at risk for developing
Addisonian Crisis?
 A patient who is post-
opt day 2 from thyroid
surgery.
 A patient who is post-
opt day 2 from an
adrenalectomy.
 A patient with Addison’s
Disease who reports
taking Prednisone
regularly.
 A patient who is having
gastrointestinal surgery.
Patients who have had removal
of the adrenal glands
(adrenalectomy) are MOST at
risk for low levels of cortisol
(since the gland that produces
the hormone has been
removed). A patient with
Addison’s Disease is at risk if
they have NOT being taking
Prednisone regularly.
Which of the following below is
NOT a sign or symptom of
Addisonian Crisis?
 Low blood pressure
 Severe pain in the
stomach, legs, and lower
back
 Hypokalemia
 Hyponatremia
Remember the 5’S & 3’H: Super
low blood pressure (nothing will
bring it up), Sudden pain in
stomach, back, and legs,
Syncope (going unconscious) ,
Shock, Severe vomiting,
diarrhea and headache &
Hyponatremia, Hyperkalemia,
Hypoglycemia
A patient was recently
discharged home after being
treated for Addison’s Disease.
The patient states they were
unable to get their prescription
for Prednisone filled after they
were discharged from the
hospital. The patient complains
of pain in their abdomen, legs,
and lowers back and is very
weak. On assessment, you note
the patient’s blood pressure is
70/32, blood glucose 63,
sodium 118, and potassium
level 6.0. Which medication do
you anticipate will be ordered
by the doctor for this patient?
 IV Solu-Cortef
 PO Hydrocortisone
 IV Morphine
 PO Prednisone
The ______ ______secretes
ACTH which causes the ______
______ to produce cortisol.
 Hypothalamus, adrenal
medulla
 Thalamus, pituitary
gland
 Pituitary gland, adrenal
cortex
  Adrenal cortex, pituitary
gland
A patient is being discharged
after recovering from
Addisonian Crisis. Which of the
following statements by the
patient causes you to re-
educate the patient about this
condition?
 “I will monitor my stress
levels closely.”
 “I can stop taking my
medication once I feel
better.”
 “I am going to wear a
Medic-Alert bracelet.”
 “I will make sure I
perform hand hygiene
regularly and avoid sick
people.”
Which of the following
abnormal electrolyte
imbalances is EXPECTED with
Addisonian Crisis?
 Potassium level of 3.2
 Sodium level of 112
 Blood glucose level of
120
 Phosphate level of 1.2
SIADH ----
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?
 SIADH
 Diabetes Insipidus
 Addison's Disease
 Fluid Volume Deficient
In the scenario above, which
drug do you anticipate the
patient will be started on per
doctor’s order?
 Desmopressin (DDAVP)
IV
 Declomycin
 Diabinese
 Stimate
Which of the following signs
and symptoms is NOT expected
with Diabetes Insipidus?
 Polyuria
 Polydipsia
 Polyphagia
 Extreme thirst
You are developing a care plan
for a patient with SIADH. Which
of the following would be a
potential nursing diagnosis for
this patient?
 Fluid volume
overload
 Fluid volume deficient
 Acute pain
 Impaired skin integrity
A patient with a mild case of
diabetes insipidus is started on
Diabinese. What would you
include in your patient teaching
with this patient?
 Signs and symptoms of
hypoglycemia
 Restricting foods
containing caffeine
 Taking the medication
on an empty stomach
 Drinking 16 oz of water
when taking the
medication
Which patient is most at risk
for developing Syndrome of
Inappropriate Anti-diuretic
Hormone (SIADH)?
 A patient diagnosed
with small cell lung
cancer.
 A patient whose kidney
tubules are failing to
reabsorb water.
 A patient with a tumor
on the anterior pituitary
gland.
 A patient taking
Declomycin.
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?
 Assessment finding of
crackles throughout the
lung fields.
 Patient reports urinating
more frequently.
 Potassium level of 5.0.
 Sodium level of 136.
Answer is "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 anti-diuretic hormone is
__________ in Diabetes
Insipidus and _________ in
SIADH.
 high, low
 absent, absent
 low, high
 low, low
Where is the anti-diuretic
hormone PRODUCED in the
body?
 Anterior pituitary gland
 Posterior pituitary gland
 Hypothalamus
 Medulla
Where is the anti-diuretic
hormone SECRETED in the
body?
 Hypothalamus
 Thyroid
 Posterior Pituitary gland
 Anterior pituitary gland
1) Nurse Perry is caring for a
female client with type 1
diabetes mellitus who exhibits
confusion, light-headedness,
and aberrant behavior. The
client is still conscious. The
nurse should first administer:
A. I.M. or subcutaneous
glucagon.
B. I.V. bolus of dextrose 50%.
C. 15 to 20 g of a fast-acting
carbohydrate such as
orange juice.
D. 10 U of fast-acting insulin.
2) A client with diabetes
mellitus has a prescription for
Glucotrol XL (glipizide). The
client should be instructed to
take the medication:
A. At bedtime
B. With breakfast
C. Before lunch
D. After dinner
3) The glycosylated hemoglobin
of a 40-year-old client with
diabetes mellitus is 2.5%. The
nurse understands that:
A. The client can have a
higher-calorie diet.
B. The client has good
control of her diabetes.
C. The client requires
adjustment in her insulin
dose.
D. The client has poor control
of her diabetes.
4) A patient with severe
hypoglycemia arrives at the ED
unconscious by ambulance. The
nurse would first…
A. Give regular insulin by IV
B. Give NPH by IV
C. Give 10-15 g CHO or
Orange juice
D. Give 1 mg glucagon
5) A male client with type 1
diabetes mellitus asks the nurse
about taking an oral antidiabetic
agent. Nurse Jack explains that
these medications are only
effective if the client:
A. prefers to take insulin
orally.
B. has type 2 diabetes.
C. has type 1 diabetes.
D. is pregnant and has type 2
diabetes.
6) Which of the following
conditions is not linked to
diabetic ketoacidosis?
A. Cerebral edema
B. Arrhythmias
C. Peptic ulcers
D. Mucormycosis
7) Which of the following
clinical characteristics is
associated with Type 1 diabetes
(previously referred to as
insulin-dependent diabetes
mellitus [IDDM])?
A. Presence of islet cell
antibodies
B. Obesity
C. Rare ketosis
D. Requirement for oral
hypoglycemic agents
8) What are the micro vascular
complications of uncontrolled
diabetes?
A. Delayed gastric emptying
B. Diarrhea
C. Glomuerular injury
D. Bleeding of retinal
caplillaries
E. Numbness of feet
F. Impotence
9) What is the number one
complication of diabetes?
A. Diabetic ketoacidosis
B. Obesity
C. Hypertension
D. Cardiovascular disease
10) Nurse Noemi administers
glucagon to her diabetic client,
then monitors the client for
adverse drug reactions and
interactions. Which type of drug
interacts adversely with
glucagon?
A. Oral anticoagulants
B. Anabolic steroids
C. Beta-adrenergic blockers
D. Thiazide diuretics
11) The newly diagnosed
diabetic patient asks the nurse
why he needs to check his feet
every day. The nurse’s best
response is….
A. To prevent leg
amputation.
B. To check for any cuts,
sores, or dry cracked skin
so they can be treated
early to prevent infection
or gangrene.
C. To see if they hurt.
D. You just need to do it.
12) What type of cells secrete
glucagon?
A. Beta cells
B. Alpha cells
C. Plasma cells
D. Acinar cells
13) Nurse John is assigned to
care for a postoperative male
client who has diabetes
mellitus. During the assessment
interview, the client reports that
he’s impotent and says he’s
concerned about its effect on
his marriage. In planning this
client’s care, the most
appropriate intervention would
be to:
A. Encourage the client to
ask questions about
personal sexuality.
B. Provide time for privacy.
C. Provide support for the
spouse or significant
other.
D. Suggest referral to a sex
counselor or other
appropriate professional.
14) Which are potential
complications of diabetes?
(Choose all that applies)
A. Amputations (BKA)
B. Cardiovascular disease
C. Edema
D. Peripheral neuropathy
E. Hyperthyroidism
F. Retinopathy
G. Cardio neuropathy
H. Coma
I. Nephropathy
J. Arteriosclerosis
K. Hypertension
L. Obesity
M. Infections
15) Which of the following is not
an effect of diabetes?
A. Small vessel occlusion
B. Necrosis of extremities
C. Ketone Body production
D. Decreased fat metabolism
16) Which of the following is not
an indicator of diabetic
ketoacidosis?
A. Hyperthermia
B. Nausea/Vomiting
C. Slow and shallow
breathing
D. Psychosis leading to
dementia
17) Dr. Kennedy prescribes
glipizide (Glucotrol), an oral
antidiabetic agent, for a male
client with type 2 diabetes
mellitus who has been having
trouble controlling the blood
glucose level through diet and
exercise. Which medication
instruction should the nurse
provide?
A. “Be sure to take glipizide
30 minutes before meals.”
B. “Glipizide may cause a low
serum sodium level, so
make sure you have your
sodium level checked
monthly.”
C. “You won’t need to check
your blood glucose level
after you start taking
glipizide.”
D. “Take glipizide after a
meal to prevent
heartburn.”
18) What type of cells secrete
insulin?
A. Beta cells
B. Alpha cells
C. Plasma cells
D. Acinar cells
19) A 65-year-old female who
has diabetes mellitus and has
sustained a large laceration on
her left wrist asks the nurse,
“How long will it take for my
scars to disappear?” which
statement would be the nurse’s
best response?
A. “The contraction phase of
wound healing can take 2
to 3 years.”
B. “Wound healing is very
individual but within 4
 months the scar should
fade.”
C. “With your history and the
type of location of the
injury, it’s hard to say.”
D. “If you don’t develop an
infection, the wound
should heal any time
between 1 and 3 years
from now.”
20) The nurse enters a patient’s
room and sees the patient
breathing rapidly with a fruity
breath smell. This is known as…
A. Trousseau’s
B. Cullen’s
C. Kussmaul’s
D. Bitot’s
21) The nurse is performing
wound care on a foot ulcer in a
client with type 1 diabetes
mellitus. Which technique
demonstrates surgical asepsis?
A. Putting on sterile gloves
then opening a container
of sterile saline.
B. Cleaning the wound with a
circular motion, moving
from outer circles toward
the center.
C. Changing the sterile field
after sterile water is
spilled on it.
D. Placing a sterile dressing
½” (1.3 cm) from the edge
of the sterile field.
22) A male client with type 1
diabetes mellitus has a highly
elevated glycosylated
hemoglobin (Hb) test result. In
discussing the result with the
client, nurse Sharmaine would
be most accurate in stating:
A. “The test needs to be
repeated following a 12-
hour fast.”
B. “It looks like you aren’t
following the prescribed
diabetic diet.”
C. “It tells us about your
sugar control for the last 3
months.”
D. “Your insulin regimen
needs to be altered
significantly.”
23) A male client has just been
diagnosed with type 1 diabetes
mellitus. When teaching the
client and family how diet and
exercise affect insulin
requirements, Nurse Joy should
include which guideline?
A. “You’ll need more insulin
when you exercise or
increase your food
intake.”
B. “You’ll need less insulin
when you exercise or
reduce your food intake.”
C. “You’ll need less insulin
when you increase your
food intake.”
D. “You’ll need more insulin
when you exercise or
decrease your food
intake.”
24) An agitated, confused
female client arrives in the
emergency department. Her
history includes type 1 diabetes
mellitus, hypertension, and
angina pectoris. Assessment
reveals pallor, diaphoresis,
headache, and intense hunger.
A stat blood glucose sample
measures 42 mg/dl, and the
client is treated for an acute
hypoglycemic reaction. After
recovery, nurse Lily teaches the
client to treat hypoglycemia by
ingesting:
A. 2 to 5 g of a simple
carbohydrate.
B. 10 to 15 g of a simple
carbohydrate.
C. 18 to 20 g of a simple
carbohydrate.
D. 25 to 30 g of a simple
carbohydrate.
25) Acarbose (Precose), an
alpha-glucosidase inhibitor, is
prescribed for a female client
with type 2 diabetes mellitus.
During discharge planning,
nurse Pauleen would be aware
of the client’s need for
additional teaching when the
client states:
A. “If I have hypoglycemia, I
should eat some sugar,
not dextrose.”
B. “The drug makes my
pancreas release more
insulin.”
C. “I should never take
insulin while I’m taking
this drug.”
D. “It’s best if I take the drug
with the first bite of a
meal.”
26) Which of the following is not
true about Type I DM?
A. May be linked to
autoimmunity
B. Onset usually prior to age
20
C. Beta islet cells destroyed
D. Does not require insulin
injections
27) Which of the following is
caused by insulin release?
A. Increased breakdown of
fats
B. Increase breakdown of
proteins
C. Decreased blood sugar
D. Causes glucose to be
phosphorylated in kidney
28) The physician has prescribed
NPH insulin for a client with
diabetes mellitus. Which
statement indicates that the
client knows when the peak
action of the insulin occurs?
A. “I will make sure I eat
breakfast within 2 hours of
taking my insulin.”
 B. “I will need to carry candy
or some form of sugar
with me all the time.”
C. “I will eat a snack around
three o’clock each
afternoon.”
D. “I can save my dessert
from supper for a bedtime
snack.”
29) Which of the following is not
an accurate test for diabetes?
A. Glucose tolerance test
B. HbA
C. Fasting glucagon test
30) A home health nurse is at
the home of a client with
diabetes and arthritis. The client
has difficulty drawing up insulin.
It would be most appropriate
for the nurse to refer the client
to
A. A social worker from the
local hospital
B. An occupational therapist
from the community
center
C. A physical therapist from
the rehabilitation agency
D. Another client with
diabetes mellitus and
takes insulin
31) Which of the following is not
true about Type II DM?
A. Considered adult onset
diabetes
B. Cause unknown may be
due to genetics
C. Require insulin 80% of
cases
D. May take a drug that
sensitize cells or increase
insulin release
32) Which of the following is not
an indicator of a hypoglycemic
condition?
A. Fatigue
B. Poor appetite
C. Tachycardia
D. Confusion
33) Glucagon increases blood
levels of glucose by causing liver
to breakdown glycogen.
A. TRUE
B. FALSE
34) A patient with a history of
diabetes mellitus is in the
second post-operative day
following cholecystectomy. She
has complained of nausea and
isn’t able to eat solid foods. The
nurse enters the room to find
the patient confused and shaky.
Which of the following is the
most likely explanation for the
patient’s symptoms?
A. Anesthesia reaction.
B. Hyperglycemia.
C. Hypoglycemia.
D. Diabetic ketoacidosis.
35) A urine test in an
undiagnosed diabetic may
show……..
A. glucose and ketones in the
urine
B. glucose and high amounts
of bilirubin in the urine
C. ketones in the urine
D. ketones and adrenaline in
the urine
36) A client has a medical
history of rheumatic fever, type
1 (insulin dependent) diabetes
mellitus, hypertension,
pernicious anemia, and
appendectomy. She’s admitted
to the hospital and undergoes
mitral valve replacement
surgery. After discharge, the
client is scheduled for a tooth
extraction. Which history
finding is a major risk factor for
infective endocarditis?
A. appendectomy
B. pernicious anemia
C. diabetes mellitus
D. valve replacement
37) Of the following types of
insulin, which is the most rapid
acting?
A. Humalog
B. Regular
C. NPH
D. Ultralente
38) The nurse’s first action upon
finding a patient with mild
hypoglycemia is to…
A. Call the rapid response
team
B. Give 1 mg of glucagon
C. Give 10-15 g of CHO or
Orange juice
D. Give insulin
39) After taking glipizide
(Glucotrol) for 9 months, a male
client experiences secondary
failure. Which of the following
would the nurse expect the
physician to do?
A. Initiate insulin therapy.
B. Switch the client to a
different oral antidiabetic
agent.
C. Prescribe an additional
oral antidiabetic agent.
D. Restrict carbohydrate
intake to less than 30% of
the total caloric intake.
40) When caring for a female
client with a history of
hypoglycemia, nurse Ruby
should avoid administering a
drug that may potentiate
hypoglycemia. Which drug fits
this description?
A. sulfisoxazole (Gantrisin)
B. mexiletine (Mexitil)
C. prednisone (Orasone)
D. lithium carbonate
(Lithobid)
41) A male client with diabetes
mellitus is receiving insulin.
Which statement correctly
describes an insulin unit?
 A. It’s a common
measurement in the
metric system.
B. It’s the basis for solids in
the avoirdupois system.
C. It’s the smallest
measurement in the
apothecary system.
D. It’s a measure of effect,
not a standard measure of
weight or quantity.
42) The physician has prescribed
Novalog insulin for a client with
diabetes mellitus. Which
statement indicates that the
client knows when the peak
action of the insulin occurs?
A. “I will make sure I eat
breakfast within 10
minutes of taking my
insulin.”
B. “I will need to carry candy
or some form of sugar
with me all the time.”
C. “I will eat a snack around
three o’clock each
afternoon.”
D. “I can save my dessert
from supper for a bedtime
snack.”
43) Which of the following
would not be considered an
acute effect of diabetes
mellitus?
A. Polyuria
B. Weight gain
C. Polydipsia
D. Polyphagia
44) Which instruction about
insulin administration should
nurse Kate give to a client?
A. “Always follow the same
order when drawing the
different insulins into the
syringe.”
B. “Shake the vials before
withdrawing the insulin.”
C. “Store unopened vials of
insulin in the freezer at
temperatures well below
freezing.”
D. “Discard the intermediate-
acting insulin if it appears
cloudy.”
45) Which of the following
drugs may be given as an
immunosuppressant soon after
onset of Type I Diabetes?
A. Torsemide
B. Cyclosporine
C. Clofibrate
D. Ceftriaxone
46) As blood glucose decreases
glucagon is inhibited.
A. TRUE
B. FALSE
47) Of the following categories
of oral antidiabetic agents,
which exert their primary action
by directly stimulating the
pancreas to secrete insulin?
A. Sulfonylureas
B. Thiazolidinediones
C. Biguanides
D. Alpha glucosidase
inhibitors
48) The nurse enters a diabetic
patient’s room at 11:30 and
notices that the patient is
diaphoretic, tachycardic,
anxious, states she is hungry,
and doesn’t remember where
she is. This patient is most likely
showing signs of what?
A. hyperglycemic
B. hypoglycemic
C. diabetic ketoacidosis
D. hyperosmolar
hyperglycemic noketotic
coma
49) A client with type 1 diabetes
mellitus who’s a multigravida
visits the clinic at 27 weeks
gestation. The nurse should
instruct the client that for most
pregnant women with type 1
diabetes mellitus:
A. Weekly fetal movement
counts are made by the
mother.
B. Contraction stress testing
is performed weekly.
C. Induction of labor is begun
at 34 weeks’ gestation.
D. Nonstress testing is
performed weekly until 32
weeks’ gestation
50) The diabetic patient’s lab
work comes back with a pH of
7.4, serum blood sugar of 950,
serum osmolarity of 460, pCO2
of 35, HCO3 of 25. The patient is
confused and dehydrated. This
patient is showing signs and
symptoms of….
A. Diabetic ketoacidosis
B. hyperosmolar
hyperglycemic noketotic
coma
C. Hypoglycemia
D. diabetic neuropathy
51) The nurse teaches the
patient about glargine (Lantus),
a “peakless” basal insulin
including which of the following
statements?
A. Do not mix the drug with
other insulins
B. Administer the total daily
dosage in two doses.
C. Draw up the drug first,
then add regular insulin.
D. The drug is rapidly
absorbed and has a fast
onset of action
52) Which of the following is not
related to a chronic diabetes
mellitus condition?
A. Atherosclerosis
B. Neuropathy
C. Glaucoma
D. Hypotension
53) During a class on exercise
for diabetic clients, a female
client asks the nurse educator
how often to exercise. The
nurse educator advises the
clients to exercise how often to
meet the goals of planned
exercise?
A. At least once a week
B. At least three times a
week
C. At least five times a week
D. Every day
54) For a diabetic male client
with a foot ulcer, the physician
orders bed rest, a wet-to-dry
dressing change every shift, and
blood glucose monitoring
before meals and bedtime. Why
are wet-to-dry dressings used
for this client?
A. They contain exudate and
provide a moist wound
environment.
B. They protect the wound
from mechanical trauma
and promote healing.
C. They debride the wound
and promote healing by
secondary intention.
D. They prevent the entrance
of microorganisms and
minimize wound
discomfort.
55) A client with type 1 diabetes
mellitus has been on a regimen
of multiple daily injection
therapy. He’s being converted
to continuous subcutaneous
insulin therapy. While teaching
the client bout continuous
subcutaneous insulin therapy,
the nurse would be accurate in
telling him the regimen includes
the use of:
A. intermediate and long-
acting insulins
B. short and long-acting
insulins
C. short-acting only
D. short and intermediate-
acting insulins
56) Patients with Type 1
diabetes mellitus may require
which of the following changes
to their daily routine during
periods of infection?
A. No changes.
B. Less insulin.
C. More insulin.
D. Oral diabetic agents.
57) At a senior citizens meeting
a nurse talks with a client who
has diabetes mellitus Type 1.
Which statement by the client
during the conversation is most
predictive of a potential for
impaired skin integrity?
A. “I give my insulin to myself
in my thighs.”
B. “Sometimes when I put
my shoes on I don’t know
where my toes are.”
C. “Here are my up and
down glucose readings
that I wrote on my
calendar.”
D. “If I bathe more than once
a week my skin feels too
dry.”
58) Which of the following is not
considered an endocrine
hormone?
A. Renin
B. Insulin
C. Glucagon
D. Somatostatin
59) A patient arrives at the ED
with a blood sugar of 578,
serum osmolarity of 300, pH of
7.3, severe thirst, dehydration,
and confusion. The patient is
breathing rapidly and has a
fruity breath smell. This patient
has symptoms of……
A. Diabetic ketoacidosis
B. hyperosmolar
hyperglycemic noketotic
coma
C. Hypoglycemia
D. diabetic neuropathy
60) A 27-year-old woman has
Type I diabetes mellitus. She
and her husband want to have a
child so they consulted her
diabetologist, who gave her
information on pregnancy and
diabetes. Of primary
importance for the diabetic
woman who is considering
pregnancy should be
A. a review of the dietary
modifications that will be
necessary.
B. early prenatal medical
care.
C. adoption instead of
conception.
D. understanding that this is
a major health risk to the
mother.
61) Clients with diabetes
mellitus require frequent vision
assessment. The nurse should
instruct the client about which
of the following eye problems
most likely to be associated
with diabetes mellitus?
A. Cataracts
B. Retinopathy
C. Astigmatism
D. Glaucoma
62) Which of the following is not
an adverse effect of glucagon?
A. Allergic reaction
B. Vomiting
C. Nausea
D. Fever
63) Which of the following is not
an adverse effect of oral
hypoglycemics?
A. Hypoglycemia
B. Headache
C. Rashes
D. Projectile vomiting
64) A 25-year-old woman is in
her fifth month of pregnancy.
She has been taking 20 units of
NPH insulin for diabetes
mellitus daily for six years. Her
diabetes has been well
controlled with this dosage. She
has been coming for routine
prenatal visits, during which
diabetic teaching has been
implemented. Which of the
following statements indicates
that the woman understands
the teaching regarding her
insulin needs during her
pregnancy?
A. “Are you sure all this
insulin won’t hurt my
baby?”
B. “I’ll probably need my
daily insulin dose raised.”
C. “I will continue to take my
regular dose of insulin.”
D. “These finger sticks make
my hand sore. Can I do
them less frequently?”
65) A nurse assigned to care for
a postoperative male client who
has diabetes mellitus. During
the assessment interview, the
client reports that he’s impotent
and says that he’s concerned
about its effect on his marriage.
In planning this client’s care, the
most appropriate intervention
would be to:
A. Encourage the client to
ask questions about
personal sexuality
B. Provide time for privacy
C. Provide support for the
spouse or significant other
D. Suggest referral to a sex
counselor or other
appropriate professional
66) Patricia a 20 year old college
student with diabetes mellitus
requests additional information
about the advantages of using a
pen like insulin deliverydevices.
The nurse explains that the
advantages of these devices
over syringes includes:
A. Accurate dose delivery
B. Shorter injection time
C. Lower cost with reusable
insulin cartridges
D. Use of smaller gauge
needle.
67) Which of the following
clinical characteristics is
associated with Type 2 diabetes
(previously referred to as non-
insulin-dependent diabetes
mellitus [NIDDM])?
A. Can control blood glucose
through diet and exercise
B. Usually thin at diagnosis
C. Ketosis-prone
D. Demonstrate islet cell
antibodies
68) The nurse teaches the
patient about diabetes including
which of the following
statements?
A. Elevated blood glucose
levels contribute to
complications of diabetes,
such as diminished vision.
B. Sugar is found only in
dessert foods.
C. The only diet change
needed in the treatment
of diabetes is to stop
eating sugar.
D. Once insulin injections are
started in the treatment of
Type 2 diabetes, they can
never be discontinued.
69) Glucagon causes increased
blood sugar and causes slow
breakdown of glycogen in the
liver.
A. TRUE
B. FALSE
70) Insulin inhibits the release
of _______.
A. Glucagon
B. ADH
C. Beta cells
D. Somatostatin
Answers and Rationales
1. C. 15 to 20 g of a fast-
acting carbohydrate such
as orange juice. This client
is having a hypoglycemic
episode. Because the
client is conscious, the
nurse should first
administer a fast-acting
carbohydrate, such as
orange juice, hard candy,
or honey. If the client has
lost consciousness, the
nurse should administer
either I.M. or
subcutaneous glucagon or
an I.V. bolus of dextrose
50%. The nurse shouldn’t
administer insulin to a
client who’s hypoglycemic;
this action will further
compromise the client’s
condition.
2. B. With
breakfast. Glucotrol XL is
given once a day with
breakfast. Answer A is
incorrect because the
client would develop
hypoglycemia while
sleeping. Answers C and D
are incorrect because the
client would develop
hypoglycemia later in the
day or evening.
3. B. The client has good
control of her
diabetes. The client’s
diabetes is well under
control. Answer A is
incorrect because it will
lead to elevated
glycosylated hemoglobin.
Answer C is incorrect
because the diet and
insulin dose are
appropriate for the client.
Answer D is incorrect
because the desired range
for glycosylated
 hemoglobin in the adult
client is 2.5%–5.9%
4. D. Give 1 mg glucagon
5. B. has type 2
diabetes. Oral antidiabetic
agents are only effective in
adult clients with type 2
diabetes. Oral antidiabetic
agents aren’t effective in
type 1 diabetes. Pregnant
and lactating women
aren’t prescribed oral
antidiabetic agents
because the effect on the
fetus is uncertain.
6. C. Peptic ulcers
7. A. Presence of islet cell
antibodies . Individuals
with Type 1 diabetes often
have islet cell antibodies.
Individuals with Type 1
diabetes are usually thin
or demonstrate recent
weight loss at the time of
diagnosis. Individuals with
Type 1 diabetes are
ketosis-prone when insulin
is absent. Individuals with
Type 1 diabetes need
insulin to preserve life.
8. A. Delayed gastric
emptying, C. Glomuerular
injury D. Bleeding of
retinal caplillaries , F.
Impotence
9. D. Cardiovascular disease
10. A. Oral anticoagulants . As
a normal body protein,
glucagon only interacts
adversely with oral
anticoagulants, increasing
the anticoagulant effects.
It doesn’t interact
adversely with anabolic
steroids, beta-adrenergic
blockers, or thiazide
diuretics.
11. B. To check for any cuts,
sores, or dry cracked skin
so they can be treated
early to prevent infection
or gangrene.
12. B. Alpha cells
13. D. Suggest referral to a sex
counselor or other
appropriate
professional. The nurse
should refer this client to a
sex counselor or other
professional. Making
appropriate referrals is a
valid part of planning the
client’s care. The nurse
doesn’t normally provide
sex counseling.
14. A. Amputations (BKA) , B.
Cardiovascular disease , D.
Peripheral neuropathy, F.
Retinopathy , G. Cardio
neuropathy , H. Coma, I.
Nephropathy, J.
Arteriosclerosis , M.
Infections
15. D. Decreased fat
metabolism
16. C. Slow and shallow
breathing
17. A. “Be sure to take
glipizide 30 minutes
before meals.”The client
should take glipizide twice
a day, 30 minutes before a
meal, because food
decreases its absorption.
The drug doesn’t cause
hyponatremia and
therefore doesn’t
necessitate monthly
serum sodium
measurement. The client
must continue to monitor
the blood glucose level
during glipizide therapy.
18. A. Beta cells
19. C. “With your history and
the type of location of the
injury, it’s hard to
say.”. Wound healing in a
client with diabetes will be
delayed. Providing the
client with a time frame
could give the client false
information.
20. C. Kussmaul’s
21. C. Changing the sterile
field after sterile water is
spilled on it. A sterile field
is considered
contaminated when it
becomes wet. Moisture
can act as a wick, allowing
microorganisms to
contaminate the field. The
outside of containers, such
as sterile saline bottles,
aren’t sterile. The
containers should be
opened before sterile
gloves are put on and the
solution poured over the
sterile dressings placed in
a sterile basin. Wounds
should be cleaned from
the most contaminated
area to the least
contaminated area—for
example, from the center
outward. The outer inch of
a sterile field shouldn’t be
considered sterile.
22. C. “It tells us about your
sugar control for the last 3
months.” The glycosylated
Hb test provides an
objective measure of
glycemic control over a 3-
month period. The test
helps identify trends or
practices that impair
glycemic control, and it
doesn’t require a fasting
period before blood is
drawn. The nurse can’t
conclude that the result
occurs from poor dietary
management or
inadequate insulin
coverage.
23. B. “You’ll need less insulin
when you exercise or
reduce your food
intake.” Exercise, reduced
food intake,
hypothyroidism, and
certain medications
decrease the insulin
requirements. Growth,
 pregnancy, greater food
intake, stress, surgery,
infection, illness, increased
insulin antibodies, and
certain medications
increase the insulin
requirements.
24. B. 10 to 15 g of a simple
carbohydrate. To reverse
hypoglycemia, the
American Diabetes
Association recommends
ingesting 10 to 15 g of a
simple carbohydrate, such
as three to five pieces of
hard candy, two to three
packets of sugar (4 to 6
tsp), or 4 oz of fruit juice.
If necessary, this
treatment can be
repeated in 15 minutes.
Ingesting only 2 to 5 g of a
simple carbohydrate may
not raise the blood
glucose level sufficiently.
Ingesting more than 15 g
may raise it above normal,
causing hyperglycemia.
25. A. “If I have hypoglycemia,
I should eat some sugar,
not dextrose.”Acarbose
delays glucose absorption,
so the client should take
an oral form of dextrose
rather than a product
containing table sugar
when treating
hypoglycemia. The alpha-
glucosidase inhibitors
work by delaying the
carbohydrate digestion
and glucose absorption.
It’s safe to be on a
regimen that includes
insulin and an alpha-
glucosidase inhibitor. The
client should take the drug
at the start of a meal, not
30 minutes to an hour
before.
26. D. Does not require insulin
injections
27. C. Decreased blood sugar
28. C. “I will eat a snack
around three o’clock each
afternoon.” NPH insulin
peaks in 8–12 hours, so a
snack should be offered at
that time. NPH insulin
onsets in 90–120 minutes,
so answer A is incorrect.
Answer B is untrue
because NPH insulin is
time released and does
not usually cause sudden
hypoglycemia.
29. C. Fasting glucagon test
30. B. An occupational
therapist from the
community center. An
occupational therapist can
assist a client to improve
the fine motor skills
needed to prepare an
insulin injection.
31. C. Require insulin 80% of
cases
32. B. Poor appetite
33. A. TRUE
34. C. Hypoglycemia. A post-
operative diabetic patient
who is unable to eat is
likely to be suffering from
hypoglycemia. Confusion
and shakiness are
common symptoms. An
anesthesia reaction would
not occur on the second
post-operative day.
Hyperglycemia and
ketoacidosis do not cause
confusion and shakiness.
35. A. glucose and ketones in
the urine
36. D. valve replacement. A
heart valve prosthesis,
such as a mitral valve
replacement, is a major
risk factor for infective
endocarditis. Other risk
factors include a history of
heart disease (especially
mitral valve prolapse),
chronic debilitating
disease, IV drug abuse,
and immunosuppression.
Although diabetes mellitus
may predispose a person
to cardiovascular disease,
it isn’t a major risk factor
for infective endocarditis,
nor is an appendectomy or
pernicious anemia.
37. A. Humalog . The onset of
action of rapid-acting
Humalog is within 10-15
minutes. The onset of
action of short-acting
regular insulin is 30
minutes-1 hour. The onset
of action of intermediate
acting NPH is 3-4 hours.
The onset of action of
long-acting Ultralente is 6-
8 hours.
38. C. Give 10-15 g of CHO or
Orange juice
39. B. Switch the client to a
different oral antidiabetic
agent. Many clients (25%
to 60%) with secondary
failure respond to a
different oral antidiabetic
agent. Therefore, it
wouldn’t be appropriate
to initiate insulin therapy
at this time. However, if a
new oral antidiabetic
agent is unsuccessful in
keeping glucose levels at
an acceptable level, insulin
may be used in addition to
the antidiabetic agent.
40. A. sulfisoxazole
(Gantrisin). Sulfisoxazole
and other sulfonamides
are chemically related to
oral antidiabetic agents
and may precipitate
hypoglycemia. Mexiletine,
an antiarrhythmic, is used
to treat refractory
ventricular arrhythmias; it
doesn’t cause
hypoglycemia. Prednisone,
a corticosteroid, is
associated with
hyperglycemia. Lithium
may cause transient
 hyperglycemia, not
hypoglycemia.
41. D. It’s a measure of effect,
not a standard measure of
weight or quantity. An
insulin unit is a measure of
effect, not a standard
measure of weight or
quantity. Different drugs
measured in units may
have no relationship to
one another in quality or
quantity.
42. A. “I will make sure I eat
breakfast within 10
minutes of taking my
insulin.” Novalog insulin
onsets very quickly, so
food should be available
within 10–15 minutes of
taking the insulin. Answer
B does not address a
particular type of insulin,
so it is incorrect. NPH
insulin peaks in 8–12
hours, so a snack should
be eaten at the expected
peak time. It may not be 3
p.m. as stated in answer C.
Answer D is incorrect
because there is no need
to save the dessert until
bedtime.
43. B. Weight gain
44. A. “Always follow the
same order when drawing
the different insulins into
the syringe.” The client
should be instructed
always to follow the same
order when drawing the
different insulins into the
syringe. Insulin should
never be shaken because
the resulting froth
prevents withdrawal of an
accurate dose and may
damage the insulin protein
molecules. Insulin also
should never be frozen
because the insulin
protein molecules may be
damaged. Intermediate-
acting insulin is normally
cloudy.
45. B. Cyclosporine
46. B. FALSE
47. A. Sulfonylureas . A
functioning pancreas is
necessary for
sulfonylureas to be
effective.
48. B. hypoglycemic
49. D. Nonstress testing is
performed weekly until 32
weeks’ gestation. For most
clients with type 1
diabetes mellitus,
nonstress testing is done
weekly until 32 weeks’
gestation and twice a
week to assess fetal well-
being.
50. B. hyperosmolar
hyperglycemic noketotic
coma
51. A. Do not mix the drug
with other insulins
. Because glargine is in a
suspension with a pH of 4,
it cannot be mixed with
other insulins because this
would cause precipitation.
When administering
glargine (Lantus) insulin it
is very important to read
the label carefully and to
avoid mistaking Lantus
insulin for Lente insulin
and vice versa.
52. D. Hypotension
53. B. At least three times a
week . Diabetic clients
must exercise at least
three times a week to
meet the goals of planned
exercise — lowering the
blood glucose level,
reducing or maintaining
the proper weight,
increasing the serum high-
density lipoprotein level,
decreasing serum
triglyceride levels,
reducing blood pressure,
and minimizing stress.
Exercising once a week
wouldn’t achieve these
goals. Exercising more
than three times a week,
although beneficial, would
exceed the minimum
requirement.
54. C. They debride the
wound and promote
healing by secondary
intention. For this client,
wet-to-dry dressings are
most appropriate because
they clean the foot ulcer
by debriding exudate and
necrotic tissue, thus
promoting healing by
secondary intention.
Moist, transparent
dressings contain exudate
and provide a moist
wound environment.
Hydrocolloid dressings
prevent the entrance of
microorganisms and
minimize wound
discomfort. Dry sterile
dressings protect the
wound from mechanical
trauma and promote
healing.
55. C. short-acting
only. Continuous
subcutaneous insulin
regimen uses a basal rate
and boluses of short-
acting insulin. Multiple
daily injection therapy
uses a combination of
short-acting and
intermediate or long-
acting insulins.
56. C. More insulin. During
periods of infection or
illness, patients with Type
1 diabetes may need even
more insulin to
compensate for increased
blood glucose levels.
57. B. “Sometimes when I put
my shoes on I don’t know
where my toes
are.” Peripheral
 neuropathy can lead to
lack of sensation in the
lower extremities. Clients
do not feel pressure
and/or pain and are at
high risk for skin
impairment.
58. A. Renin
59. A. Diabetic ketoacidosis
60. B. early prenatal medical
care. A review of dietary
modifications is important
once the woman is
pregnant. However, it is
not of primary importance
when considering
pregnancy. Pregnancy
makes metabolic control
of diabetes more difficult.
It is essential that the
client start prenatal care
early so that potential
complications can be
controlled or minimized by
the efforts of the client
and health care team. The
alternative of adoption is
not necessary just because
the client is a diabetic.
Many diabetic women
have pregnancies with
successful outcomes if
they receive good care.
While there is some risk to
the pregnant diabetic
woman, it is not
considered a major health
risk. The greater risk is to
the fetus.
61. B. Retinopathy
62. D. Fever
63. D. Projectile vomiting
64. B. “I’ll probably need my
daily insulin dose
raised.” The client starts to
need increased insulin in
the second trimester. This
statement indicates a lack
of understanding. As a
result of placental
maturation and placental
production of lactogen,
insulin requirements begin
increasing in the second rarely demonstrate
trimester and may double ketosis, except in stress or
or quadruple by the end of infection. Individuals with
pregnancy. The client Type 2 diabetes do not
starts to need increased demonstrate islet cell
insulin in the second antibodies.
trimester. This statement 68. A. Elevated blood glucose
indicates a lack of levels contribute to
understanding. Insulin complications of diabetes,
doses depend on blood such as diminished
glucose levels. Finger vision. When blood
sticks for glucose levels glucose levels are well
must be continued. controlled, the potential
65. D. Suggest referral to a sex for complications of
counselor or other diabetes is reduced.
appropriate 69. B. FALSE
professional. The nurse 70. A. Glucagon
should refer this client to a
sex counselor or other
professional. Making
appropriate referrals is a
valid part of planning the
client’s care. The nurse
doesn’t normally provide
sex counseling. Therefore,
providing time for privacy
and providing support for
the spouse or significant
other are important, but
not as important as
referring the client to a
sex counselor.
66. A. Accurate dose
delivery. These devices are
more accurate because
they are easily to used and
have improved adherence
in insulin regimens by
young people because the
medication can be
administered discreetly.
67. A. Can control blood
glucose through diet and
exercise . Oral
hypoglycemic agents may
improve blood glucose
levels if dietary
modification and exercise
are unsuccessful.
Individuals with Type 2
diabetes are usually obese
at diagnosis. Individuals
with Type 2 diabetes