Endocrine System Disorders

1. 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, the nurse 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.

2. A female adult client with a history of chronic hyperparathyroidism

admits to being noncompliant. Based on initial assessment findings, the
nurse formulates the nursing diagnosis of Risk for injury. To complete
the nursing diagnosis statement for this client, which related-to
phrase should the nurse add?

A. Related to bone demineralization resulting in pathologic fractures

B. Related to exhaustion secondary to an accelerated metabolic rate
C. Related to edema and dry skin secondary to fluid infiltration into the
interstitial spaces
D. Related to tetany secondary to a decreased serum calcium level

3. Nurse Joey is assigned to care for a postoperative male client who

has diabetes mellitus. During the assessment interview, the client
reports that hes impotent and says hes concerned about its effect on
his marriage. In planning this clients 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.

4. 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

5. Nurse Oliver should expect a client with hypothyroidism to report

which health concerns?

A. Increased appetite and weight loss

B. Puffiness of the face and hands
C. Nervousness and tremors
D. Thyroid gland swelling

6. A female client with hypothyroidism (myxedema) is receiving

levothyroxine (Synthroid), 25 mcg P.O. daily. Which finding should
nurse Hans recognize as an adverse drug effect?

A. Dysuria
B. Leg cramps
C. Tachycardia
D. Blurred vision

7. A 67-year-old male client has been complaining of sleeping more,

increased urination, anorexia, weakness, irritability, depression, and
bone pain that interferes with her going outdoors. Based on these
assessment findings, nurse Richard would suspect which of the
following disorders?

A. Diabetes mellitus
B. Diabetes insipidus
C. Hypoparathyroidism
D. Hyperparathyroidism

8. When caring for a male client with diabetes insipidus, nurse Juliet
expects to administer:

A. vasopressin (Pitressin Synthetic).

B. furosemide (Lasix).
C. regular insulin.
D. 10% dextrose.

9. The nurse is aware that the following is the most common cause of
hyperaldosteronism?

A. Excessive sodium intake

B. A pituitary adenoma
C. Deficient potassium intake
D. An adrenal adenoma

10. 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 arent 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.
11. Following a unilateral adrenalectomy, nurse Betty would assess
for hyperkalemia shown by which of the following?

A. Muscle weakness
B. Tremors
C. Diaphoresis
D. Constipation

12. Nurse Louie is developing a teaching plan for a male client

diagnosed with diabetes insipidus. The nurse should include
information about which hormone lacking in clients with diabetes
insipidus?

A. antidiuretic hormone (ADH).

B. thyroid-stimulating hormone (TSH).
C. follicle-stimulating hormone (FSH).
D. luteinizing hormone (LH).

13. Early this morning, a female client had a subtotal thyroidectomy.

During evening rounds, nurse Tina assesses the client, who now has
nausea, a temperature of 105 F (40.5 C), tachycardia, and extreme
restlessness. What is the most likely cause of these signs?

A. Diabetic ketoacidosis
B. Thyroid crisis
C. Hypoglycemia
D. Tetany

14. For a male client with hyperglycemia, which assessment finding

best supports a nursing diagnosis of Deficient fluid volume?

A. Cool, clammy skin

B. Distended neck veins
C. Increased urine osmolarity
D. Decreased serum sodium level

15. When assessing a male client with pheochromocytoma, a tumor of

the adrenal medulla that secretes excessive catecholamine, nurse April
is most likely to detect:

A. a blood pressure of 130/70 mm Hg.

B. a blood glucose level of 130 mg/dl.
C. bradycardia.
D. a blood pressure of 176/88 mm Hg.

16. A male client is admitted for treatment of the syndrome of

inappropriate antidiuretic hormone (SIADH). Which nursing
intervention is appropriate?

A. Infusing I.V. fluids rapidly as ordered

B. Encouraging increased oral intake
C. Restricting fluids
D. Administering glucose-containing I.V. fluids as ordered

17. A female client has a serum calcium level of 7.2 mg/dl. During the
physical examination, nurse Noah expects to assess:

A. Trousseaus sign.
B. Homans sign.
C. Hegars sign.
D. Goodells sign.

18. Which outcome indicates that treatment of a male client with

diabetes insipidus has been effective?
A. Fluid intake is less than 2,500 ml/day.
B. Urine output measures more than 200 ml/hour.
C. Blood pressure is 90/50 mm Hg.
D. The heart rate is 126 beats/minute.

19. Jemma, who weighs 210 lb (95 kg) and has been diagnosed with
hyperglycemia tells the nurse that her husband sleeps in another room
because her snoring keeps him awake. The nurse notices that she has
large hands and a hoarse voice. Which of the following would the nurse
suspect as a possible cause of the clients hyperglycemia?

A. Acromegaly
B. Type 1 diabetes mellitus
C. Hypothyroidism
D. Deficient growth hormone

20. Nurse Kate is providing dietary instructions to a male client with

hypoglycemia. To control hypoglycemic episodes, the nurse should
recommend:

A. Increasing saturated fat intake and fasting in the afternoon.

B. Increasing intake of vitamins B and D and taking iron supplements.
C. Eating a candy bar if lightheadedness occurs.
D. Consuming a low-carbohydrate, high protein diet and avoiding fasting.

21. An incoherent female client with a history of hypothyroidism is

brought to the emergency department by the rescue squad. Physical
and laboratory findings reveal hypothermia, hypoventilation,
respiratory acidosis, bradycardia, hypotension, and nonpitting edema of
the face and pretibial area. Knowing that these findings suggest
severe hypothyroidism, nurse Libby prepares to take emergency action
to prevent the potential complication of:
A. Thyroid storm.
B. Cretinism.
C. myxedema coma.
D. Hashimotos thyroiditis.

22. 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.

23. 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)

24. 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.
25. During preoperative teaching for a female client who will undergo
subtotal thyroidectomy, the nurse should include which statement?

A. The head of your bed must remain flat for 24 hours after surgery.
B. You should avoid deep breathing and coughing after surgery.
C. You wont be able to swallow for the first day or two.
D. You must avoid hyperextending your neck after surgery.

26. Nurse Ronn is assessing a client with possible Cushings syndrome.

In a client with Cushings 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.

27. A male client with primary diabetes insipidus is ready for discharge
on desmopressin (DDAVP). Which instruction should nurse Lina
provide?

A. Administer desmopressin while the suspension is cold.

B. Your condition isnt chronic, so you wont need to wear a medical
identification bracelet.
C. You may not be able to use desmopressin nasally if you have nasal
discharge or blockage.
D. You wont need to monitor your fluid intake and output after you start taking
desmopressin.

28. Nurse Wayne is aware that a positive Chvosteks sign indicate?

A. Hypocalcemia
B. Hyponatremia
C. Hypokalemia
D. Hypermagnesemia

29. In a 29-year-old female client who is being successfully treated for

Cushings syndrome, nurse Lyzette would expect a decline in:

A. Serum glucose level.

B. Hair loss.
C. Bone mineralization.
D. Menstrual flow.

30. A male client has recently undergone surgical removal of a pituitary

tumor. Dr. Wong prescribes corticotropin (Acthar), 20 units I.M. q.i.d.
as a replacement therapy. What is the mechanism of action of
corticotropin?

A. It decreases cyclic adenosine monophosphate (cAMP) production and affects

the metabolic rate of target organs.
B. It interacts with plasma membrane receptors to inhibit enzymatic actions.
C. It interacts with plasma membrane receptors to produce enzymatic actions
that affect protein, fat, and carbohydrate metabolism.
D. It regulates the threshold for water resorption in the kidneys.

31. Capillary glucose monitoring is being performed every 4 hours for a

female client diagnosed with diabetic ketoacidosis. Insulin is
administered using a scale of regular insulin according to glucose
results. At 2 p.m., the client has a capillary glucose level of 250 mg/dl
for which he receives 8 U of regular insulin. Nurse Vince should expect
the doses:

A. Onset to be at 2 p.m. and its peak to be at 3 p.m.

B. Onset to be at 2:15 p.m. and its peak to be at 3 p.m.
C. Onset to be at 2:30 p.m. and its peak to be at 4 p.m.
D. Onset to be at 4 p.m. and its peak to be at 6 p.m.

32. A female client with Cushings 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

33. 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

34. After undergoing a subtotal thyroidectomy, a female client

develops hypothyroidism. Dr. Smith prescribes levothyroxine
(Levothroid), 25 mcg P.O. daily. For which condition is levothyroxine
the preferred agent?

A. Primary hypothyroidism
B. Graves disease
C. Thyrotoxicosis
D. Euthyroidism
35. Which of these signs suggests that a male client with the syndrome
of inappropriate antidiuretic hormone (SIADH) secretion is
experiencing complications?

A. Tetanic contractions
B. Neck vein distention
C. Weight loss
D. Polyuria

36. A female client with a history of pheochromocytoma is admitted to

the hospital in an acute hypertensive crisis. To reverse hypertensive
crisis caused by pheochromocytoma, nurse Lyka expects to administer:

A. phentolamine (Regitine).
B. methyldopa (Aldomet).
C. mannitol (Osmitrol).
D. felodipine (Plendil).

37. A male client with a history of hypertension is diagnosed with

primary hyperaldosteronism. This diagnosis indicates that the clients
hypertension is caused by excessive hormone secretion from which of
the following glands?

A. Adrenal cortex
B. Pancreas
C. Adrenal medulla
D. Parathyroid

38. Nurse Troy is aware that the most appropriate for a client with
Addisons disease?

A. Risk for infection

B. Excessive fluid volume
C. Urinary retention
D. Hypothermia

39. 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 clients 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 Im taking this drug.
D. Its best if I take the drug with the first bite of a meal.

40. A female client whose physical findings suggest a hyperpituitary

condition undergoes an extensive diagnostic workup. Test results
reveal a pituitary tumor, which necessitates
a transsphenoidal hypophysectomy. The evening before the surgery,
nurse Jacob reviews preoperative and postoperative instructions given
to the client earlier. Which postoperative instruction should the nurse
emphasize?

A. You must lie flat for 24 hours after surgery.

B. You must avoid coughing, sneezing, and blowing your nose.
C. You must restrict your fluid intake.
D. You must report ringing in your ears immediately.

41. 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 wont need to check your blood glucose level after you start taking
glipizide.
D. Take glipizide after a meal to prevent heartburn.

42. 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.

43. When instructing the female client diagnosed with

hyperparathyroidism about diet, nurse Gina should stress the
importance of which of the following?

A. Restricting fluids
B. Restricting sodium
C. Forcing fluids
D. Restricting potassium

44. Which nursing diagnosis takes highest priority for a female client
with hyperthyroidism?

A. Risk for imbalanced nutrition: More than body requirements related to

thyroid hormone excess
B. Risk for impaired skin integrity related to edema, skin fragility, and poor
wound healing
C. Body image disturbance related to weight gain and edema
D. Imbalanced nutrition: Less than body requirements related to thyroid
hormone excess

45. A male client with a tentative diagnosis of hyperosmolar

hyperglycemic nonketotic syndrome (HHNS) has a history of type 2
diabetes that is being controlled with an oral diabetic agent, tolazamide
(Tolinase). Which of the following is the most important laboratory test
for confirming this disorder?

A. Serum potassium level

B. Serum sodium level
C. Arterial blood gas (ABG) values
D. Serum osmolarity

46. 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. Youll need more insulin when you exercise or increase your food intake.
B. Youll need less insulin when you exercise or reduce your food intake.
C. Youll need less insulin when you increase your food intake.
D. Youll need more insulin when you exercise or decrease your food intake.

47. 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
48. 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.

49. 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.

50. For the first 72 hours after thyroidectomy surgery, nurse Jamie
would assess the female client for Chvosteks sign and Trousseaus sign
because they indicate which of the following?

A. Hypocalcemia
B. Hypercalcemia
C. Hypokalemia
D. Hyperkalemia

Answers and Rationale

1. Answer: 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.

2. Answer: A. Related to bone demineralization resulting in pathologic

fractures

Poorly controlled hyperparathyroidism may cause an elevated serum calcium

level. This, in turn, may diminish calcium stores in the bone, causing bone
demineralization and setting the stage for pathologic fractures and a risk for
injury. Hyperparathyroidism doesnt accelerate the metabolic rate. A decreased
thyroid hormone level, not an increased parathyroid hormone level, may cause
edema and dry skin secondary to fluid infiltration into the interstitial spaces.
Hyperparathyroidism causes hypercalcemia, not hypocalcemia; therefore, it isnt
associated with tetany.

3. Answer: 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 clients care. The
nurse doesnt normally provide sex counseling.

4. Answer: 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 wouldnt achieve these goals. Exercising more
than three times a week, although beneficial, would exceed the minimum
requirement.

5. Answer: B. Puffiness of the face and hands

Hypothyroidism (myxedema) causes facial puffiness, extremity edema, and

weight gain. Signs and symptoms of hyperthyroidism (Graves disease) include
an increased appetite, weight loss, nervousness, tremors, and thyroid gland
enlargement (goiter).

6. Answer: C. Tachycardia

Levothyroxine, a synthetic thyroid hormone, is given to a client

with hypothyroidism to simulate the effects of thyroxine. Adverse effects of this
agent include tachycardia. The other options arent associated with
levothyroxine.

7. Answer: D. Hyperparathyroidism

Hyperparathyroidism is most common in older women and is characterized by

bone pain and weakness from excess parathyroid hormone (PTH). Clients also
exhibit hypercalciuria-causing polyuria. While clients with diabetes mellitus and
diabetes insipidus also have polyuria, they dont have bone pain and increased
sleeping. Hypoparathyroidism is characterized by urinary frequency rather than
polyuria.

8. Answer: A. vasopressin (Pitressin Synthetic).

Because diabetes insipidus results from decreased antidiuretic hormone

(vasopressin) production, the nurse should expect to administer synthetic
vasopressin for hormone replacement therapy. Furosemide, a diuretic, is
contraindicated because a client with diabetes insipidus experiences polyuria.
Insulin and dextrose are used to treat diabetes mellitus and its complications,
not diabetes insipidus.

9. Answer: D. An adrenal adenoma

An autonomous aldosterone-producing adenoma is the most common cause of

hyperaldosteronism. Hyperplasia is the second most frequent cause.
Aldosterone secretion is independent of sodium and potassium intake as well as
of pituitary stimulation.

10. Answer: 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 doesnt require a fasting period before blood is drawn.
The nurse cant conclude that the result occurs from poor dietary management
or inadequate insulin coverage.

11. Answer: A. Muscle weakness

Muscle weakness, bradycardia, nausea, diarrhea, and paresthesia of the hands,

feet, tongue, and face are findings associated with hyperkalemia, which is
transient and occurs from transient hypoaldosteronism when the adenoma is
removed. Tremors, diaphoresis, and constipation arent seen in hyperkalemia.

12. Answer: A. antidiuretic hormone (ADH).

ADH is the hormone clients with diabetes insipidus lack. The clients TSH, FSH,
and LH levels wont be affected.

13. Answer: B. Thyroid crisis

Thyroid crisis usually occurs in the first 12 hours after thyroidectomy and
causes exaggerated signs of hyperthyroidism, such as high fever, tachycardia,
and extreme restlessness. Diabetic ketoacidosis is more likely to produce
polyuria, polydipsia, and polyphagia; hypoglycemia, to produce weakness,
tremors, profuse perspiration, and hunger. Tetany typically causes
uncontrollable muscle spasms, stridor, cyanosis, and possibly asphyxia.

14. Answer: C. Increased urine osmolarity

In hyperglycemia, urine osmolarity (the measurement of dissolved particles in

the urine) increases as glucose particles move into the urine. The client
experiences glycosuria and polyuria, losing body fluids and experiencing fluid
volume deficit. Cool, clammy skin; distended neck veins; and a decreased
serum sodium level are signs of fluid volume excess, the opposite imbalance.

15. Answer: D. a blood pressure of 176/88 mm Hg.

Pheochromocytoma, a tumor of the adrenal medulla that secretes excessive

catecholamine, causes hypertension, tachycardia, hyperglycemia,
hypermetabolism, and weight loss. It isnt associated with the other options.

16. Answer: C. Restricting fluids

To reduce water retention in a client with the SIADH, the nurse should restrict
fluids. Administering fluids by any route would further increase the clients
already heightened fluid load.

17. Answer: A. Trousseaus sign.

This clients serum calcium level indicates hypocalcemia, an electrolyte

imbalance that causes Trousseaus sign (carpopedal spasm induced by inflating
the blood pressure cuff above systolic pressure). Homans sign (pain on
dorsiflexion of the foot) indicates deep vein thrombosis. Hegars sign (softening
of the uterine isthmus) and Goodells sign (cervical softening) are probable
signs of pregnancy.

18. Answer: A. Fluid intake is less than 2,500 ml/day.

Diabetes insipidus is characterized by polyuria (up to 8 L/day), constant thirst,

and an unusually high oral intake of fluids. Treatment with the appropriate drug
should decrease both oral fluid intake and urine output. A urine output of 200
ml/hour indicates continuing polyuria. A blood pressure of 90/50 mm Hg and a
heart rate of 126 beats/minute indicate compensation for the continued fluid
deficit, suggesting that treatment hasnt been effective.

19. Answer: A. Acromegaly

Acromegaly, which is caused by a pituitary tumor that releases excessive

growth hormone, is associated with hyperglycemia, hypertension, diaphoresis,
peripheral neuropathy, and joint pain. Enlarged hands and feet are related to
lateral bone growth, which is seen in adults with this disorder. The
accompanying soft tissue swelling causes hoarseness and often sleep apnea.
Type 1 diabetes is usually seen in children, and newly diagnosed persons are
usually very ill and thin. Hypothyroidism isnt associated with hyperglycemia,
nor is growth hormone deficiency.

20. Answer: D. Consuming a low-carbohydrate, high protein diet and

avoiding fasting.

To control hypoglycemic episodes, the nurse should instruct the client to

consume a low-carbohydrate, high protein diet, avoid fasting, and avoid simple
sugars. Increasing saturated fat intake and increasing vitamin supplementation
wouldnt help control hypoglycemia.

21. Answer: C. myxedema coma.

Severe hypothyroidism may result in myxedema coma, in which a drastic drop
in the metabolic rate causes decreased vital signs, hypoventilation (possibly
leading to respiratory acidosis), and nonpitting edema. Thyroid storm is an
acute complication of hyperthyroidism. Cretinism is a form
of hypothyroidism that occurs in infants. Hashimotos thyroiditis is a common
chronic inflammatory disease of the thyroid gland in which autoimmune factors
play a prominent role.

22. Answer: B. has type 2 diabetes.

Oral antidiabetic agents are only effective in adult clients with type 2 diabetes.
Oral antidiabetic agents arent effective in type 1 diabetes. Pregnant and
lactating women arent prescribed oral antidiabetic agents because the effect on
the fetus is uncertain.

23. Answer: 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 doesnt cause hypoglycemia.
Prednisone, a corticosteroid, is associated with hyperglycemia. Lithium may
cause transient hyperglycemia, not hypoglycemia.

24. Answer: 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 wouldnt 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.

25. Answer: D. You must avoid hyperextending your neck after

surgery.
To prevent undue pressure on the surgical incision after subtotal thyroidectomy,
the nurse should advise the client to avoid hyperextending the neck. The client
may elevate the head of the bed as desired and should perform deep breathing
and coughing to help prevent pneumonia. Subtotal thyroidectomy doesnt affect
swallowing.

26. Answer: C. Deposits of adipose tissue in the trunk and dorsocervical

area.

Because of changes in fat distribution, adipose tissue accumulates in the trunk,

face (moonface), and dorsocervical areas (buffalo hump). Hypertension is
caused by fluid retention. Skin becomes thin and bruises easily because of a
loss of collagen. Muscle wasting causes muscle atrophy and thin extremities.

27. Answer: C. You may not be able to use desmopressin nasally if you
have nasal discharge or blockage.

Desmopressin may not be absorbed if the intranasal route is compromised.

Although diabetes insipidus is treatable, the client should wear medical
identification and carry medication at all times to alert medical personnel in an
emergency and ensure proper treatment. The client must continue to monitor
fluid intake and output and receive adequate fluid replacement.

28. Answer: A. Hypocalcemia

Chvosteks sign is elicited by tapping the clients face lightly over the facial
nerve, just below the temple. If the clients facial muscles twitch, it indicates
hypocalcemia. Hyponatremia is indicated by weight loss, abdominal cramping,
muscle weakness, headache, and postural hypotension. Hypokalemia causes
paralytic ileus and muscle weakness. Clients with hypermagnesemia exhibit a
loss of deep tendon reflexes, coma, or cardiac arrest.

29. Answer: A. Serum glucose level.

Hyperglycemia, which develops from glucocorticoid excess, is a manifestation of
Cushings syndrome. With successful treatment of the disorder, serum glucose
levels decline. Hirsutism is common in Cushings syndrome; therefore, with
successful treatment, abnormal hair growth also declines. Osteoporosis occurs
in Cushings syndrome; therefore, with successful treatment, bone
mineralization increases. Amenorrhea develops in Cushings syndrome. With
successful treatment, the client experiences a return of menstrual flow, not a
decline in it.

30. Answer: C. It interacts with plasma membrane receptors to produce

enzymatic actions that affect protein, fat, and carbohydrate
metabolism.

Corticotropin interacts with plasma membrane receptors to produce enzymatic

actions that affect protein, fat, and carbohydrate metabolism. It doesnt
decrease cAMP production. The posterior pituitary hormone, antidiuretic
hormone, regulates the threshold for water resorption in the kidneys.

31. Answer: C. Onset to be at 2:30 p.m. and its peak to be at 4 p.m.

Regular insulin, which is a short-acting insulin, has an onset of 15 to 30 minutes

and a peak of 2 to 4 hours. Because the nurse gave the insulin at 2 p.m., the
expected onset would be from 2:15 p.m. to 2:30 p.m. and the peak from 4 p.m.
to 6 p.m.

32. Answer: A. Depression

Agitation, irritability, poor memory, loss of appetite, and neglect of ones

appearance may signal depression, which is common in clients with Cushings
syndrome. Neuropathy affects clients with diabetes mellitus not Cushings
syndrome. Although hypoglycemia can cause irritability, it also produces
increased appetite, rather than loss of appetite. Hyperthyroidism typically
causes such signs as goiter, nervousness, heat intolerance, and weight loss
despite increased appetite.

33. Answer: A. Tetany

Tetany may result if the parathyroid glands are excised or damaged during
thyroid surgery. Hemorrhage is a potential complication after thyroid surgery
but is characterized by tachycardia, hypotension, frequent swallowing, feelings
of fullness at the incision site, choking, and bleeding. Thyroid storm is another
term for severe hyperthyroidism not a complication of thyroidectomy.
Laryngeal nerve damage may occur postoperatively, but its signs include a
hoarse voice and, possibly, acute airway obstruction.

34. Answer: A. Primary hypothyroidism

Levothyroxine is the preferred agent to treat

primary hypothyroidism and cretinism, although it also may be used to treat
secondary hypothyroidism. It is contraindicated in Graves disease and
thyrotoxicosis because these conditions are forms of hyperthyroidism.
Euthyroidism, a term used to describe normal thyroid function, wouldnt require
any thyroid preparation.

35. Answer: B. Neck vein distention

SIADH secretion causes antidiuretic hormone overproduction, which leads to

fluid retention. Severe SIADH can cause such complications as vascular fluid
overload, signaled by neck vein distention. This syndrome isnt associated with
tetanic contractions. It may cause weight gain and fluid retention (secondary to
oliguria).

36. Answer: A. phentolamine (Regitine).

Pheochromocytoma causes excessive production of epinephrine and
norepinephrine, natural catecholamines that raise the blood pressure.
Phentolamine, an alpha-adrenergic blocking agent given by I.V. bolus or drip,
antagonizes the bodys response to circulating epinephrine and norepinephrine,
reducing blood pressure quickly and effectively. Although methyldopa is an
antihypertensive agent available in parenteral form, it isnt effective in treating
hypertensive emergencies. Mannitol, a diuretic, isnt used to treat hypertensive
emergencies. Felodipine, an antihypertensive agent, is available only in
extended-release tablets and therefore doesnt reduce blood pressure quickly
enough to correct hypertensive crisis.

37. Answer: A. Adrenal cortex

Excessive secretion of aldosterone in the adrenal cortex is responsible for the

clients hypertension. This hormone acts on the renal tubule, where it promotes
reabsorption of sodium and excretion of potassium and hydrogen ions. The
pancreas mainly secretes hormones involved in fuel metabolism. The adrenal
medulla secretes the catecholamines epinephrine and norepinephrine. The
parathyroids secrete parathyroid hormone.

38. Answer: A. Risk for infection

Addisons disease decreases the production of all adrenal hormones,

compromising the bodys normal stress response and increasing the risk
of infection. Other appropriate nursing diagnoses for a client with Addisons
disease include Deficient fluid volume and Hyperthermia. Urinary retention isnt
appropriate because Addisons disease causes polyuria.

39. Answer: 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. Its 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.

40. Answer: B. You must avoid coughing, sneezing, and blowing your
nose.

After a transsphenoidal hypophysectomy, the client must refrain from coughing,

sneezing, and blowing the nose for several days to avoid disturbing the surgical
graft used to close the wound. The head of the bed must be elevated, not kept
flat, to prevent tension or pressure on the suture line. Within 24 hours after a
hypophysectomy, transient diabetes insipidus commonly occurs; this calls for
increased, not restricted, fluid intake. Visual, not auditory, changes are a
potential complication of hypophysectomy.

41. Answer: 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 doesnt cause hyponatremia and
therefore doesnt necessitate monthly serum sodium measurement. The client
must continue to monitor the blood glucose level during glipizide therapy.

42. Answer: 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.
43. Answer: C. Forcing fluids

The client should be encouraged to force fluids to prevent renal calculi

formation. Sodium should be encouraged to replace losses in urine. Restricting
potassium isnt necessary in hyperparathyroidism.

44. Answer: D. Imbalanced nutrition: Less than body requirements

related to thyroid hormone excess

In the client with hyperthyroidism, excessive thyroid hormone production leads

to hypermetabolism and increased nutrient metabolism. These conditions may
result in a negative nitrogen balance, increased protein synthesis and
breakdown, decreased glucose tolerance, and fat mobilization and depletion.
This puts the client at risk for marked nutrient and calorie deficiency, making
Imbalanced nutrition: Less than body requirements the most important nursing
diagnosis. Options B and C may be appropriate for a client with hypothyroidism,
which slows the metabolic rate.

45. Answer: D. Serum osmolarity

Serum osmolarity is the most important test for confirming HHNS; its also used
to guide treatment strategies and determine evaluation criteria. A client with
HHNS typically has a serum osmolarity of more than 350 mOsm/L. Serum
potassium, serum sodium, and ABG values are also measured, but they arent
as important as serum osmolarity for confirming a diagnosis of HHNS. A client
with HHNS typically has hypernatremia and osmotic diuresis. ABG values reveal
acidosis, and the potassium level is variable.

46. Answer: B. Youll 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.

47. Answer: A. Oral anticoagulants

As a normal body protein, glucagon only interacts adversely with

oral anticoagulants, increasing the anticoagulant effects. It doesnt interact
adversely with anabolic steroids, beta-adrenergic blockers, or thiazide diuretics.

48. Answer: 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.

49. Answer: 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 shouldnt administer insulin to a client whos
hypoglycemic; this action will further compromise the clients condition.

50. Answer: A. Hypocalcemia

The client who has undergone a thyroidectomy is at risk for developing

hypocalcemia from inadvertent removal or damage to the parathyroid gland.
The client with hypocalcemia will exhibit a positive Chvosteks sign (facial
muscle contraction when the facial nerve in front of the ear is tapped) and a
positive Trousseaus sign (carpal spasm when a blood pressure cuff is inflated
for a few minutes). These signs arent present with hypercalcemia,
hypokalemia, or hyperkalemia.

Diabetes Mellitus
1. Knowing that gluconeogenesis helps to maintain blood levels, a
nurse should:

1. Document weight changes because of fatty acid mobilization

2. Evaluate the patients sensitivity to low room temperatures because of
decreased adipose tissue insulation
3. Protect the patient from sources of infection because of decreased cellular
protein deposits
4. Do all of the above

2. Clinical manifestations associated with a diagnosis of type 1 DM

include all of the following except:

1. Hypoglycemia
2. Hyponatremia
3. Ketonuria
4. Polyphagia

3. The lowest fasting plasma glucose level suggestive of a diagnosis of

DM is:

1. 90mg/dl
2. 115mg/dl
3. 126mg/dl
4. 180mg/dl
4. Rotation sites for insulin injection should be separated from one
another by 2.5 cm (1 inch) and should be used only every:

1. Third day
2. Week
3. 2-3 weeks
4. 2-4 weeks

5. A clinical feature that distinguishes a hypoglycemic reaction from a

ketoacidosis reaction is:

1. Blurred vision
2. Diaphoresis
3. Nausea
4. Weakness

6. Clinical nursing assessment for a patient with microangiopathy who

has manifested impaired peripheral arterial circulation includes all of
the following except:

1. Integumentary inspection for the presence of brown spots on the lower

extremities
2. Observation for paleness of the lower extremities
3. Observation for blanching of the feet after the legs are elevated for 60
seconds
4. Palpation for increased pulse volume in the arteries of the lower extremities

7. The nurse expects that a type 1 diabetic may receive ____ of his or
her morning dose of insulin preoperatively:

1. 10-20%
2. 25-40%
3. 50-60%
4. 85-90%

8. Albert, a 35-year-old insulin dependent diabetic, is admitted to the

hospital with a diagnosis of pneumonia. He has been febrile since
admission. His daily insulin requirement is 24 units of NPH. Every
morning Albert is given NPH insulin at 0730. Meals are served at 0830,
1230, and 1830. The nurse expects that the NPH insulin will reach its
maximum effect (peak) between the hours of:

1. 1130 and 1330

2. 1330 and 1930
3. 1530 and 2130
4. 1730 and 2330

9. A bedtime snack is provided for Albert. This is based on the

knowledge that intermediate-acting insulins are effective for an
approximate duration of:

1. 6-8 hours
2. 10-14 hours
3. 16-20 hours
4. 24-28 hours

10. Albert refuses his bedtime snack. This should alert the nurse to
assess for:

1. Elevated serum bicarbonate and a decreased blood pH.

2. Signs of hypoglycemia earlier than expected.
3. Symptoms of hyperglycemia during the peak time of NPH insulin.
4. Sugar in the urine
11. A client is taking NPH insulin daily every morning. The nurse
instructs the client that the most likely time for a hypoglycemic reaction
to occur is:

1. 2-4 hours after administration

2. 6-14 hours after administration
3. 16-18 hours after administration
4. 18-24 hours after administration

12. An external insulin pump is prescribed for a client with DM. The
client asks the nurse about the functioning of the pump. The nurse
bases the response on the information that the pump:

1. Gives small continuous dose of regular insulin subcutaneously, and the client
can self-administer a bolus with an additional dosage from the pump before
each meal.
2. Is timed to release programmed doses of regular or NPH insulin into the
bloodstream at specific intervals.
3. Is surgically attached to the pancreas and infuses regular insulin into the
pancreas, which in turn releases the insulin into the bloodstream.
4. Continuously infuses small amounts of NPH insulin into the bloodstream while
regularly monitoring blood glucose levels.

13. A client with a diagnosis of diabetic ketoacidosis (DKA) is being

treated in the ER. Which finding would a nurse expect to note as
confirming this diagnosis?

1. Elevated blood glucose level and a low plasma bicarbonate

2. Decreased urine output
3. Increased respirations and an increase in pH
4. Comatose state
14. A client with DM demonstrates acute anxiety when first admitted
for the treatment of hyperglycemia. The most appropriate intervention
to decrease the clients anxiety would be to:

1. Administer a sedative
2. Make sure the client knows all the correct medical terms to understand what
is happening.
3. Ignore the signs and symptoms of anxiety so that they will soon disappear
4. Convey empathy, trust, and respect toward the client.

15. A nurse is preparing a plan of care for a client with DM who

has hyperglycemia. The priority nursing diagnosis would be:

1. High risk for deficient fluid volume

2. Deficient knowledge: disease process and treatment
3. Imbalanced nutrition: less than body requirements
4. Disabled family coping: compromised.

16. A nurse is caring for a client admitted to the ER with DKA. In the
acute phase the priority nursing action is to prepare to:

1. Administer regular insulin intravenously

2. Administer 5% dextrose intravenously
3. Correct the acidosis
4. Apply an electrocardiogram monitor.

17. A nurse performs a physical assessment on a client with type 2 DM.

Findings include a fasting blood glucose of 120mg/dl, temperature of
101, pulse of 88, respirations of 22, and a bp of 140/84. Which finding
would be of most concern of the nurse?

1. Pulse
2. BP
3. Respiration
4. Temperature

18. A client with type 1 DM calls the nurse to report recurrent episodes
of hypoglycemia with exercise. Which statement by the client indicated
an inadequate understanding of the peak action of NPH insulin and
exercise?

1. The best time for me to exercise is every afternoon.

2. The best time for me to exercise is right after I eat.
3. The best time for me to exercise is after breakfast.
4. The best time for me to exercise is after my morning snack.

19. A client with diabetes mellitus visits a health care clinic. The
clients diabetes previously had been well controlled with glyburide
(Diabeta), 5 mg PO daily, but recently the fasting blood glucose has
been running 180-200mg/dl. Which medication, if added to the clients
regimen, may have contributed to the hyperglycemia?

1. Prednisone (Deltasone)
2. Atenolol (Tenormin)
3. Phenelzine (Nardil)
4. Allopurinol (Zyloprim)

20. Glucose is an important molecule in a cell because this molecule is

primarily used for:

1. Extraction of energy
2. Synthesis of protein
3. Building of genetic material
4. Formation of cell membranes.
21. When a client is first admitted with hyperglycemic hyperosmolar
nonketotic syndrome (HHNS), the nurses priority is to provide:

1. Oxygen
2. Carbohydrates
3. Fluid replacement
4. Dietary instruction

22. The nurse is admitting a client with hypoglycemia. Identify the

signs and symptoms the nurse should expect. Select all that apply.

1. Thirst
2. Palpitations
3. Diaphoresis
4. Slurred speech
5. Hyperventilation

23. When a client is in diabetic ketoacidosis, the insulin that would be

administered is:

1. Human NPH insulin

2. Human regular insulin
3. Insulin lispro injection
4. Insulin glargine injection

24. The nurse recognizes that additional teaching is necessary when

the client who is learning alternative site testing (AST) for glucose
monitoring says:

1. I need to rub my forearm vigorously until warm before testing at this site.
2. The fingertip is preferred for glucose monitoring if hyperglycemia is
suspected.
3. I have to make sure that my current glucose monitor can be used at an
alternate site.
4. Alternate site testing is unsafe if I am experiencing a rapid change in
glucose levels.

25. Which adaptations should the nurse caring for a client with diabetic
ketoacidosis expect the client to exhibit? Select all that apply:

1. Sweating
2. Low PCO2
3. Retinopathy
4. Acetone breath
5. Elevated serum bicarbonate

26. A clients blood gases reflect diabetic acidosis. The nurse should
expect:

1. Increased pH
2. Decreased PO2
3. Increased PCO2
4. Decreased HCO3

27. The nurse knows that glucagon may be given in the treatment of
hypoglycemia because it:

1. Inhibits gluconeogenesis
2. Stimulates the release of insulin
3. Increases blood glucose levels
4. Provides more storage of glucose.

28. A client with type 1 DM has a fingerstick glucose level of 258mg/dl

at bedtime. An order for sliding scale insulin exists. The nurse should:
1. Call the physician
2. Encourage the intake of fluids
3. Administer the insulin as ordered
4. Give the client c. of orange juice

29. The physician orders 36 units of NPH and 12 units of regular insulin.
The nurse plans to administer these drugs in 1 syringe. Identify the
steps in this procedure by listing them in priority order.

1. Inject air equal to NPH dose into NPH vial

2. Invert regular insulin bottle and withdraw regular insulin dose
3. Inject air equal to regular dose into regular dose
4. Invert NPH vial and withdraw NPH dose.

30. The insulin that has the most rapid onset of action would be:

1. Lente
2. Lispro
3. Ultralente
4. Humulin N

31. A client with DM states, I cannot eat big meals; I prefer to snack
throughout the day. The nurse should carefully explain that the:

1. Regulated food intake is basic to control

2. Salt and sugar restriction is the main concern
3. Small, frequent meals are better for digestion
4. Large meals can contribute to a weight problem

32. A client with DM has an above-knee amputation because of severe

peripheral vascular disease, Two days following surgery, when
preparing the client for dinner, it is the nurses primary responsibility
to:
1. Check the clients serum glucose level
2. Assist the client out of bed to the chair
3. Place the client in a high-Fowlers position
4. Ensure that the clients residual limb is elevated.

33. Which of the following nursing interventions should be taken for a

client who complains of nausea and vomits one hour after taking his
glyburide (DiaBeta)?

1. Give glyburide again

2. Give subcutaneous insulin and monitor blood glucose
3. Monitor blood glucose closely, and look for signs of hypoglycemia.
4. Monitor blood glucose, and assess for signs of hyperglycemia.

34. Which of the following chronic complications is associated

with diabetes?

1. Dizziness, dyspnea on exertion, and coronary artery disease.

2. Retinopathy, neuropathy, and coronary artery disease
3. Leg ulcers, cerebral ischemic events, and pulmonary infarcts
4. Fatigue, nausea, vomiting, muscle weakness, and cardiac arrhythmias

35. Rotating injection sites when administering insulin prevents which

of the following complications?

1. Insulin edema
2. Insulin lipodystrophy
3. Insulin resistance
4. Systemic allergic reactions

36. Which of the following methods of insulin administration would be

used in the initial treatment of hyperglycemia in a client with diabetic
ketoacidosis?
1. Subcutaneous
2. Intramuscular
3. IV bolus only
4. IV bolus, followed by continuous infusion.

37. Insulin forces which of the following electrolytes out of the plasma
and into the cells?

1. Calcium
2. Magnesium
3. Phosphorus
4. Potassium

38. Which of the following causes of HHNS is most common?

1. Insulin overdose
2. Removal of the adrenal gland
3. Undiagnosed, untreated hyperpituitarism
4. Undiagnosed, untreated diabetes mellitus

39. A client is in DKA, secondary to infection. As the condition

progresses, which of the following symptoms might the nurse see?

1. Kussmauls respirations and a fruity odor on the breath

2. Shallow respirations and severe abdominal pain
3. Decreased respirations and increased urine output.
4. Cheyne-stokes respirations and foul-smelling urine

40. Clients with type 1 diabetes may require which of the following
changes to their daily routine during periods of infection?

1. No changes
2. Less insulin
3. More insulin
4. Oral antidiabetic agents

Answers and Rationale

1. Answer: 4. Do all of the above

2. Answer: 1. Hypoglycemia

3. Answer: 3. 126mg/dl

4. Answer: 3. 2-3 weeks

5. Answer: 2. Diaphoresis

6. Answer: 4. Palpation for increased pulse volume in the arteries of the

lower extremities

7. Answer: 3. 50-60%

8. Answer: 2. 1330 and 1930

9. Answer: 3. 16-20 hours

10. Answer: 2. Signs of hypoglycemia earlier than expected.

11. Answer: 2. 6-14 hours after administration

NPH is intermediate acting insulin. The onset of action is 1-2 hours, it peaks in
6-14 hours, and its duration of action is 24 hours. Hypoglycemic reactions most
likely occur during peak time.
12. Answer: 1. Gives small continuous dose of regular insulin
subcutaneously, and the client can self-administer a bolus with an
additional dosage from the pump before each meal.

An insulin pump provides a small continuous dose of regular insulin

subcutaneously throughout the day and night, and the client can self-administer
a bolus with additional dosage from the pump before each meal as needed.
Regular insulin is used in an insulin pump. An external pump is not attached
surgically to the pancreas.

13. Answer: 1. Elevated blood glucose level and a low plasma

bicarbonate

In diabetic acidosis, the arterial pH is less than 7.35. plasma bicarbonate is less
than 15mEq/L, and the blood glucose level is higher than 250mg/dl and ketones
are present in the blood and urine. The client would be experiencing polyuria,
and Kussmauls respirations would be present. A comatose state may occur if
DKA is not treated, but coma would not confirm the diagnosis

14. Answer: 4. Convey empathy, trust, and respect toward the client.

The most appropriate intervention is to address the clients feelings related to

the anxiety. Administering a sedative is not the most appropriate intervention.
The nurse should not ignore the clients anxious feelings. A client will not relate
to medical terms, particularly when anxiety exists.

15. Answer: 1. High risk for deficient fluid volume

Increased blood glucose will cause the kidneys to excrete the glucose on the
urine. This glucose is accompanied by fluids and electrolytes, causing osmotic
diuresis leading to dehydration. This fluid loss must be replaced when it
becomes severe. Options B, C, and D are not related specifically to the issue of
the question.
16. Answer: 1. Administer regular insulin intravenously

Lack (absolute or relative) of insulin is the primary cause of DK1. Treatment

consists of insulin administration (regular insulin), IV fluid administration
(normal saline initially), and potassium replacement, followed by correcting
acidosis. Applying an electrocardiogram monitor is not a priority action.

17. Answer: 4. Temperature

An elevated temperature may indicate infection. Infection is a leading cause

of hyperglycemic hyperosmolar nonketotic syndrome or diabetic ketoacidosis.

18. Answer: 1. The best time for me to exercise is every afternoon.

A hypoglycemic reaction may occur in the response to increased exercise.

Clients should avoid exercise during the peak time of insulin. NPH insulin peaks
at 6-14 hours; therefore afternoon exercise will occur during the peak of the
medication. Options B, C, and D do not address peak action times.

19. Answer: 1. Prednisone (Deltasone)

Prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics,

and potassium supplements.

20. Answer: 1. Extraction of energy

Glucose catabolism is the main pathway for cellular energy production.

21. Answer: 3. Fluid replacement

As a result of osmotic pressures created by increased serum glucose, the cells

become dehydrated; the client must receive fluid and then insulin.
22. Answer: 2, 3, 4.

Palpitations, an adrenergic symptom, occur as the glucose levels fall; the

sympathetic nervous system is activated and epinephrine and norepinephrine
are secreted causing this response. Diaphoresis is a sympathetic nervous
system response that occurs as epinephrine and norepinephrine are released.
Slurred speech is a neuroglycopenic symptom; as the brain receives insufficient
glucose, the activity of the CNS becomes depressed.

23. Answer: 2. Human regular insulin

Regular insulin (Humulin R) is a short-acting insulin and is administered via

IV with an initial dose of 0.3 units/kg, followed by 0.2 units/kg 1 hour later,
followed by 0.2 units/kg every 2 hours until blood glucose becomes <13.9
mmol/L (<250 mg/dL). At this point, insulin dose should be decreased by half,
to 0.1 units/kg every 2 hours, until the resolution of DKA.

24. Answer: 2. The fingertip is preferred for glucose monitoring if

hyperglycemia is suspected.

The fingertip is preferred for glucose monitoring if hypoglycemia, not

hyperglycemia, is suspected.

25. Answer: 2, 3.

Metabolic acidosis initiates respiratory compensation in the form of Kussmauls

respirations to counteract the effects of ketone buildup, resulting in a lowered
PCO2. A fruity odor to the breath (acetone breath) occurs when the ketone level
is elevated in ketoacidosis.

26. Answer: 4. Decreased HCO3

The bicarbonate-carbonic acid buffer system helps maintain the pH of the body
fluids; in metabolic acidosis, there is a decrease in bicarbonate because of an
increase of metabolic acids.

27. Answer: 3. Increases blood glucose levels

Glucagon, an insulin antagonist produced by the alpha cells in the islets of

Langerhans, leads to the conversion of glycogen to glucose in the liver.

28. Answer: 3. Administer the insulin as ordered

A value of 258mg/dl is above the expected range of 70-105 mg/dl; the nurse
should administer the insulin as ordered.

29. Answer: 1, 3, 2, 4.

30. Answer: 2. Lispro

Lispro has an immediate onset, a peak of 30-90 minutes, and duration of 2-4
hours.

31. Answer: 1. Regulated food intake is basic to control

An understanding of the diet is imperative for compliance. A balance of

carbohydrates, proteins, and fats usually apportioned over three main meals
and two between meals snacks needs to be tailored to the clients specific
needs, with due regard for activity, diet, and therapy.

32. Answer: 1. Check the clients serum glucose level

Because the client has diabetes, it is essential that the blood glucose level be
determined before meals to evaluate the success of control of diabetes and the
possible need for insulin coverage.
33. Answer: 3. Monitor blood glucose closely, and look for signs of
hypoglycemia.

When a client who has taken an oral antidiabetic agent vomits, the nurse would
monitor glucose and assess him frequently for signs of hypoglycemia. Most of
the medication has probably been absorbed. Therefore, repeating the dose
would further lower glucose levels later in the day. Giving insulin would also
lower the glucose levels, causing hypoglycemic. The client wouldnt have
hyperglycemia if the glyburide was absorbed.

34. Answer: 2. Retinopathy, neuropathy, and coronary artery disease

These are all chronic complications of diabetes. Dizziness, dyspnea on exertion,

and coronary artery disease are symptoms of aortic valve stenosis. Fatigue,
nausea, vomiting, muscle weakness, and cardiac arrhythmias are symptoms of
hyperparathyroidism. Leg ulcers, cerebral ischemic events, and pulmonary
infarcts are complications of sickle cell anemia.

35. Answer: 2. Insulin lipodystrophy

Insulin lipodystrophy produces fatty masses at the injection sites, causing

unpredictable absorption of insulin injected into these sites.

36. Answer: 4. IV bolus, followed by continuous infusion.

An IV bolus of insulin is given initially to control the hyperglycemia; followed by

a continuous infusion, titrated to control blood glucose. After the client is
stabilized, subcutaneous insulin is given. Insulin is never given intramuscularly.

37. Answer: 4. Potassium

Insulin forces potassium out of the plasma, back into the cells,
causing hypokalemia. Potassium is needed to help transport glucose and insulin
into the cells. Calcium, magnesium, and phosphorus arent affected by insulin.

38. Answer: 4. Undiagnosed, untreated diabetes mellitus

Undiagnosed, untreated DM is one of the most common causes of HHNS.

39. Answer: 1. Kussmauls respirations and a fruity odor on the breath

Coma and severe acidosis are ushered in with Kussmauls respirations (very
deep but not labored respirations) and a fruity odor on the breath (academia).

40. Answer: 3. More insulin

During periods of infection or illness, diabetics may need even more insulin to
compensate for increased blood glucose levels.

1. Marlisa has been diagnosed with diabetes mellitus type 1. She asks
Nurse Errol what this means. What is the best response by the nurse?
Select all that apply.

A. Your alpha cells should be able to secrete insulin, but cannot.

B. The exocrine function of your pancreas is to secrete insulin.
C. Without insulin, you will develop ketoacidosis (DKA).
D. The endocrine function of your pancreas is to secrete insulin.
E. It means your pancreas cannot secrete insulin.

2. Dr. Shrunk orders intravenous (IV) insulin for Rita, a client with a
blood sugar of 563. Nurse AJ administers insulin lispro (Humalog)
intravenously (IV). What does the best evaluation of the nurse reveal?
Select all that apply.
A. The nurse could have given the insulin subcutaneously.
B. The nurse should have contacted the physician.
C. The nurse should have used regular insulin (Humulin R).
D. The nurse used the correct insulin.

3. Ben injects his insulin as prescribed, but then gets busy and forgets
to eat. What will the best assessment of the nurse reveal?

A. The client will be very thirsty.

B. The client will complain of nausea.
C. The client will need to urinate.
D. The client will have moist skin.

4. A clinical instructor teaches a class for the public

about diabetes mellitus. Which individual does the nurse assess as
being at highest risk for developing diabetes?

A. The 50-year-old client who does not get any physical exercise
B. The 56-year-old client who drinks three glasses of wine each evening
C. The 42-year-old client who is 50 pounds overweight
D. The 38-year-old client who smokes one pack of cigarettes per day

5. Steven John has type 1 diabetes mellitus and receives insulin. Which
laboratory test will the nurse assess?

A. Potassium
B. AST (aspartate aminotransferase)
C. Serum amylase
D. Sodium

6. Jansen receives metformin (Glucophage). What will the best plan of

the nurse include with regard to patient education with this drug?
Select all that apply.
A. It stimulates the pancreas to produce more insulin.
B. It must be taken with meals.
C. It decreases sugar production in the liver.
D. It inhibits absorption of carbohydrates.
E. It reduces insulin resistance.

7. Serafica who has diabetes mellitus type 1 is found unresponsive in

the clinical setting. Which nursing action is a priority? arrange from 1 to
4.

1. Treat the client for hypoglycemia.

2. Call the physician STAT.
3. Assess the vital signs.
4. Call a code.

A. 1, 2, 3, 4
B. 1, 3, 2, 4
C. 3, 1, 2, 4
D. 4, 3, 2, 1

8. Serge who has diabetes mellitus is taking oral agents, and is

scheduled for a diagnostic test that requires him to be NPO. What is the
best plan of the nurse with regard to giving the client his oral
medications?

A. Administer the oral agents immediately after the test.

B. Notify the the diagnostic department and request orders.
C. Notify the physician and request orders.
D. Administer the oral agents with a sip of water before the test.

9. A client diagnosed with type 1 diabetes receives insulin. He asks the

nurse why he cant just take pills instead. What is the best response by
the nurse?
A. Insulin must be injected because it needs to work quickly.
B. Insulin cant be in a pill because it is destroyed in stomach acid.
C. Have you talked to your doctor about taking pills instead?
D. I know it is tough, but you will get used to the shots soon.

10. Nurse Andy has finished teaching a client with diabetes

mellitus how to administer insulin. He evaluates the learning has
occurred when the client makes which statement?

A. I should check my blood sugar immediately prior to the administration.

B. I should provide direct pressure over the site following the injection.
C. I should use the abdominal area only for insulin injections.
D. I should only use calibrated insulin syringe for the injections.

11. Genevieve has diabetes type 1 and receives insulin for glycemic
control. She tells the nurse that she likes to have a glass of wine with
dinner. What will the best plan of the nurse for client education
include?

A. The alcohol could cause pancreatic disease.

B. The alcohol could cause serious liver disease.
C. The alcohol could predispose you to hypoglycemia.
D. The alcohol could predispose you to hyperglycemia.

12. Dr. Wijangco orders insulin lispro (Humalog) 10 units for Alicia, a
client with diabetes mellitus. When will the nurse administer this
medication?

A. When the client is eating

B. Thirty minutes before meals
C. fifteen minutes before meals
D. When the meal trays arrive on the floor
13. Nurse Matt makes a home visit to the client with diabetes mellitus.
During the visit, Nurse Matt notes the clients additional insulin vials
are not refrigerated. What is the best action by the nurse at this time?

A. Instruct the client to label each vial with the date when opened.
B. Tell the client there is no need to keep additional vials.
C. Have the client place the insulin vials in the refrigerator.
D. Have the client discard the vials.

14. During the morning rounds, Nurse AJ accompanied the physician in

every patients room. The physician writes orders for the client
with diabetes mellitus. Which order would the nurse validate with the
physician?

A. Use Humalog insulin for sliding scale coverage.

B. Metformin (Glucophage) 1000 mg per day in divided doses.
C. Administer regular insulin 30 minutes prior to meals.
D. Lantus insulin 20U BID.

15. Gary has diabetes type 2. Nurse Martha has taught him about the
illness and evaluates learning has occurred when the client makes
which statement?

A. My cells have increased their receptors, but there is enough insulin.

B. My peripheral cells have increased sensitivity to insulin.
C. My beta cells cannot produce enough insulin for my cells.
D. My cells cannot use the insulin my pancreas makes.

16. The principal goals of therapy for older patients who have poor
glycemic control are:

A. Enhancing quality of life.

B. Decreasing the chance of complications.
C. Improving self-care through education.
D. All of the above.

17. Which of the following is accurate pertaining to physical exercise

and type 1 diabetes mellitus?

A. Physical exercise can slow the progression of diabetes mellitus.

B. Strenuous exercise is beneficial when the blood glucose is high.
C. Patients who take insulin and engage in strenuous physical exercise might
experience hyperglycemia.
D. Adjusting insulin regimen allows for safe participation in all forms of exercise.

18. Harry is a diabetic patient who is experiencing a reaction of

alternating periods of nocturnal hypoglycemia and hyperglycemia. The
patient might be manifesting which of the following?

A. Uncontrolled diabetes
B. Somogyi phenomenon
C. Brittle diabetes
D. Diabetes insipidus

19. Dr. Hugo has prescribed sulfonylureas for Rebecca in the

management of diabetes mellitus type 2. As a nurse, you know that the
primary purpose of sulfonylureas, such as long-acting glyburide
(Micronase), is to:

A. Induce hypoglycemia by decreasing insulin sensitivity.

B. Improve insulin sensitivity and decrease hyperglycemia.
C. Stimulate the beta cells of the pancreas to secrete insulin.
D. Decrease insulin sensitivity by enhancing glucose uptake.

20. Rosemary has been taking Glargine (Lantus) to treat her condition.
One of the benefits of Glargine (Lantus) insulin is its ability to:
A. Release insulin rapidly throughout the day to help control basal glucose.
B. Release insulin evenly throughout the day and control basal glucose levels.
C. Simplify the dosing and better control blood glucose levels during the day.
D. Cause hypoglycemia with other manifestation of other adverse reactions.

21. A 50-year-old widower is admitted to the hospital with a diagnosis

of diabetes mellitus and complaints of rapid-onset weight loss, elevated
blood glucose levels, and polyphagia, the gerontology nurse should
anticipate which of the following secondary medical diagnoses?

A. Impaired glucose tolerance

B. Gestational diabetes mellitus
C. Pituitary tumor
D. Pancreatic tumor

22. An older woman with diabetes mellitus visits the clinic concerning
her condition. Of which of the following symptoms might an older
woman with diabetes mellitus complain?

A. Anorexia
B. Pain intolerance
C. Weight loss
D. Perineal itching

23. Gregory is a 52-year-old man identified as high-risk for diabetes

mellitus. Which laboratory test should a nurse anticipate a physician
would order for him? (Select all that apply.)

A. Fasting Plasma Glucose (FPG)

B. Two-hour Oral Glucose Tolerance Test (OGTT)
C. Glycosylated hemoglobin (HbA1C)
D. Finger stick glucose three times daily
24. According to the National Diabetes Statistics
Report, diabetes remains as one of the leading causes of death in the
United States since 2010. Which of the following factors are risks for
the development of diabetes mellitus? (Select all that apply.)

A. Age over 45 years

B. Overweight with a waist/hip ratio >1
C. Having a consistent HDL level above 40 mg/dl
D. Maintaining a sedentary lifestyle

25. During a visit in the hospital, the student nurses are asked which of
the following persons would most likely be diagnosed with diabetes
mellitus. They are correct if they answered a 44-year-old:

A. Caucasian woman.
B. Asian woman.
C. African-American woman.
D. Hispanic male.

26. An ailing 70-year-old woman with a diagnosis of type 2 diabetes

mellitus has been ill with pneumonia. The clients intake has been very
poor, and she is admitted to the hospital for observation and
management as needed. What is the most likely problem with this
patient?

A. Insulin resistance has developed.

B. Diabetic ketoacidosis is occurring.
C. Hypoglycemia unawareness is developing.
D. Hyperglycemic hyperosmolar non-ketotic coma.

27. Daniel is diagnosed of having hyperthyroidism (Graves disease).

Which of the following is a drug of choice for his condition?
A. Furosemide (Lasix)
B. Digoxin (Lanoxin)
C. Propranolol (Inderal)
D. Propylthiouracil (PTU)

28. Which of the following medications are most likely to

cause hypothyroidism? (Select all that apply.)

A. Acetylsalicylic acid (aspirin)

B. Furosemide (Lasix)
C. Docusate sodium (Colace)
D. Rifampin (Rifadin)

29. After visiting the physician, Angela found out that she has a thyroid
problem. In line with her condition, which of the following diagnostic
studies is done to determine the size and composition of the thyroid
gland?

A. Thyroid scan with RAI 123I

B. Electrocardiography
C. Ultrasonography
D. Venous duplex Doppler study

30. Nurse Gil is caring for a patient with a diagnosis of hypothyroidism.

Which nursing diagnosis should the nurse most seriously consider when
analyzing the needs of the patient?

A. High risk for aspiration related to severe vomiting

B. Diarrhea related to increased peristalsis
C. Hypothermia related to slowed metabolic rate
D. Oral mucous membrane, altered related to disease process

Answers and Rationale

Here are the answers for this exam. Gauge your performance by counter
checking your answers to those below. If you have any disputes or clarifications,
please direct them to the comments section.

1. Answer: C, D, E

One function of your pancreas is to secrete insulin. The endocrine function of

the pancreas is to secrete insulin. The endocrine, not the exocrine, function of
the pancreas is to secrete insulin. Insulin is secreted by the beta, not the alpha,
cells of the pancreas. A consequence of diabetes mellitus type 1 is that without
insulin, severe metabolic disturbances, such as ketoacidosis (DKA) will result.

2. Answer: B, C

Regular insulin is the only insulin that can be given intravenously (IV). The
nurse did not use correct insulin as it was not regular insulin. Contact the
provider to clarify the order, regular insulin is the only insulin that can be given
intravenously (IV). The nurse cannot give the insulin subcutaneously when it is
ordered to be given intravenously (IV).

3. Answer: D. The client will have moist skin.

Moist skin is the sign of hypoglycemia, which the client would experience if he
injected himself with insulin and did not eat. Thirst, nausea, and increased
urination are signs of hyperglycemia.

4. Answer: C. The 42-year-old client who is 50 pounds overweight

Obesity increases the likelihood of developing diabetes mellitus due to over

stimulation of the endocrine system. Exercise is important, but lack of exercise
is not as big a risk factor as obesity. Smoking is a serious health concern but is
not a specific risk factor for diabetes. Consuming alcohol is associated with liver
disease but is not as high a risk factor for diabetes as obesity.
5. Answer: A. Potassium

Insulin causes potassium to move into the cell and may cause hypokalemia.
There is no need to monitor the sodium, serum amylase, and AST levels.

6. Answer: B, C, E

Metformin (Glucophage) reduces insulin resistance, decreases sugar production

in the liver, and should be taken with meals for the best absorption and effect.
It does not stimulate the pancreas to produce more insulin and does not inhibit
the absorption of carbohydrates.

7. Answer: A. 1, 2, 3, 4

When a patient with diabetes mellitus type 1 is unresponsive, the nurse should
focus on and treat for hypoglycemia, as this is more likely than hyperglycemia.
This is an emergency situation where the nurse must act before calling the
physician. Vital signs should be taken after the client is treated for
hypoglycemia. Assessment for ABCs should precede calling a code; there is no
information that the client is not breathing.

8. Answer: C. Notify the physician and request orders.

It is best to notify the clients physician and request orders. The client should
not receive the medication during NPO status unless directed by the physician.
The medications should not be given upon return unless the physician orders
this; the client may still need to be NPO. The radiologist in the diagnostic
department might give orders, but it would be best to check with the clients
physician first.

9. Answer: B. Insulin cant be in a pill because it is destroyed in

stomach acid.
Insulin must be injected because it is destroyed in the stomach acid if taken
orally. Telling he will get used to shots does not answer his question and is
condescending. Insulin must be injected because it is destroyed in stomach acid
if taken orally; the onset of action is not the issue here. The nurse should
answer the clients question, not refer him back to the physician.

10. Answer: D. I should only use calibrated insulin syringe for the
injections.

To ensure the correct insulin dose, a calibrated insulin syringe must be used.
Insulin injections should be rotated to the arm and thigh, not just the abdominal
area. There is no need to apply direct pressure over the site following an insulin
injection. There is no need to check blood glucose immediately prior to the
injection.

11. Answer: C. The alcohol could predispose you to hypoglycemia.

Alcohol can potentiate hypoglycemic, not hypoglycemic, effects in the client.

Alcohol can cause pancreatic disease, but the clients pancreas is not producing
any insulin currently. Alcohol can cause liver disease, but the more immediate
concern is hypoglycemia.

12. Answer: A. When the client is eating

The onset action for the insulin lispro (Humalog) is 10 to 15 minutes so it must
be given when the client is eating to prevent hypoglycemia. It must be given
when the client is eating, not when the meal trays arrive on the floor and not
thirty minutes before meals.

13. Answer: C. Have the client place the insulin vials in the refrigerator.

Vials not in use should be refrigerated to preserve drug potency. There is no

need to discard the vials. The client should always have additional vials of
insulin available. Writing the date of opening on the vial is good practice, but
does not address the need to refrigerate additional vials.

14. Answer: D. Lantus insulin 20U BID.

Lantus insulin is usually prescribed once-a-day so an order for BID dosing

should be validated with the physician. Humalog insulin can be prescribed for
sliding scale coverage. Regular insulin is administered 30 minutes before meals.
Metformin (Glucophage) is often prescribed in divided doses of 1000 mg per
day.

15. Answer: D. My cells cannot use the insulin my pancreas makes.

With type 2 diabetes mellitus, the pancreas produces insulin, but the cells
cannot use it. Peripheral cells have a decreased, not an increased, sensitivity to
insulin. The beta cells continue to produce insulin with type 2 diabetes. There is
a decrease, not an increase, in receptor sites with type 2 diabetes.

16. Answer: D. All of the above.

The principal goals of therapy for older persons with diabetes mellitus and poor
glycemic control are enhancing quality of life, decreasing the chance of
complications, improving self-care through education, and maintaining or
improving general health status.

17. Answer: A. Physical exercise can slow the progression of diabetes

mellitus.

Physical exercise slows the progression of diabetes mellitus because exercise

has beneficial effects on carbohydrate metabolism and insulin sensitivity.
Strenuous exercise can cause retinal damage and can cause hypoglycemia.
Insulin and foods both must be adjusted to allow safe participation in exercise.
18. Answer: B. Somogyi phenomenon

Somogyi phenomenon manifests itself with nocturnal hypoglycemia, followed by

a marked increase in glucose and increase in ketones.

19. Answer: C. Stimulate the beta cells of the pancreas to secrete

insulin.

Sulfonylureas such as glyburide are used only with patients who have some
remaining pancreatic-beta cell function. These drugs stimulate insulin secretion,
which reduces liver glucose output and increases cell uptake of glucose,
enhancing the number of and sensitivity of cell receptor sites for interaction
with insulin.

20. Answer: B. Release insulin evenly throughout the day and control
basal glucose levels.

Glargine (Lantus) insulin is designed to release insulin evenly throughout the

day and control basal glucose levels.

21. Answer: D. Pancreatic tumor

The onset of hyperglycemia in the older adult can occur more slowly. When the
older adult reports rapid-onset weight loss, elevated blood glucose levels, and
polyphagia, the healthcare provider should consider pancreatic tumor.

22. Answer: D. Perineal itching

Older women might complain of perineal itching due to vaginal candidiasis.

23. Answer: A, B
When an older person is identified as high-risk for diabetes, appropriate testing
would include FPG and OGTT. An FPG greater than 140 mg/dL usually
indicates diabetes. The OGTT is to determine how the body responds to the
ingestion of carbohydrates in a meal. HbA1C evaluates long-term glucose
control. A finger stick glucose three times daily spot-checks blood glucose
levels.

24. Answer: A, B, D

Aging results in reduced ability of beta cells to respond with insulin effectively.
Overweight with waist/hip ratio increase is part of the metabolic syndrome of
DM II. There is an increase in atherosclerosis with DM due to the metabolic
syndrome and sedentary lifestyle.

25. Answer: C. African-American woman.

Age-specific prevalence of diagnosed diabetes mellitus (DM) is higher for

African-Americans and Hispanics than for Caucasians. Among those younger
than 75, black women had the highest incidence.

26. Answer: D. Hyperglycemic hyperosmolar non-ketotic coma.

Illness, especially with the frail elderly patient whose appetite is poor, can result
in dehydration and HHNC. Insulin resistance usually is indicated by a daily
insulin requirement of 200 units or more. Diabetic ketoacidosis, an acute
metabolic condition, usually is caused by absent or markedly decreased
amounts of insulin.

27. Answer: D. Propylthiouracil (PTU)

Propylthiouracil (PTU) initially is given in divided doses, and functions to block

thyroid hormone synthesis.
28. Answer: A, B, D

Acetylsalicylic acid (aspirin), Furosemide (Lasix), and Rifampin (Rifadin) are

most likely to cause hypothyroidism.

29. Answer: C. Ultrasonography

Although thyroid scans frequently are done to evaluate the thyroid gland, I 123
is used to destroy overactive thyroid cells such as are seen in thyroid cancer.
Ultrasonography can be used early in the evaluation process to rule out Graves
disease, nodular goiter, or other thyroid dysfunction.

30. Answer: C. Hypothermia related to slowed metabolic rate

Thyroid hormone deficiency results in reduction in the metabolic rate, resulting

in hypothermia, and does predispose the older adult to a host of other health-
related issues. One-quarter of affected elderly experience constipation.

1. During lecture, the clinical instructor tells the students that 50% to
60% of daily calories should come from carbohydrates. What should the
nurse say about the types of carbohydrates that can be eaten?

A. Try to limit simple sugars to between 10% and 20% of daily calories.
B. Simple carbohydrates are absorbed more rapidly than complex
carbohydrates.
C. Simple sugars cause rapid spike in glucose levels and should be avoided.
D. Simple sugars should never be consumed by someone with diabetes.

2. At the time Cherrie Ann found out that the symptoms

of diabetes were caused by high levels of blood glucose, she decided to
break the habit of eating carbohydrates. With this, the nurse would be
aware that the client might develop what complication?
A. retinopathy
B. atherosclerosis
C. glycosuria
D. acidosis

3. Joko has recently been diagnosed with Type I diabetes and asks
Nurse Jessica for help formulating a nutrition plan. Which of the
following recommendations would the nurse make to help the client
increase calorie consumption to offset absorption problems?

A. Eat small meals with two or three snacks throughout the day to keep blood
glucose levels steady
B. Increase consumption of simple carbohydrates
C. Eating small meals with two or three snacks may be more helpful in
maintaining blood glucose levels than three large meals.
D. Skip meals to help lose weight

4. Billy is being asked concerning his health in the emergency

department. When obtaining a health history from a patient with
acute pancreatitis, the nurse asks the patient specifically about a
history of

A. alcohol use.
B. cigarette smoking.
C. diabetes mellitus.
D. high-protein diet.

5. Nurse Shey is educating a pregnant client who has

gestational diabetes. Which of the following statements should the
nurse make to the client? Select all that apply.

A. Cakes, candies, cookies, and regular soft drinks should be avoided.

B. Gestational diabetes increases the risk that the mother will
develop diabetes later in life.
C. Gestational diabetes usually resolves after the baby is born.
D. Insulin injections may be necessary.
E. The baby will likely be born with diabetes
F. The mother should strive to gain no more weight during the pregnancy.

6. The goal for pre-prandial blood glucose for those with Type
1 diabetes mellitus is:

A. <80 mg/dl
B. <130 mg/dl
C. <180 mg/dl
D. <6%

7. The guidelines for Carbohydrate Counting as medical nutrition

therapy for diabetes mellitus includes all of the following EXCEPT:

A. Flexibility in types and amounts of foods consumed

B. Unlimited intake of total fat, saturated fat and cholesterol
C. Including adequate servings of fruits, vegetables and the dairy group
D. Applicable to with either Type 1 or Type 2 diabetes mellitus

8. The nurse working in the physicians office is reviewing lab results

on the clients seen that day. One of the clients who has classic diabetic
symptoms had an eight-hour fasting plasma glucose (FPG) test done.
The nurse realizes that diagnostic criteria developed by the
American Diabetes Association for diabetes include classic diabetic
symptoms plus which of the following fasting plasma glucose levels?

A. Higher than 106 mg/dl

B. Higher than 126 mg/dl
C. Higher than 140 mg/dl
D. Higher than 160 mg/dl
9. When taking a health history, the nurse screens for manifestations
suggestive of Diabetes Type I. Which of the following manifestations
are considered the primary manifestations of Diabetes Type I and
would be most suggestive and require follow-up investigation?

A. Excessive intake of calories, rapid weight gain, and difficulty losing weight
B. An increase in three areas: thirst, intake of fluids, and hunger
C. Poor circulation, wound healing, and leg ulcers,
D. Lack of energy, weight gain, and depression

10. The nurse is working with an overweight client who has a high-
stress job and smokes. This client has just received a diagnosis of Type
II Diabetes and has just been started on an oral hypoglycemic agent.
Which of the following goals for the client which if met, would be most
likely to lead to an improvement in insulin efficiency to the point the
client would no longer require oral hypoglycemic agents?

A. Comply with medication regimen 100% for 6 months

B. Quit the use of any tobacco products by the end of three months
C. Lose a pound a week until weight is in normal range for height and exercise
30 minutes daily
D. Practice relaxation techniques for at least five minutes five times a day for at
least five months

11. During a visit in a community, the nurse will recommend routine

screening for diabetes when the person has one or more of seven risk
criteria. Which of the following persons that the nurse comes in contact
with most needs to be screened for diabetes based on the seven risk
criteria?

A. A client with an HDL cholesterol level of 40 mg/dl and a triglyceride level of

300 mg/dl
B. A woman who is at 90% of standard body weight after delivering an eight-
pound baby
C. A middle-aged Caucasian male
D. An older client who is hypotensive

12. During the admission of a client with diabetic ketoacidosis, Nurse

Kendra will anticipate the physician ordering which of the following
types of intravenous solution if the client cannot take fluids orally?

A. Lactated Ringers solution

B. 0.9 normal saline solution
C. 5% dextrose in water (D5W)
D. 0.45% normal saline solution

13. You are doing some teaching with a client who is starting on a
sulfonylurea antidiabetic agent. The client mentions that he usually has
a couple of beers each night and takes an aspirin each day to
prevent heart attack and/or strokes. Which of the following responses
would be best on the part of the nurse?

A. As long as you only drink two beers and take one aspirin, this should not be a
problem
B. The aspirin is alright but you need to give up drinking any alcoholic
beverages
C. Taking alcohol and/or aspirin with a sulfonylurea drug can cause development
of hypoglycemia
D. Aspirin and alcohol will cause the stomach to bleed more when on a
sulfonylurea drug

14. Which of the following if stated by the nurse is correct

about Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS)?

A. This syndrome occurs mainly in people with Type I Diabetes

B. It has a higher mortality rate than Diabetic Ketoacidosis
C. The client with HHNS is in a state of overhydration
D. This condition develops very rapidly

15. Nurse Robedee is teaching a thin client about the proper

methods/techniques when giving insulin. Which one of the following is
proper?

A. Pinch the skin up and use a 90 degree angle

B. Use a 45 degree angle with the skin pinched up
C. Massage the area of injection after injecting the insulin
D. Warm the skin with a warmed towel or washcloth prior to the injection

16. Nurse Pira is explaining to the client about Type II Diabetes. Risk
factors of such condition include all of the following except:

A. Advanced age
B. Physical inactivity
C. Obesity
D. Smoking

17. Blood sugar is well controlled when Hemoglobin A1C is:

A. Below 5.7%
B. Between 12%-15%
C. Less than 180 mg/dL
D. Between 90 and 130 mg/dL

18. Which of the following diabetes drugs acts by decreasing the

amount of glucose produced by the liver?

A. Alpha-glucosidase inhibitors
B. Biguanides
C. Meglitinides
D. Sulfonylureas

19. A 39-year-old company driver presents with shakiness,

sweating, anxiety, and palpitations and tells the nurse he has Type
I Diabetes Mellitus. Which of the follow actions should the nurse do
first?

A. Inject 1 mg of glucagon subcutaneously.

B. Administer 50 mL of 50% glucose I.V.
C. Give 4 to 6 oz (118 to 177 mL) of orange juice.
D. Give the client four to six glucose tablets.

20. An external insulin pump is prescribed for a client with diabetes

mellitus and the client asks the nurse about the functioning of the
pump. The nurse bases the response on the information that the pump:

A. is timed to release programmed doses of regular or NPH insulin into the

bloodstream at specific intervals
B. gives a small continuously dose of regular insulin subcutaneously, and the
client can self-administer a bolus with an additional dose from the pump before
each meal
C. continuously infuses small amounts of NPH insulin into the bloodstream while
regularly monitoring blood glucose levels
D. is surgically attached to the pancreas and infuses regular insulin into the
pancreas, which in turn releases the insulin into the bloodstream

21. Which of the following persons would most likely be diagnosed

with Diabetes Mellitus? A 44-year-old:

A. Caucasian woman.
B. Asian woman.
C. African-American woman.
D. Hispanic male.

22. Which of the following factors are risks for the development
of Diabetes Mellitus? Select all that apply.

A. Age over 45 years

B. Overweight with a waist/hip ratio >1
C. Having a consistent HDL level above 40 mg/dl
D. Maintaining a sedentary lifestyle

23. Anton brought his grandfather to the clinic to confirm his blood
sugar levels. Which laboratory test should a nurse anticipate a
physician would order when an older person is identified as high-risk
for Diabetes Mellitus? Select all that apply.

A. Fasting Plasma Glucose (FPG)

B. Two-hour Oral Glucose Tolerance Test (OGTT)
C. Glycosylated hemoglobin (HbA1C)
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

B. anorexia and lethargy
C. diaphoresis and trembling
D. headache and polyuria

25. Mr. Wesley is newly diagnosed with Type I DM and is being seen by
the home health nurse. The doctors orders include: 1200 calorie ADA
diet, 15 units NPH insulin before breakfast, and check blood sugar qid.
When the nurse visits the patient at 5 pm, the nurse observes the man
performing blood sugar analysis. The result is 50 mg/dL. The nurse
would expect the patient to be

A. confused with cold, clammy skin and pulse of 110

B. lethargic with hot dry skin and rapid deep respirations
C. alert and cooperative with BP of 130/80 and respirations of 12
D. short of breath, with distended neck veins and bounding pulse of 96.

Answers and Rationale

Here are the answers for this exam. Gauge your performance by counter
checking your answers to those below. If you have any disputes or clarifications,
please direct them to the comments section.

1. Answer: A. Try to limit simple sugars to between 10% and 20% of

daily calories.

It is recommended that carbohydrates provide 50% to 60% of the daily

calories. Approximately 40% to 50% should be from complex carbohydrates.
The remaining 10% to 20 % of carbohydrates could be from simple sugars.
Studies give no evidence that carbohydrates from simple sugars are digested
and absorbed more rapidly that are complex carbohydrates, and they do not
appear to affect blood sugar control.

2. Answer: D. acidosis

When a clients carbohydrate consumption is inadequate, ketones are produced

from the breakdown of fat. These ketones lower the pH of the blood, potentially
causing acidosis that can lead to a diabetic coma.

3. Answer: C. Eating small meals with two or three snacks may be more
helpful in maintaining blood glucose levels than three large meals.
Eating small meals with two or three snacks may be more helpful in maintaining
blood glucose levels than three large meals.

4. Answer: A. alcohol use.

Alcohol use is one of the most common risk factors for pancreatitis in the United
States.

5. Answer: A, B, C, D

Gestational diabetes can occur between the 16th and 28th week of pregnancy.
If not responsive to diet and exercise, insulin injections may be necessary.
Concentrated sugars should be avoided. Weight gain should continue, but not in
excessive amounts. Usually, gestational diabetes disappears after the infant is
born. However, diabetes can develop 5 to 10 years after the pregnancy.

6. Answer: B. <130 mg/dl

The goal for pre-prandial blood glucose for those with Type 1 diabetes
mellitus is <130 mg/dl.

7. Answer: B. Unlimited intake of total fat, saturated fat and cholesterol

The guidelines for Carbohydrate Counting as medical nutrition therapy

for diabetes mellitus includes all of the following EXCEPT option B, unlimited
intake of total fat, saturated fat and cholesterol.

8. Answer: B. Higher than 126 mg/dl

Diabetes is diagnosed at fasting blood glucose of greater than or equal to 126

mg/dl.
9. Answer: B. An increase in three areas: thirst, intake of fluids, and
hunger

The primary manifestations of diabetes type I are polyuria (increased urine

output), polydipsia (increased thirst), polyphagia (increased hunger).

10. Answer: C. Lose a pound a week until weight is in normal range for
height and exercise 30 minutes daily

When Type II diabetics lose weight through diet and exercise they sometimes
have an improvement in insulin efficiency sufficient to the degree they no longer
require oral hypoglycemic agents.

11. Answer: A. A client with an HDL cholesterol level of 40 mg/dl and a

triglyceride level of 300 mg/dl

The seven risk criteria include: greater than 120% of standard body weight,
Certain races but not including Caucasian, delivery of a baby weighing more
than 9 pounds or a diagnosis of gestational diabetes, hypertensive, HDL greater
than 35 mg/dl or triglyceride level greater than 250 or a triglyceride level of
greater than 250 mg/dl, and, lastly, impaired glucose tolerance or impaired
fasting glucose on prior testing.

12. Answer: D. 0.45% normal saline solution

0.45% normal saline solution is recommended.

13. Answer: C. Taking alcohol and/or aspirin with a sulfonylurea drug

can cause development of hypoglycemia

Alcohol and/or aspirin taken with a sulfonylurea can cause development

of hypoglycemia.
14. Answer: B. It has a higher mortality rate than Diabetic Ketoacidosis

HHNS occurs only in people with Type II Diabetes. It is a medical emergency

and has a higher mortality rate than Diabetic Ketoacidosis. This condition
develops very slowly over hours or days.

15. Answer: A. Pinch the skin up and use a 90 degree angle

The best angle for a thin person is 90 degrees with the skin pinched up. The
area is not massaged and it is not necessary to warm it.

16. Answer: D. Smoking

Additional risk factors for type 2 diabetes are a family history of diabetes,
impaired glucose metabolism, history of gestational diabetes, and
race/ethnicity. African-Americans, Hispanics/Latinos, Asian Americans, Native
Hawaiians, Pacific Islanders, and Native Americans are at greater risk of
developing diabetes than whites.

17. Answer: A. Below 5.7%

A1c measures the percentage of hemoglobin that is glycated and determines

average blood glucose during the 2 to 3 months prior to testing. Used as a
diagnostic tool, A1C levels of 6.5% or higher on two tests indicate diabetes. A1C
of 6% to 6.5% is considered prediabetes.

18. Answer: B. Biguanides

Biguanides, such as metformin, lower blood glucose by reducing the amount of

glucose produced by the liver. Sulfonylureas and Meglitinides stimulate the beta
cells of the pancreas to produce more insulin. Alpha-glucosidase inhibitors block
the breakdown of starches and some sugars, which helps to reduce blood
glucose levels
19. Answer: C. Give 4 to 6 oz (118 to 177 mL) of orange juice.

Because the client is awake and complaining of symptoms, the nurse should
first give him 15 grams of carbohydrate to treat hypoglycemia. This could be 4
to 6 oz of fruit juice, five to six hard candies such as Lifesavers, or 1 tablespoon
of sugar. When a client has worsening symptoms of hypoglycemia or is
unconscious, treatment includes 1 mg of glucagon subcutaneously or
intramuscularly, or 50 mL of 50% glucose I.V. The nurse may also give two to
three glucose tablets for a hypoglycemic reaction.

20. Answer: B. gives a small continuously dose of regular insulin

subcutaneously, and the client can self-administer a bolus with an
additional dose from the pump before each meal

An insulin pump provides a small continuous dose of regular insulin

subcutaneously throughout the day and night, and the client can self-administer
a bolus with an additional dose from the pump before each meal as needed.
Regular insulin is used in an insulin pump. An external pump is not attached
surgically to the pancreas.

21. Answer: C. African-American woman.

Age-specific prevalence of diagnosed diabetes mellitus (DM) is higher for

African-Americans and Hispanics than for Caucasians. Among those younger
than 75, black women had the highest incidence.

22. Answer: A, B, D

Aging results in reduced ability of beta cells to respond with insulin effectively.
Overweight with waist/hip ratio increase is part of the metabolic syndrome of
DM II. There is an increase in atherosclerosis with DM due to the metabolic
syndrome and sedentary lifestyle.
23. Answer: A, B

When an older person is identified as high-risk for diabetes, appropriate testing

would include FPG and OGTT. A FPG greater than 126 mg/dL usually
indicates diabetes. The OGTT is to determine how the body responds to the
ingestion of carbohydrates in a meal. HbA1C evaluates long-term glucose
control. A finger stick glucose three times daily spot-checks blood glucose
levels.

24. Answer: C. diaphoresis and trembling

Diaphoresis and trembling indicates hypoglycemia.

25. Answer: A. confused with cold, clammy skin and pulse of 110

Confused with cold, clammy skin and pulse of 110 indicate hypoglycemia.