125242827-Exam5

Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Chapter 64: Assessment of the Endocrine System

1. What is the effect on the client’s hormone response to a naturally occurring hormone if the client

takes a drug that blocks that hormone’s receptor site?

a. Greater hormone metabolism

b. Decreased hormone activity

c. Increased hormone activity

d. Hormone response would be unchanged

ANS: B

Hormones cause an activity in the target tissues by binding with their specific cellular receptor

sites, thereby changing the cell’s activity. When the receptor sites are occupied by other

substances that block hormone binding, the cell’s response is the same as when there is a

decreased level of the hormone.

2. How does a tropic hormone differ from other hormones?

a. Tropic hormones are synthetic and are given to clients who have a hormone

deficiency.

b. Tropic hormones are exclusively involved in the production of sex hormones.

c. Tropic hormones stimulate other endocrine glands to secrete hormones.

d. Tropic hormones are not under negative feedback control.

ANS: C

The target tissues for tropic hormones are other endocrine glands. The effect of these agents is to

stimulate another endocrine gland to secrete its hormone. Tropic hormones are involved in more

complex negative feedback regulatory loops.

3. The ovaries of an older woman are producing only minimal amounts of estrogen. How will this

effect other hormone production?

a. Increased gonadotropin-releasing hormone (Gn-RH), increased follicle-stimulating

hormone (FSH)

b. Increased Gn-RH, decreased FSH

c. Decreased Gn-RH, increased FSH

d. Decreased Gn-RH, decreased FSH

ANS: A

The trigger for Gn-RH is decreased circulating levels of estrogen. As a woman’s ovarian

production of estrogen decreases, the circulating levels of estrogen also decrease, stimulating the

hypothalamus to increase production and release of Gn-RH. This stimulates the anterior pituitary

gland to increase production and release of FSH.

4. Which will the nurse assess next in a male client who begins to have fluid secretion from his

breasts?

a. Posterior pituitary hormones

b. Adrenal medulla functioning

c. Anterior pituitary hormones

d. Parathyroid functioning

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ANS: C

Breast fluid and milk production are induced by the presence of prolactin, secreted from the

anterior pituitary gland. The hypothalamus regulates secretion of prolactin through the activity of

prolactin-inhibiting hormone. A problem in the hypothalamus or the anterior pituitary gland can

cause lactation in men or women.

5. The client is receiving 300 mg of morphine daily for severe pain. Which is the nurse’s priority

intervention?

a. Measuring intake and output

b. Taking the client’s temperature every 4 hours

c. Auscultating bowel sounds in all four quadrants

d. Asking the client to rate pain on a visual analogue scale

ANS: A

Opiates, particularly morphine, increase the release of vasopressin (antidiuretic hormone),

thereby decreasing urine output.

6. Which statement indicates that the client understands the effect of daily corticosteroids on his

blood glucose levels?

a. “Corticosteroids have destroyed the ability of the pancreas to synthesize insulin.”

b. “I have developed diabetes mellitus.”

c. “My blood glucose level is elevated because corticosteroids increase glucose

synthesis.”

d. “Steroids stimulate insulin production and decrease glucose levels.”

ANS: C

Corticosteroids cause what is termed pseudodiabetes. Increased blood glucose levels result

because of stimulation of liver synthesis of glucose and suppression of glucose use by cells. The

ability of the pancreas to synthesize insulin is unaffected.

7. Which effects does the nurse expect daily cortisol therapy to have on a client’s circulating levels

of adrenocorticotropic hormone (ACTH) and aldosterone?

a. Increased ACTH, increased aldosterone

b. Increased ACTH, decreased aldosterone

c. Decreased ACTH, increased aldosterone

d. Decreased ACTH, decreased aldosterone

ANS: D

Taking exogenous cortisol increases the blood levels of cortisol, causing the negative feedback

loops to be inhibited. The elevated cortisol levels will suppress hypothalamic secretion of

corticotropin-releasing hormone (CRH). Low levels of CRH suppress the anterior pituitary

production of ACTH. Elevated blood levels of cortisol cause increased sodium retention and

water reabsorption, inhibiting aldosterone synthesis.

8. Which is the expected clinical manifestation for a client who has excessive production of

melanocyte-stimulating hormone?

a. Hypoglycemia and hyperkalemia

b. Irritability and insomnia

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c. Increased urine output

d. Darkening of the skin

ANS: D

Melanocyte-stimulating hormone increases the size of melanocytes in the skin and increases the

amount of pigment (melanin) that they produce.

9. Which assessment finding in a client taking a drug that stimulates beta1 receptors requires

immediate action by the nurse?

a. Pulse rate, 50 beats/min

b. Pulse rate, 95 beats/min

c. Pulse rate, 85 beats/min

d. Pulse rate, 100 beats/min

ANS: A

Stimulation of beta1 receptor sites in the heart has positive chronotropic and inotropic actions.

The nurse expects an increase in heart rate and increased cardiac output. The client with a heart

rate of 50 beats/min would be cause for concern, because this would indicate that the client was

not responding to the medication. The other heart rates are within normal limits but on the higher

end and would be considered a therapeutic response to the medication.

10. Which situation or condition is likely to result in an increased production of thyroid hormones?

a. Starvation

b. Dehydration

c. Adequate sleep

d. Cold environmental temperature

ANS: D

Cold environmental temperatures stimulate the hypothalamus to secrete thyrotropin-releasing

hormone, which in turn stimulates the anterior pituitary gland to secrete thyroid-stimulating

hormone (TSH). TSH then stimulates the thyroid gland to secrete thyroid hormones, which,

when bound to target tissues, increase the rate of metabolism to maintain body temperature near

normal.

11. Which endocrine gland function is most important to assess in a client who has bilateral patchy

areas of skin depigmentation on the arms and face?

a. Adrenal gland

b. Thyroid gland

c. Pancreas

d. Ovary

ANS: A

Vitiligo, patchy areas of depigmentation of the skin, is associated with primary hypofunction of

the adrenal glands.

12. Which test result indicates further evaluation is necessary concerning the client’s ability to

manage their diabetes mellitus?

a. Random blood glucose level of 90 mg/dL

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b. 2-hour glucose tolerance test result of 140 mg/dL

c. Glycosylated hemoglobin level of 9%

d. Fasting blood glucose level of 70 mg/dL

ANS: C

The glycosylated hemoglobin level reveals the average blood glucose level over a period of 2 to

3 months. Its primary use is in assessing overall control of the glucose level in diabetes mellitus.

The expected level that indicates good control of diabetes is 7% or lower, according to the

American Diabetes Association. Higher levels indicate that the client’s glucose level has been

consistently higher on a daily basis, which indicates incorporation of more glucose into the

hemoglobin.

13. Which client statement indicates the need for clarification regarding the instructions for

collecting a 24-hour urine specimen for the assessment of endocrine function?

a. “I will continue to take my prescribed heart medicine.”

b. “I will add the preservative to the container at the beginning of the test.”

c. “The collection begins with the urine I excrete first thing in the morning with time

noted.”

d. “The collection ends when I urinate the last specimen 24 hours after the test was

started.”

ANS: C

The 24-hour urine collection specimen is started when the client first arises and urinates. This

first specimen is discarded, but the time is noted. This first urine is discarded because there is no

way to know how long it has been in the bladder. The client adds all urine voided after that first

discarded specimen during the next 24 hours. When the 24-hour mark is reached, the client voids

one last time and adds this specimen to the collection.

14. The client scheduled to have a radioimmunoassay to determine blood hormone levels asks the

nurse how long she will be radioactive. Which is the nurse’s best response?

a. “The level of radiation used is so low that you will not be radioactive.”

b. “The radioisotope is added to the blood sample after it is drawn. You are never

radioactive.”

c. “The term radioimmunoassay is an old term. Radiation is no longer used in this

test.”

d. “Usually, people excrete the isotope within 24 hours, so you will be radioactive for

1 day.”

ANS: B

The client is not exposed to radiation during a radioimmunoassay. The radioisotope is added to

the client’s specimen after it is obtained from the client.

15. The nurse is assessing a client who is suspected of having a gonadotropin deficiency. Which is

the most important assessment finding obtained?

a. Infertility

b. Dry skin

c. Absent menstrual periods

d. Dyspareunia

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ANS: B

The assessment finding of dry skin is the only finding that can be obtained through observation.

Although infertility, absent menstrual periods, and dyspareunia are all characteristic of

gonadotropin deficiency, these findings are not obtained by observation of the client, but by an

interview.

16. The client has been diagnosed with Addison’s disease. His wife asks the nurse if he could be

developing Alzheimer’s disease because he has been exhibiting memory loss. Which is the most

accurate response from the nurse?

a. “I’ll arrange with his physician for testing.”

b. “I’ll perform an assessment and try to determine if there is evidence present of the

disease.”

c. “Have you told your doctor you are concerned about Alzheimer’s disease in your

family?”

d. “Forgetfulness is a symptom of Addison’s disease. I’ll tell your doctor that you are

concerned.”

ANS: D

Forgetfulness is known to be a symptom of Addison’s disease. The nurse cannot determine the

presence or absence of the disease by performing an assessment and should not merely avoid the

issue by asking the client if she has spoken with her physician yet. This would not allay the

wife’s fears.

17. The client is scheduled to begin treatment with androgen replacement and has a concern about

self-administration because of his arthritis. How will the nurse suggest that this medication be

ordered?

a. Oral tablets

b. Intramuscular injection

c. Transdermal patch

d. Intradermal injection

ANS: C

Because this client may be lacking in adequate hand strength, he probably will not be a candidate

for intramuscular injection and therefore should use the transdermal patch. Oral tablets and

intradermal injections are not appropriate routes of administration for androgen replacement

therapy.

18. The client expresses some concern that the drug prescribed prior to endocrine testing is to be

taken during the night. How will the nurse best advise the client?

a. “Take the drug prior to going to sleep at your normal bed time.”

b. “Stay up as late as you can and take the drug right before you go to sleep.”

c. “Set an alarm and take the drug at the scheduled time during the night.”

d. “Take the drug if you wake up during the night. Otherwise, wait until morning.”

ANS: C

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It is important for the nurse to emphasize the importance of taking a drug prescribed for

endocrine testing on time. Setting an alarm during the night will help maintain the proper

schedule and ensure the most accurate results.

MULTIPLE RESPONSE

1. Which are common key features of hormones? (Select all that apply.)

a. The activity of most hormones is of long duration.

b. Continued hormone activity requires continued production and secretion.

c. All hormones exert their influence at a low blood concentration.

d. Most hormones are stored in the target tissue for use later.

e. Most hormones cause target tissues to increase or decrease their activity by

changing gene activity.

ANS: A, B, C

Hormone activity can increase or decrease based on the body’s needs, and continued hormone

activity requires a continued production and secretion loop. Most hormones remain active in the

body over a long duration. Low blood concentration leads to the release of the appropriate

hormones to return the body to a normal, level state.

2. Which assessment finding is expected in a client who is receiving a medication that increases the

release of aldosterone? (Select all that apply.)

a. Blood pressure, 160/90 mm/Hg

b. Potassium, 3.0 mEq/L

c. Blood pressure, 90/50 mm/Hg

d. Potassium, 6.0 mEq/L

ANS: A, B

Aldosterone increases the reabsorption of water and sodium, causing hypertension, and increases

the renal excretion of potassium, resulting in hypokalemia.

Chapter 65: Care of Patients with Pituitary and Adrenal Gland Problems

1. The client has a hormone deficiency. Which deficiency is the highest priority?

a. Growth hormone

b. Luteinizing hormone

c. Thyroid-stimulating hormone

d. Follicle-stimulating hormone

ANS: C

A deficiency of thyroid-stimulating hormone (TSH) is the most life-threatening deficiency of the

hormones listed in this question. TSH is needed to ensure proper synthesis and secretion of the

thyroid hormones, whose functions are essential for life.

2. An adult female client has been diagnosed with a deficiency of most anterior pituitary hormones.

Which fact reported in her history could have contributed to this problem?

a. The client’s mother and sister have adult-onset diabetes mellitus.

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b. The client experienced a postpartum hemorrhage 5 years ago.

c. The client has a severe allergy to shellfish and iodine.

d. The client has used oral contraceptives for 5 years.

ANS: B

Postpartum hemorrhage is the most common cause of pituitary infarction. With this injury to the

pituitary gland, secretion of more than one hormone is deficient. The condition may develop

immediately postpartum or years after the delivery. The other answer options do not necessarily

impact pituitary hormones.

3. Which safety measure will the nurse use for the adult client who has growth hormone

deficiency?

a. Avoiding intramuscular medications

b. Placing the client in protective isolation

c. Using a lift sheet to reposition the client

d. Assisting the client to move slowly from a sitting to a standing position

ANS: C

In adults, growth hormone is necessary to maintain bone density and strength. Adults with

growth hormone deficiency have thin, fragile bones. Avoiding IM medications, using protective

isolation, and assisting the client as he or she moves from sitting to standing will not serve as

safety measures when the client is deficient in growth hormone.

4. The male client with hypopituitarism asks the nurse how long he will have to take testosterone

hormone replacement therapy. Which is the nurse’s best answer?

a. “When your blood levels of testosterone are normal, the therapy is no longer

needed.”

b. “When your beard thickens and your voice deepens, the dose is decreased but will

continue forever.”

c. “When your sperm count is high enough to demonstrate fertility, you will no

longer need this therapy.”

d. “When you start to have undesirable side effects, the dose is decreased to the

lowest possible level and continued until you are 50 years old.”

ANS: B

Testosterone therapy is initiated with high-dose testosterone derivatives and continued until

virilization is achieved. The dose is then decreased, but therapy continues throughout life.

5. When performing personal care on a middle-aged woman, the nurse observes that the client has

very little pubic and axillary hair. Which is the nurse’s best action?

a. Asking the client if she has less pubic hair now than 5 years ago

b. Asking the client the date of her last menstrual period

c. Examining the client’s scalp hair for texture and thickness

d. Drawing blood for laboratory studies

ANS: A

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Although pubic hair thickness varies from person to person, loss of pubic hair is associated with

gonadotropin deficiency. The nurse needs to determine whether this manifestation is normal for

this client. The other answer options would not be applicable to gonadotropin deficiency.

6. The client thought to have a problem with the pituitary gland is given 25 U of regular insulin. A

short time later, blood analysis reveals elevated levels of growth hormone (GH) and

adrenocorticotropic hormone (ACTH). Which is the nurse’s interpretation of this finding?

a. The client has pituitary hypofunction.

b. The client has pituitary hyperfunction.

c. The client has pituitary-induced diabetes mellitus.

d. The client has a normal pituitary response to insulin.

ANS: D

Some tests for pituitary function involve administering agents that are known to stimulate the

secretion of specific pituitary hormones and then measuring the response. Such tests are termed

stimulation tests. For example, the presence of insulin in those with normal pituitary function

causes an increased release of GH and ACTH. The stimulation test for GH or ACTH assessment

involves injecting the client with regular insulin (0.05 to 1 U/kg of body weight) and checking

the circulating levels of GH and ACTH.

7. The client, a middle-aged woman, has acromegaly as a result of a pituitary adenoma found and

removed when she was a teenager. During a physical assessment before surgery for a knee

replacement, the nurse discovers that she has a moderately enlarged liver. Which is the nurse’s

best action?

a. Counseling the client on the health risks of alcoholism

b. Assessing for jaundice

c. Documenting the finding and monitoring the client

d. Drawing blood for lactate dehydrogenase (LDH), serum glutamate pyruvate

transaminase (SGPT), and serum glutamic-oxaloacetic transaminase (SGOT)

ANS: C

Clients with acromegaly or gigantism commonly have organomegaly of the heart and liver.

Other than documenting the finding and monitoring the client, the other actions would be

inappropriate, because the finding is commonly associated with acromegaly.

8. The client just diagnosed with acromegaly is scheduled for a hypophysectomy. Which statement

made by the client indicates a need for clarification regarding this treatment?

a. “I will drink whenever I feel thirsty after surgery.”

b. “I’m glad there will be no visible incision from this surgery.”

c. “I hope I can go back to wearing size 8 shoes instead of size 12.”

d. “I will wear slip-on shoes after surgery so I don’t have to bend over.”

ANS: C

Although removal of the tissue that is oversecreting hormones can relieve many symptoms of

hyperpituitarism, skeletal changes and organ enlargement are not reversible. It will be

appropriate for the client to drink as needed postoperatively, avoid bending over, and reassured

that the incision will not be visible.

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9. The client who had a trans-sphenoidal hypophysectomy 2 days ago now has nuchal rigidity.

Which is the nurse’s priority action?

a. Encouraging the client to do active range-of-motion exercises for the neck

b. Documenting the finding and monitoring the client

c. Taking the client’s temperature

d. Administering pain medication

ANS: C

Nuchal rigidity is a major manifestation of meningitis, a potential postoperative complication

associated with this surgery. Meningitis is an infection, and usually the client also will have a

fever. Range-of-motion exercises are definitely inappropriate because meningitis is probably

present. Although pain medication may be a palliative measure, it is not the most appropriate

initial action.

10. Which statement made by the client who is going home after a trans-sphenoidal hypophysectomy

indicates an adequate understanding of actions to prevent complications from this treatment?

a. “I will wear dark glasses whenever I am outdoors.”

b. “I will keep food on upper shelves in the refrigerator so that I do not have to bend

over.”

c. “I will wash the incision line every day with peroxide and redress it immediately.”

d. “I will remember to cough and deep breathe at least every 2 hours while I am

awake.”

ANS: B

After this surgery, the client must take care to avoid activities that can increase intracranial

pressure. They should avoid bending from the waist and should not bear down, cough, or lie flat.

11. The family of a client with syndrome of inappropriate antidiuretic hormone (SIADH) asks the

nurse if the water restriction is a punishment for the client’s uncooperative behavior. Which is

the nurse’s best response?

a. “Limiting fluid intake decreases the risk of kidney failure.”

b. “Limiting water intake prevents the client from losing too much fluid by

vomiting.”

c. “Limiting fluid intake keeps the client’s blood from becoming more dilute and

causing other complications.”

d. “Limiting fluid decreases the client’s sense of thirst and prevents him from

drinking liquids that contain an excess of sodium.”

ANS: C

The increased water reabsorption that occurs with SIADH causes a fluid overload and can dilute

serum electrolytes, especially sodium, to dangerously low levels. Appropriate therapy aims to

reduce the overhydration by limiting fluids and increasing urine output.

12. Which safety measure is most important for the nurse to institute for a client who has Cushing’s

disease?

a. Padding the siderails of the client’s bed

b. Assisting the client to change positions slowly

c. Using a lift sheet to change the client’s position

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d. Keeping suctioning equipment at the client’s bedside

ANS: C

Cushing’s syndrome or disease greatly increases the serum levels of cortisol, which contributes

to excessive bone demineralization and increases the risk for pathologic bone fractures. The

client should not require suctioning. Padding the siderails and assisting the client to change

position may be effective, but they will not protect him or her as much as using a lift sheet.

13. Which dietary alterations will the nurse make for the client with Cushing’s disease?

a. High protein, high carbohydrate, low potassium

b. Low carbohydrate, high calorie, low sodium

c. Low protein, high carbohydrate, low calcium

d. High carbohydrate, low potassium, fluid restriction

ANS: B

The client with Cushing’s disease has weight gain, muscle loss, hyperglycemia, and sodium

retention. Dietary modifications need to include reduction of total calories and carbohydrates to

prevent or reduce the degree of hyperglycemia. The sodium retention causes water retention and

hypertension. Clients are encouraged to restrict their sodium intake moderately.

14. The client who has been taking high-dose corticosteroid therapy for 1 month to treat a severe

inflammatory condition, which has now resolved, asks the nurse why she needs to continue

taking the corticosteroids. Which is the nurse’s best response?

a. “It is possible for the inflammation to recur.”

b. “Once you have been started on a replacement hormone, you must continue the

hormone replacement therapy for a certain amount of time.”

c. “The drug suppresses your adrenal gland secretion of corticosteroids and you need

to decrease your dose slowly so your glands will begin to work again.”

d. “The drug suppresses your immune system and you need to build this back up by

slowly decreasing the medication.”

ANS: B

One of the most common causes of adrenal insufficiency, a life-threatening problem, is the

sudden cessation of long-term, high-dose corticosteroid therapy. This therapy suppresses the

hypothalamic-pituitary-adrenal axis and must be withdrawn gradually to allow for pituitary

production of ACTH and adrenal production of cortisol.

15. The client has received vasopressin (DDAVP) for diabetes insipidus. Which assessment finding

indicates a therapeutic response to this therapy?

a. Urine output is increased; specific gravity is increased.

b. Urine output is increased; specific gravity is decreased.

c. Urine output is decreased; specific gravity is increased.

d. Urine output is decreased; specific gravity is decreased.

ANS: C

Diabetes insipidus causes urine output to be greatly increased, with a low urine osmolarity, as

evidenced by a low specific gravity. Effective treatment results in a decreased urine output that is

more concentrated, as evidenced by an increased specific gravity.

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16. The client with adrenocortical insufficiency has an irregular pulse. Which is the nurse’s priority

intervention?

a. Documenting the finding and reassessing in 1 hour

b. Assessing blood pressure in both arms

c. Administering atropine sulfate

d. Assessing the telemetry reading

ANS: D

Adrenocortical insufficiency causes excessive reabsorption of potassium, leading to

hyperkalemia. The hyperkalemia is considered to be a life-threatening emergency, resulting in

dysrhythmias and cardiac arrest. The nurse should further assess the cardiac rhythm and then

assess laboratory findings as well. Documenting and reassessing are not the only actions that the

nurse should take. Atropine is administered for bradycardia, not irregular pulse rhythms.

Assessing blood pressure is not going to help determine why the pulse is irregular.

17. The client with adrenal hyperfunction screams at her husband, bursts into tears, and throws her

water pitcher against the wall. She then tells the nurse, “I feel like I am going crazy.” Which is


a. “I will ask your doctor to order a psychiatric consult for you.”

b. “You feel this way because of your hormone levels.”

c. “Can I bring you information about support groups?”

d. “I will close the door to your room and restrict visitors.”

ANS: B

Changes in blood cortisol levels can cause the client to show neurotic or psychotic behavior. The

client needs to know that these behavior changes do not reflect a true psychiatric disorder and

will resolve when therapy results in lower and steadier blood cortisol levels. Drug therapy to

reduce these feelings and behaviors may be appropriate.

18. Which client statement indicates a need for further clarification regarding medications after a

bilateral adrenalectomy?

a. “I will take my cortisol replacement with food.”

b. “I will avoid aspirin or aspirin-containing products.”

c. “If I have any kind of stress, I will increase my doses of cortisol.”

d. “If I have nausea or vomiting, I will skip the medication until it is resolved.”

ANS: D

Cortisol replacement after bilateral adrenalectomy must continue on a daily basis for the rest of

the client’s life. Skipping doses could cause adrenal crisis. If the client cannot take the

replacement by mouth, arrangements must be made for the client to receive the drug parenterally.

19. Which serum electrolyte values alert the nurse to the possibility of hyperaldosteronism?

a. Serum sodium 150 mmol/L, serum potassium 2.5 mmol/L

b. Serum sodium 140 mmol/L, serum potassium 5.0 mmol/L

c. Serum sodium 130 mmol/L, serum potassium 2.5 mmol/L

d. Serum sodium 130 mmol/L, serum potassium 7.5 mmol/L

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ANS: A

Aldosterone increases the reabsorption of sodium and excretion of potassium.

Hyperaldosteronism causes hypernatremia and hypokalemia.

20. The client is being treated with spironolactone (Aldactone). Which precautions will the nurse

teach this client?

a. “Read the label before using salt substitutes.”

b. “Avoid salty foods.”

c. “Avoid exposure to sunlight.”

d. “Avoid acetaminophen.”

ANS: A

Spironolactone is a potassium-sparing diuretic and its use can lead to hyperkalemia. Some salt

substitutes are composed of potassium chloride and should be avoided by clients on

spironolactone therapy. There is no reason why the client can’t eat salty foods, be exposed to

sunlight, or use acetaminophen.

21. Which assessment maneuver will the nurse avoid performing with a client suspected of having a

pheochromocytoma?

a. Having the client attempt to touch the chin to the chest

b. Inflating the blood pressure cuff above 200 mm Hg

c. Attempting to dorsiflex the feet

d. Palpating the abdomen

ANS: D

Pheochromocytomas are found on the adrenal glands or in the abdomen. Palpation of a

pheochromocytoma can cause intense release of catecholamines and precipitate a hypertensive

crisis. There is no reason why the nurse could not dorsiflex the feet, touch the client’s chin to the

chest, or inflate the blood pressure cuff above 200 mm Hg.

22. The client has chronic hypercortisolism. Which intervention is the highest priority for the nurse?

a. Washing the hands when entering room

b. Keeping the client in isolation

c. Observing the client for increased white blood cell counts

d. Assessing the daily chest x-ray

ANS: A

Excess cortisol reduces the number of circulating lymphocytes, inhibits maturation of

macrophages, reduces antibody synthesis, and inhibits production of cytokines and inflammatory

chemicals. As a result, these clients are at greater risk of infection and may not have the expected

inflammatory manifestations when an infection is present. The nurse needs to take precautions to

decrease the client’s risk. It is not necessary to keep the client in isolation. The client with

hypercortisolism will not have the expected response to an infection and will be difficult to

assess.

23. The client is beginning treatment with bromocriptine (Parlodel). The nurse has initiated teaching

sessions about potential side effects. Which is the most important point of instruction?

a. “Take your temperature daily.”

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b. “Begin treatment to prevent constipation.”

c. “Plan to take the medication on an empty stomach.”

d. “Report syncopal episodes.”

ANS: B

Constipation is an expected side effect of treatment with bromocriptine, whereas changes in

temperature and syncope are not. The client may experience hypotension. The medication should

be taken with food to minimize the side effects.

24. The nurse is caring for a client who has undergone a hypophysectomy. Which is the nurse’s

priority postoperative intervention?

a. Keeping the head of the bed flat

b. Instructing the client to cough, turn and deep breathe

c. Reporting any clear or yellow drainage from the nose or incision site

d. Applying petroleum jelly to the client’s lips to avoid mouth dryness

ANS: C

A light yellow drainage or a halo effect on the dressing is indicative of a cerebrospinal leak. The

client should have the head of the bed elevated after surgery. Although deep breathing is

important postoperatively, coughing should be avoided to prevent cerebrospinal leakage.

Although the application of petroleum jelly to the lips will help with mouth dryness, this

instruction is not as important as reporting the yellowish drainage.

25. The client is being treated with demeclocycline (Declomycin). Which is the nurse’s priority

intervention while the client is undergoing treatment with this medication?

a. Assessing oral mucous membranes daily

b. Applying petroleum lubricant to lips

c. Applying lotion as needed

d. Rinsing the client’s toothbrush with hot water

ANS: A

The client should have his oral mucous membranes assessed daily for evidence of yeast

infection. His toothbrush should be rinsed with bleach. Water-soluble lubricant should be used,

not petroleum-based. Applying lotion to the client’s skin is not a priority intervention.

26. Which set of laboratory results would be most indicative of hypofunction of the adrenal gland?

a. Hypernatremia and hypokalemia

b. Hyperkalemia and hypercalcemia

c. Hypercortisol and hypokalemia

d. Hypocalcemia and hypokalemia

ANS: B

Hypofunction of the adrenal gland will result in decreased sodium, increased potassium,

increased calcium, increased bicarbonate, increased blood urea nitrogen (BUN), normal to

decreased glucose, and decreased cortisol levels.

MULTIPLE RESPONSE

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1. Which physical characteristics are indicative of anterior pituitary hyperfunction? (Select all that

apply.)

a. Narrowed lips

b. Protrusion of the lower jaw

c. High-pitched voice

d. Enlarged hands and feet

e. Kyphosis

f. Barrel-shaped chest

g. Excessive sweating

ANS: B, D, E, F, G

Anterior pituitary hyperfunction typically will cause thickened lips, protrusion of the lower jaw,

deepening of the voice, enlarged hands and feet, kyphosis, barrel-shaped chest, and excessive

sweating.

2. Which condition may cause hypopituitarism? (Select all that apply.)

a. Benign tumors

b. Diplopia

c. Anorexia nervosa

d. Hypotension

e. Shock

f. Weight gain

g. Infertility

h. Hyperglycemia

ANS: A, C, D, E

These four conditions can cause hypopituitarism. The other options are not indicative of

hypopituitarism.

Chapter 66: Care of Patients with Problems of the Thyroid and Parathyroid Glands

1. A client presents with elevations in triiodothyronine (T3) and thyroxine (T4), and a decrease in

thyroid stimulating hormone levels (TSH). Which is the nurse’s priority intervention?

a. Administer levothyroxine (Synthroid).

b. Administer liothyronine (Cytomel).

c. Monitor the apical pulse.

d. Assess for Trousseaus’ sign.

ANS: C

The client’s laboratory findings suggest that the client is experiencing hyperthyroidism. The

reduction in TSH comes as a negative feedback from the elevated thyroid hormone levels and

elevated metabolic rate. The increased metabolic rate can cause an increase in the client’s heart

rate and the client should be monitored for the development of dysrhythmias. Placing the client

on telemetry monitory might also be a precaution.

2. Which is the best instruction for the nurse to give a client scheduled for a thyroid scan?

a. “You will have external beam radiation.”

b. “No radiation is used for this scan.”

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c. “Low-dose radiation is used and is excreted by the kidneys.”

d. “Your thyroid will be radioactive for weeks.”

ANS: C

The radioactive iodine used in thyroid scans is of low intensity and has such a short half-life that

the client is not considered to be a radiation hazard. Thus, no radiation precautions are necessary.

3. Which dietary modification will the nurse provide for the client with hyperthyroidism?

a. Decreased calories and proteins and increased carbohydrates

b. Elimination of carbohydrates and increased proteins and fats

c. Increased calories, proteins, and carbohydrates

d. Supplemental vitamins and reduction of calories

ANS: C

The client is hypermetabolic and has an increased need for calories, carbohydrates, and proteins.

Proteins are especially important because the client is at risk for a negative nitrogen balance.

4. Which client would not be able to have radioactive iodine therapy?

a. An adult with asthma

b. A pregnant woman

c. A man with type 2 diabetes mellitus

d. An older woman with mild heart failure

ANS: B

Radioactive iodine therapy is contraindicated in pregnant women because 131

I crosses the

placenta and can adversely affect the fetal thyroid gland. The other clients would have no

contraindication to the substance.

5. The client with hyperthyroidism is taking lithium carbonate. Which finding indicates that the

client is having side effects of this therapy?

a. Blurred vision

b. Increased thirst and urination

c. Increased sweating and diarrhea

d. Decreased attention span and insomnia

ANS: B

Lithium antagonizes antidiuretic hormone and can cause symptoms of diabetes insipidus. The

other choices are not specific to lithium.

6. The client scheduled for a partial thyroidectomy asks the nurse why she is being given an iodine

preparation before surgery. Which is the nurse’s best response?

a. “It is to make the internal surgical environment sterile.”

b. “It is to stimulate the storage of thyroid hormones.”

c. “It is to replace the thyroid hormones that will be eliminated as a result of your

surgery.”

d. “It is to decrease the size of the blood vessels in the thyroid and prevent excessive

bleeding during surgery.”

ANS: D

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Iodine preparations decrease the size and vascularity of the thyroid gland, reducing the risk for

hemorrhage and the potential for thyroid storm during surgery.

7. Twelve hours after a total thyroidectomy, the client develops stridor on exhalation. Which is the

nurse’s priority intervention?

a. Reassuring the client that the voice change is temporary

b. Documenting the finding and assessing the client hourly

c. Hyperextending the client’s neck

d. Calling for emergency assistance

ANS: D

Stridor on exhalation is a hallmark of respiratory distress, usually caused by obstruction resulting

from edema. One emergency measure is to remove the surgical clips to relieve the pressure. This

might be a physician function. Emergency intubation also may be necessary. The other choices

would not address the emergency situation.

8. On the second postoperative day after a subtotal thyroidectomy, the client tells the nurse that he

feels numbness and tingling around his mouth. Which is the nurse’s priority intervention?

a. Offering mouth care

b. Loosening the dressing

c. Notifying the physician immediately

d. Documenting the finding and assessing the client hourly

ANS: C

Numbness and tingling around the mouth or in the fingers and toes are manifestations of

hypocalcemia, which could progress to cause tetany and seizure activity. The other choices

would not address the emergency situation.

9. Which client statement alerts the nurse to the possibility of hypothyroidism?

a. “My sister has thyroid problems.”

b. “I seem to feel the heat more than other people.”

c. “Food just doesn’t taste good without a lot of salt.”

d. “I am always tired, even with 10 or 12 hours of sleep.”

ANS: D

Clients with hypothyroidism usually feel tired or weak and often report an increase in time spent

sleeping, sometimes up to 14 to 16 hours daily.

10. Which medication will the nurse be prepared to administer to a client with bradycardia as a result

of hypothyroidism?

a. Atropine sulfate

b. Levothyroxine sodium (Synthroid)

c. Propranolol (Inderal)

d. Epinephrine

ANS: B

The treatment for bradycardia from hypothyroidism is to treat the hypothyroidism using

levothyroxine sodium.

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11. Which is the priority nursing diagnosis for the client with hypothyroidism?

a. Hyperthermia

b. Disturbed Body Image

c. Disturbed Thought Processes

d. Imbalanced Nutrition: More than Body Requirements

ANS: C

Hypothyroidism causes many problems in psychosocial functioning. Depression is the most

common reason for seeking medical attention. Memory and attention span may be impaired.

Paranoia and agitation also may be present.

12. Which assessment finding best indicates that treatment with levothyroxine (Synthroid) has been

successful?

a. The client is thirsty.

b. The client’s weight has been the same for 3 weeks.

c. The client’s total white blood cell count is 6000 cells/mm3.

d. The client’s heart rate is 70 beats/min.

ANS: D

Hypothyroidism decreases body functioning, and can result in effects such as bradycardia,

confusion, and constipation. If a client’s heart rate is bradycardic while on thyroid hormone

replacement, this is an indicator that the replacement may not be adequate. Conversely, a heart

rate above 100 beats/min may indicate that the client is receiving too much of the thyroid

hormone. Changes in other body systems such as bowel regularity may also give an indication

about thyroid hormone status. The client should have regular tests to determine TSH, T3, and T4

levels.

13. The client with hypothyroidism as a result of Hashimoto’s thyroiditis asks the nurse how long

she will have to take thyroid medication. Which is the nurse’s best response?

a. “You will need to take the thyroid medication until the goiter is completely gone.”

b. “The thyroiditis will be cured with antibiotics. Then you won’t need the thyroid

medication.”

c. “You’ll need thyroid replacement therapy for life because the gland function will

not return.”

d. “When thyroid function studies indicate a normal blood level, you can stop the

medication.”

ANS: C

Hashimoto’s thyroiditis results in a permanent loss of thyroid function.

14. Which client is at greatest risk for hyperparathyroidism?

a. The client with pregnancy-induced hypertension

b. The client receiving dialysis for end-stage kidney disease

c. The older adult client with moderate heart failure

d. The older adult on home oxygen therapy

ANS: B

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Clients who have chronic kidney disease do not completely activate vitamin D and poorly absorb

calcium from the gastrointestinal (GI) tract. They are chronically hypocalcemic, which triggers

overstimulation of the parathyroid glands.

15. Which intervention will the nurse use to prevent injury in the client with hyperparathyroidism?

a. Instruct the client to place both hands behind his or her neck when moving.

b. Use a lift sheet to assist the client with position changes.

c. Instruct the client to use a soft-bristled toothbrush.

d. Strain all urine for at least 24 hours.

ANS: B

Hyperparathyroidism causes increased resorption of calcium from the bones, increasing the risk

for pathologic fractures. The use of a lift sheet when moving or positioning the client, instead of

pulling on the client, reduces the risk of bone injury. The other interventions would not be

effective for the client with hyperparathyroidism.

DIF: Cognitive Level: Application REF: N/A for Application and above

OBJ: Learning Outcome 3

TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection

Control) MSC: Integrated Process: Nursing Process (Implementation)

16. When taking the blood pressure of a client after a parathyroidectomy, the nurse notes that the

client’s hand has gone into flexion contractions. Which does the nurse determine may be the

cause of this symptom?

a. Hypokalemia

b. Hyperkalemia

c. Hyponatremia

d. Hypocalcemia

ANS: D

Hypocalcemia destabilizes excitable membranes and can lead to muscle twitches, spasms, and

tetany. This effect of hypocalcemia is enhanced in the presence of tissue hypoxia. The flexion

contractions (Trousseau’s sign) occurring during blood pressure measurement are indicative of

hypocalcemia.

17. The client is receiving methimazole (Tapazole). Which should be included in client education

regarding the initiation of this therapy?

a. “An increased need for sleep can occur with this drug. If it does, call your doctor.”

b. “Nausea and vomiting are serious complication of the medication you are taking.”

c. “Take your pulse every day, as you were taught. If it is too fast, call your doctor.”

d. “This medication may cause dyspnea or vertigo. Call your doctor if this occurs.”

ANS: A

Antithyroid medication may result in hypothyroidism, which is manifested by sleepiness and

intolerance to cold. The client must be closely monitored to determine the need for drug regimen

changes.

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18. The client has diabetes mellitus. Her daughter has recently been diagnosed with Graves’ disease.

The client asks the nurse if she is responsible for her daughter having Graves’ disease. Which

will be the best response of the nurse?

a. “There is no known connection between Graves’ disease and diabetes, so you can

be certain that you having diabetes did not cause your daughter to have Graves’

disease.”

b. “There is an association between Graves’ disease and diabetes, but you having

diabetes did not cause your daughter to have Graves’ disease.”

c. “Graves’ disease is associated with autoimmune diseases such as rheumatoid

arthritis, but not with a disease such as diabetes.”

d. “Unfortunately, Graves’ disease is associated with diabetes, and there is a

possibility that your diabetes could have led to your daughter having Graves’

disease.”

ANS: B

There is a known association between autoimmmune diseases such as rheumatoid arthritis and

diabetes mellitus. The predisposition is probably polygenic.

19. The nurse is assessing a client with Graves’ disease. Which finding will the nurse report

immediately to the health care provider?

a. Blood pressure increased from 130/90 to 135/90 mm Hg.

b. Respiratory rate increased from 22 to 24 breaths/min.

c. Temperature increased 1° F.

d. Apical pulse increased from 80 to 85 beats/min.

ANS: C

A temperature increase of 1° F may indicate the development of thyroid storm. There is no

evidence that a slight increase in respiratory rate, blood pressure, or apical pulse would be as

indicative of thyroid storm as a 1° F increase in temperature.

20. The client has undergone a complete thyroidectomy. Which statement by the client indicates that

further instruction is needed?

a. “I may need calcium replacement.”

b. “After the surgery, I won’t need to take any more thyroid medication.”

c. “I’ll need to take thyroid hormones for life.”

d. “I can receive pain medication if I feel that I need it.”

ANS: B

After the client undergoes a thyroidectomy, the client must be given thyroid replacement

medication for life. He or she may also need calcium if the parathyroid is damaged during

surgery, and can receive pain medication postoperatively.

21. Which alteration in vital signs is most indicative of hypothyroidism?

a. Temperature of 97.9° F

b. Respiratory rate of 16 breaths/min

c. Blood pressure of 118/70 mm/Hg

d. Apical rate of 50 beats/min

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ANS: D

The heart rate is frequently less than 60 beats/min when hypothyroidism develops. Of the vital

sign assessments provided, none would be as indicative of hypothyroidism as a heart rate of 50

beats/min.

MULTIPLE RESPONSE

1. Which condition increases the risk of Graves’ disease? (Select all that apply.)

a. Autoimmune disease

b. Gene mutation

c. Type 1 diabetes

d. Pernicious anemia

ANS: A, C, D

The pattern of inheritances of Graves’ disease appears to be familial clustering. However, a

specific gene or gene mutation has not been identified as a cause of Graves’ disease. Those with

autoimmune disease appear to be at a higher risk.

Chapter 67: Care of Patients with Diabetes Mellitus

1. In preparing a staff inservice presentation about diabetes mellitus, the nurse includes which

information?

a. Diabetes increases the risk for development of epilepsy.

b. The cure for diabetes is the administration of insulin.

c. Diabetes increases the risk for development of cardiovascular disease.

d. Carbohydrate metabolism is disturbed in diabetes, but protein and lipid metabolism

are normal.

ANS: C

Diabetes mellitus is a major risk factor for morbidity and mortality caused by coronary artery

disease, cerebrovascular disease, and peripheral vascular disease.

2. The client with diabetes asks the nurse why it is necessary to maintain blood glucose levels no

lower than about 74 mg/dL. Which is the nurse’s best response?

a. “Glucose is the only type of fuel used by body cells to produce the energy needed

for physiologic activity.”

b. “The central nervous system, which cannot store glucose, requires a continuous

supply of glucose for fuel.”

c. “Without a minimum level of glucose circulating in the blood, erythrocytes cannot

produce ATP.”

d. “The presence of glucose in the blood counteracts the formation of lactic acid and

prevents acidosis.”

ANS: B

Because the brain cannot synthesize or store significant amounts of glucose, a continuous supply

from the body’s circulation is needed to meet the fuel demands of the central nervous system.

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3. In monitoring a client with hypoglycemia, the nurse recognizes which action of glucagon?

a. Glucagon enhances the activity of insulin, restoring blood glucose levels to normal

more quickly after a high-calorie meal.

b. Glucagon is a storage form of glucose and can be broken down for energy when

blood glucose levels are low.

c. Glucagon converts the excess glucose into glycogen, lowering blood glucose levels

in times of excess.

d. Glucagon prevents hypoglycemia by promoting glucose release from liver storage

sites.

ANS: D

Glycogen is a counterregulatory hormone secreted by the alpha cells of the pancreas when blood

glucose levels are low. The actions of glycogen that raise blood glucose levels include

stimulating the liver to break down glycogen (glycogenolysis) and forming new glucose from

protein breakdown (gluconeogenesis).

4. The nurse correlates the polyuria seen in clients with untreated diabetes mellitus with which

physiologic response?

a. Inadequate secretion of antidiuretic hormone (ADH)

b. Early-stage renal failure causing a loss of urine-concentrating capacity

c. Chronic stimulation of the detrusor muscle by the ketone bodies in the urine

d. Hyperosmolarity of the extracellular fluids secondary to hyperglycemia

ANS: D

Polyuria results from an osmotic diuresis caused by excess excretion of glucose in the urine.

5. The nurse correlates which assessment finding in the client with diabetes mellitus with

decreasing renal function?

a. Ketone bodies in the urine during acidosis

b. Glucose in the urine during hyperglycemia

c. Protein in the urine during a random urinalysis

d. White blood cells in the urine during a random urinalysis

ANS: C

Urine should not contain protein. The presence of proteinuria in a diabetic marks the beginning

of renal problems known as diabetic nephropathy, which progresses eventually to end-stage

kidney disease. Chronically elevated blood glucose levels cause renal hypertension and excess

kidney perfusion, with leakage from the renal vasculature. The excess leaking allows larger

substances, such as proteins, to be filtered into the urine.

6. A client newly diagnosed with type 1 diabetes mellitus wears glasses for myopia and asks the

nurse how frequently he should see his ophthalmologist. Which is the nurse’s best answer?

a. “At your age, you do not need to change your usual patterns for visiting the

ophthalmologist.”

b. “See your ophthalmologist whenever you have a vision problem and yearly after

you are 40 years old.”

c. “Your vision will change more quickly now. You should see the ophthalmologist

whenever you find that your glasses are not strong enough to allow you to read

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comfortably.”

d. “The disease increases your risk for cataracts, glaucoma, and retinal blood vessel

changes, so you should see the ophthalmologist yearly, even when you do not have

a new vision problem.”

ANS: D

Diabetic retinopathy is a leading cause of blindness in North America. All clients with diabetes,

regardless of age, should be examined by an ophthalmologist (rather than an optometrist or

optician) at diagnosis and at least yearly thereafter.

7. During the assessment of a client with a 15-year history of diabetes, the nurse notes that the

client has decreased tactile sensation in both feet. Which action does the nurse take first?

a. Documents the finding as the only action

b. Tests sensory perception in the client’s hands

c. Examines the client’s feet for signs of injury

d. Notifies the health care provider

ANS: C

Diabetic neuropathy is common when the disease is of long duration. It cannot be reversed. The

client is at great risk for injury in any area with decreased sensation, because he or she is less

able to feel injurious events.

8. Which is the nurse’s best response about developing diabetes to the client whose father has type

1 diabetes mellitus?

a. “You have a greater susceptibility for developing the disease, with a 1 in 20 to 50

chance.”

b. “Your risk is the same as the general population, because there is no genetic risk

for development of type 1 diabetes.”

c. “Type 1 diabetes is inherited in an autosomal dominant pattern. Therefore, the risk

for becoming diabetic is 50%.”

d. “Because you are a woman and your father is the parent with the diabetes, your

risk is not increased for eventual development of the disease. However, your

brothers will become diabetic.”

ANS: A

Although type 1 diabetes does not follow any specific genetic pattern of inheritance, clients who

have one parent with type 1 diabetes are at an increased risk for its development. The incidence

of diabetes in those with a parent with type 1 diabetes ranges between 1 in 20 to 50, compared

with 1 in 400 to 1000 in those without a parent with type 1 diabetes.

9. To delay the onset of microvascular and macrovascular complications in the diabetic client, the

nurse stresses which action?

a. Controlling hyperglycemia

b. Preventing hypoglycemia

c. Restricting fluid intake

d. Preventing ketosis

ANS: A

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The Diabetes Control and Complications Trial, a prospective study involving 29 medical centers

and more than 1400 clients with type 1 diabetes, has provided convincing evidence that

hyperglycemia is a critical factor in the pathogenesis of long-term diabetic complications.

10. The nurse recognizes which client as being at greatest risk for undiagnosed diabetes mellitus?

a. Young white man

b. Middle-aged African-American man

c. Young African-American woman

d. Middle-aged Native American woman

ANS: D

The highest incidence of diabetes mellitus in the United States is among Native Americans. The

incidence of diabetes increases in all races and ethnic groups with age.

11. A client whose mother has type 2 diabetes mellitus asks the nurse what the chances are of

developing diabetes because of her mother’s disease. Which is the nurse’s best response?

a. “You have a greater susceptibility for developing the disease, with a 1 in 20 to 50

chance.”

b. “Your risk is the same as the general population, because there is no genetic risk

for development of type 2 diabetes.”

c. “Type 2 diabetes is inherited in an autosomal dominant pattern. Therefore, your

risk for becoming diabetic is 50%.”

d. “Children of people with type 2 diabetes have a 15% chance of developing the

disease, but environmental factors, such as obesity, also influence your risk.”

ANS: D

Type 2 diabetes shows a stronger genetic predisposition or tendency than type 1. The risk for

people who have one parent with type 2 diabetes is at least 15% for actually developing the

disease and 30% for having impaired glucose tolerance. This type of diabetes is greatly

influenced by other modifiable variables, such as obesity and a sedentary lifestyle.

12. To prevent bloodborne infections in clients with diabetes, the nurse includes which statement in

the teaching about self-monitoring of blood glucose levels?

a. “Wash your hands before beginning the test.”

b. “Do not share your monitoring equipment.”

c. “Blot excess blood from the strip.”

d. “Use gloves during monitoring.”

ANS: B

Small particles of blood can adhere to the monitoring device and infection can be transported

from one user to another.

13. The nurse includes which information when teaching the client newly diagnosed with type 1

diabetes mellitus about when to measure urine ketone bodies?

a. “Daily, just before you take your insulin.”

b. “Whenever you test your blood for glucose.”

c. “Whenever you are ill or your blood sugar is consistently higher than 300 mg/dL.”

d. “Whenever you participate in vigorous exercise or experience a change in your

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daily activity level.”

ANS: C

The presence of ketone bodies in the urine may indicate impending ketoacidosis. Daily testing is

not necessary. Urine should be tested for ketone bodies whenever the client is acutely ill, under

stress, pregnant, or participating in a weight reduction program, or has symptoms of ketoacidosis

(nausea, vomiting, and abdominal pain).

14. A client who has type 2 diabetes is prescribed to take an oral sulfonylurea agent to maintain

control of blood glucose levels. Which precautions does the nurse need to include in the teaching

plan related to this medication?

a. “Change positions slowly.”

b. “Avoid taking nonsteroidal anti-inflammatory drugs.”

c. “Do not skip the medication, even if you are unable to eat.”

d. “Discontinue the medication if you develop an infection.”

ANS: B

Nonsteroidal anti-inflammatory drugs potentiate the hypoglycemic effects of sulfonylurea

agents.

15. The client with type 2 diabetes has recently been changed from the oral antidiabetic agents

glyburide (Micronase) and metformin (Glucophage) to glyburide-metformin (Glucovance). The

nurse includes which information in the teaching about this medication?

a. “Glucovance is more effective than glyburide and metformin.”

b. “Glucovance contains a combination of glyburide and metformin.”

c. “Glucovance is a new oral insulin and replaces all other oral antidiabetic agents.”

d. “Your diabetes is improving and you now only need one drug for blood glucose

control.”

ANS: B

Glucovance is composed of glyburide and metformin. It is given to increase the convenience of

antidiabetic therapy with glyburide and metformin.

16. Which statement made by the client with type 2 diabetes taking nateglinide (Starlix) indicates

understanding of this therapy?

a. “I’ll take this medicine with my meals.”

b. “I’ll take this medicine 15 minutes before I eat.”

c. “I’ll take this medicine just before I go to bed.”

d. “I’ll take this medicine as soon as I wake up in the morning.”

ANS: B

Nateglinide is a D-phenylalanine derivative that causes the beta cells of the pancreas to undergo

depolarization and release a small amount of preformed insulin. The peak action occurs about 20

minutes after ingestion. To obtain the best action and prevent hypoglycemia, clients are

instructed to take the drug about 15 minutes before eating.

17. The client who has been taking pioglitazone (Actos) for 6 months reports to the nurse that his

urine has become darker since starting the medication. Which is the nurse’s first action?

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a. Reviewing results of liver enzyme studies

b. Documenting the report as the only action

c. Instructing the client to increase his water intake

d. Testing a sample of urine for the presence of occult blood

ANS: A

The glitazone drugs, including pioglitazone, have been reported to affect liver function, and there

have been some cases of liver failure. Dark urine is one indicator of liver impairment because

bilirubin increases in the blood and is excreted in the urine.

18. The client with diabetes asks why more than one injection of insulin is required each day. Which

is the nurse’s best response?

a. “You need to start with multiple injections until you become more proficient at

self-injection.”

b. “A single dose of insulin each day would not match your blood insulin levels and

your food intake patterns closely enough.”

c. “A regimen of a single dose of insulin injected each day would require that you

could eat no more than one meal each day.”

d. “A single dose of insulin would be too large to be absorbed predictably, so you

would be in danger of unexpected insulin shock.”

ANS: B

Even when a single injection of insulin contains a combined dose of different-acting insulins, the

timing of the actions and the timing of food intake may not match well enough to prevent wide

variations in blood glucose levels.

19. Which statement made by a client indicates the need for further teaching about injection site

selection and rotation of insulin?

a. “The abdominal site is best because it is closest to the pancreas.”

b. “I can reach my thigh the best, so I will use different areas of the same thigh.”

c. “By rotating the sites in one area, my chances of having tissue increases or

decreases is less.”

d. “If I change injection sites from the thigh to the arm, the rate of absorption will be

different.”

ANS: A

The abdominal site has the fastest rate of absorption because of the blood vessels in the area and

not because of its proximity to the pancreas.

20. The client who has used insulin for diabetes control for 20 years has a spongy swelling at the site

used most frequently for insulin injection. Which is the nurse’s best action?

a. Applying ice to this area

b. Documenting the finding as the only action

c. Assessing the client for other signs of cellulitis

d. Instructing the client to use a different site for insulin injection

ANS: D

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The client has hypertrophic lipodystrophy as a result of repeated injections at the same site.

Avoiding this site for an extended period of time allows the dystrophic changes to regress or at

least not to become worse.

21. A client with diabetes is prescribed to take insulin glargine once daily and regular insulin four

times daily. How will the nurse teach the client to take these two medications when the first dose

of regular insulin should be given at the same time of day as the insulin glargine dose?

a. “Draw up and inject the insulin glargine first and then draw up and inject the dose

of regular insulin.”

b. “Draw up and inject the insulin glargine first, wait 1 hour, and then draw up and

inject the dose of regular insulin.”

c. “First draw up the dose of regular insulin, and then draw up the dose of insulin

glargine in the same syringe, mix, and inject the two insulins together.”

d. “First draw up the dose of insulin glargine, and then draw up the dose of regular

insulin in the same syringe, mix, and inject the two insulins together.”

ANS: A

Insulin glargine must not be diluted or mixed with any other insulin or solution. Mixing results in

an unpredictable alteration in the onset of action and time to peak action.

22. The client on an intensified insulin regimen consistently has a fasting blood glucose level

between 70 and 80 mg/dL, a postprandial blood glucose level below 200 mg/dL, and a

hemoglobin A1c level of 5.5%. Which is the nurse’s interpretation of these findings?

a. Increased risk for developing ketoacidosis

b. Increased risk for developing hyperglycemia

c. Signs of insulin resistance

d. Good control of blood glucose

ANS: D

The client is maintaining blood glucose levels within the defined ranges for goals in an

intensified regimen (fasting blood glucose, 60 to 120 mg/dL; postprandial blood glucose, less

than 200 mg/dL; hemoglobin A1c, 4% to 6%).

23. The client with diabetes is visually impaired and wants to know if syringes can be prefilled and

stored for use later. Which is the nurse’s best response?

a. “Yes, prefilled syringes can be stored for up to 3 weeks in the refrigerator in a

vertical position with the needle pointing up.”

b. “Yes, prefilled syringes can be stored for up to 3 weeks in the refrigerator, placed

in a horizontal position.”

c. “Insulin reacts with plastic, so prefilled syringes must be made of glass.”

d. “No, insulin cannot be stored for any length of time outside of the container.”

ANS: A

Insulin is relatively stable when stored in a cool, dry place away from light. When refrigerated,

prefilled syringes are stable for up to 3 weeks. They should be stored in the vertical position with

the needle pointing up to prevent suspended insulin particles from clogging the needle.

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24. To prevent complications of infection related to insulin infusion pumps, which intervention does

the nurse teach the client?

a. “Test your urine daily for the presence of ketone bodies.”

b. “Use buffered insulin to prevent crystal formation.”

c. “Keep the insulin frozen until you fill the pump.”

d. “Change the needle every 3 days.”

ANS: D

Having the same needle remain in place through the skin for longer than 3 days drastically

increases the risk for infection in or through the delivery system.

25. Which statement made by the client newly diagnosed with type 2 diabetes mellitus indicates a

need for further teaching regarding nutrition therapy?

a. “I should increase my intake of vegetables with moderate to high amounts of

dietary fiber.”

b. “My intake of saturated fats should be no more than 10% of my total calorie

intake.”

c. “I should try to keep my diet free from carbohydrates.”

d. “My intake of plain water each day is not restricted.”

ANS: C

Carbohydrates are an extremely important source of energy. They should compose at least 50%

to 60% of the diabetic person’s total caloric intake.

26. The client newly diagnosed with type 2 diabetes tells the nurse that since increasing fiber intake,

he is having loose stools, flatulence, and abdominal cramping. Which is the nurse’s best

response?

a. “Decrease your intake of water and other fluids.”

b. “Decrease your intake of fiber now and gradually add high-fiber foods back into

your diet.”

c. “You must have allergies to high-fiber foods and will need to avoid them in the

future.”

d. “Taking an antacid 1 hour before meals or 2 hours after meals should reduce the

intensity of your bowel problems.”

ANS: B

Many people experience these side effects when first increasing dietary fiber. Gradually

incorporating high-fiber foods into the diet can minimize abdominal cramping, discomfort, loose

stools, and flatulence.

27. The nurse recommends the pen-type injector insulin delivery system for the client with which

clinical presentation?

a. Confusion and reliance on another person for insulin injections

b. Requirements for intensive therapy with small, frequent insulin doses

c. Visual impairment affecting ability to draw up insulin accurately

d. Frequent episodes of hypoglycemia

ANS: B

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The pen-type injector allows greater accuracy with small doses, especially doses lower than 5 U.

It is not recommended for those who have visual or neurologic impairments.

28. The nurse teaches which action to the diabetic client who self-injects insulin to prevent or limit

local irritation at the injection site?

a. “Do not reuse needles.”

b. “Massage the site for 1 full minute after injection.”

c. “Try to make the injection deep enough to enter muscle.”

d. “Allow the insulin to warm to room temperature before injection.”

ANS: D

Cold insulin directly from the refrigerator is the most common cause of irritation (not infection)

at the insulin injection site.

29. To reduce complications of diabetes, the nurse teaches the client with normal renal function to

modify intake of which nutritional group?

a. Fats

b. Fiber

c. Proteins

d. Carbohydrates

ANS: A

Diabetes causes abnormalities in fat metabolism that lead to hyperlipidemia. The high lipid

levels can lead to atherosclerosis and many pathologic consequences of vascular insufficiency.

Although fats are essential and the diet of a diabetic needs to contain some fat, total fats should

be limited to 15% to 20% of the total daily caloric intake.

30. A client with diabetes has proliferative retinopathy, nephropathy, and peripheral neuropathy.

What should the nurse teach this client about exercise?

a. “The type of exercise that would most efficiently help you to lose weight, decrease

insulin requirements, and maintain cardiovascular health would be jogging for 20

minutes 4 to 7 days each week.”

b. “Considering the complications you already have, vigorous exercise for 1 hour

every day is needed to prevent progression of disease.”

c. “Considering the complications you already have, you should avoid engaging in

any form of exercise.”

d. “Swimming or water aerobics 30 minutes each day would be the safest exercise

routine for you.”

ANS: D

Exercise is not contraindicated for this client, although modifications are necessary based on

existing pathology to prevent further injury. A person with nephropathy and peripheral

neuropathy should avoid jogging or any activity that increases blood pressure or jars the kidneys

and joints. Swimming or, if the client does not know how to swim, dancing or doing exercises in

water, provides support for joints and muscles, greatly reducing the risk for injury while

increasing the uptake of glucose and promoting cardiovascular health.

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31. The nurse assesses for which clinical manifestation in a client with uncontrolled diabetes

mellitus and ketoacidosis?

a. Increased rate and depth of respiration

b. Extremity tremors followed by seizure activity

c. Oral temperature of 102° F (38.9° C)

d. Severe orthostatic hypotension

ANS: A

Ketoacidosis decreases the pH of the blood, stimulating the respiratory control areas of the brain

to buffer the effects of increasing acidosis. The rate and depth of respiration are increased

(Kussmaul respirations) in an attempt to excrete more acids by exhalation.

Adaptation)

32. The nurse determines that which arterial blood gas values are consistent with ketoacidosis in the

client with diabetes?

a. pH 7.38, HCO3– 22 mEq/L, PCO2 38 mm Hg, PO2 98 mm Hg

b. pH 7.28, HCO3– 18 mEq/L, PCO2 28 mm Hg, PO2 98 mm Hg

c. pH 7.48, HCO3– 28 mEq/L, PCO2 38 mm Hg, PO2 98 mm Hg

d. pH 7.28, HCO3– 22 mEq/L, PCO2 58 mm Hg, PO2 88 mm Hg

ANS: B

When the lungs can no longer offset the acidosis, the pH decreases below normal. The arterial

blood gases show primary metabolic acidosis with decreased bicarbonate levels and a

compensatory respiratory alkalosis with decreased carbon dioxide levels.

33. Which priority intervention does the nurse take for the client having Kussmaul respirations as a

result of diabetic ketoacidosis?

a. Administration of oxygen by mask or nasal cannula

b. Intravenous administration of 10% glucose

c. Implementation of seizure precautions

d. Administration of intravenous insulin

ANS: D

The rapid, deep respiratory efforts of Kussmaul respiration is the body’s attempt to reduce the

acids produced by using fat rather than glucose for fuel. The client who is in ketoacidosis and

who does not also have a respiratory impairment does not need additional oxygen. Only the

administration of insulin will reduce this type of respiration by assisting glucose to move into

cells and to be used for fuel instead of fat.

34. The client with type 1 diabetes asks whether an occasional glass of wine is allowed? Which is


a. “Insulin activity is dramatically reduced under the influence of alcohol and

drinking even one glass of wine will increase your insulin requirements.”

b. “Diabetics have decreased kidney function and should avoid ingesting alcohol in

all forms at all times.”

c. “You shouldn’t drink any alcohol because it is likely to increase your sense of

hunger and make you overeat.”

d. “One glass of wine can be ingested with a meal and is counted as two fat

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exchanges.”

ANS: D

Under normal circumstances, blood glucose levels will not be affected by the moderate use of

alcohol when diabetes is well controlled. When using insulin, two alcoholic beverages for men

and one for women can be ingested with and in addition to the normal meal plan. Because

alcohol can induce hypoglycemia, it should be ingested with or shortly after a meal. One

alcoholic beverage is substituted for two fat exchanges when caloric intake is calculated.

35. The nurse monitors for which nutritional problem in older adult clients with diabetes mellitus?

a. Obesity

b. Malnutrition

c. Alcoholism

d. Hyperglycemia

ANS: B

Older adults are more at risk for developing malnutrition as a result of multiple factors.

Inadequate income, poor dentition, decreased cognition, decreased motor ability, depression, and

lack of understanding about which foods constitute an adequate diet all contribute to an increased

risk for malnutrition in all older adult clients, including those with diabetes mellitus.

36. The nurse teaches the newly diagnosed client with type 1 diabetes that insulin needs can be

decreased through which action?

a. Reducing intake of water and other liquids to no more than 2 L/day

b. Eating animal organ meats high in insulin

c. Taking two 1-hour naps daily

d. Walking 1 mile each day

ANS: D

Moderate exercise, such as walking, helps regulate blood glucose levels on a daily basis and

results in lowered insulin requirements for clients with type 1 diabetes.

37. Which finding in the client with diabetes indicates that exercise should be avoided at this time?

a. Ketone bodies in the urine

b. Blood sugar level of 155 mg/dL

c. Pulse rate of 66 beats/min

d. Weight 1 pound higher than the week before

ANS: A

The presence of ketone bodies in the urine is a contraindication to exercise because it indicates

that the amount of insulin available is inadequate to promote intracellular glucose transport and

uptake. Exercise would lead to further elevations in blood glucose levels.

38. Two months after a simultaneous pancreas-kidney (SPK) transplantation, the client is diagnosed

as being in an acute rejection episode. The client states, “I was doing so well with my new

organs, and the thought of having to go back to living on hemodialysis and taking insulin is so

depressing.” Which is the nurse’s best response?

a. “You should have followed your drug regimen better.”

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b. “You should be glad that at least dialysis treatment is an option for you. Remember

that people whose liver transplants are rejected have no other options.”

c. “You should keep in mind that one acute rejection episode does not mean that you

will lose the new organs. Usually, these episodes can be reversed with the right

treatment.”

d. “You should remember that finding a donor for a new kidney or pancreas is the

easiest transplantation option. Our center is high on the list for obtaining organs for

transplantation from the national registry.”

ANS: C

An episode of acute rejection does not automatically mean that the client will lose the transplant.

Pharmacologic manipulation of host immune responses at this time can limit damage to the

organ and allow the graft to be maintained.

39. Which statement made by the client getting ready for discharge after pancreas transplantation

indicates a need for further teaching about the prescribed drug regimen?

a. “If I develop an infection, I should stop taking my corticosteroid.”

b. “If I have pain over the area of the transplant, I will call the transplantation team

immediately.”

c. “I should avoid people who are ill or who have an infection because I am

somewhat immunosuppressed now.”

d. “I should mix my cyclosporine exactly the way I was taught, because it won’t

work as well if I change the routine.”

ANS: A

Immunosuppressive agents should not be stopped without the consultation of the transplantation

physician, even if an infection is present. Stopping immunosuppressive therapy endangers the

transplanted organ.

40. The nurse correlates which laboratory value with inadequate functioning of a transplanted

pancreas?

a. Total white blood cell count 5000/mm3

b. 50% decrease in urine amylase level

c. Blood urea nitrogen 30 mg/dL

d. Elevated bilirubin level

ANS: B

Most pancreas transplants are anastomosed to the bladder and drain pancreatic enzymes into the

urine. When the pancreas is rejected or functioning inadequately, the level of pancreatic enzymes

in the urine decreases by 25% or more.

41. Three hours after surgery, the nurse notes that the breath of the client with type 1 diabetes has a

“fruity” odor. Which is the nurse’s best first action?

a. Documenting the finding as the only action

b. Increasing the IV fluid flow rate

c. Testing the serum for ketone bodies

d. Performing oral care

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ANS: C

The stress of surgery increases the action of counterregulatory hormones and suppresses the

action of insulin, predisposing the client to ketoacidosis and metabolic acidosis.

42. The client with type 1 diabetes has a blood glucose level of 160 mg/dL on arrival at the operating

room. Which is the nurse’s best action?

a. Documenting the finding as the only action

b. Administering regular insulin

c. Canceling the surgery

d. Notifying the physician

ANS: A

Clients who have type 1 diabetes and are having surgery have been found to have fewer

complications, lower rates of infection, and better wound healing if blood glucose levels are

maintained between 120 and 200 mg/dL throughout the perioperative period.

43. The nurse teaches which intervention to prevent injury in the diabetic client who has numbness

and reduced sensation secondary to severe peripheral neuropathy?

a. “Examine your feet daily.”

b. “Rotate your insulin injection sites.”

c. “Wear white socks instead of colored socks.”

d. “Use a bath thermometer to test the water temperature.”

ANS: D

Clients with diminished sensory perception can easily experience a burn injury when bath water

is too hot. Examining the feet daily does not prevent injury.

44. A client with a 20-year history of diabetes mellitus and severe burning pain in the feet and hands

as a result of peripheral neuropathy asks the nurse why an antidepressant has been prescribed.

Which is the nurse’s best response?

a. “Many people experiencing chronic pain become depressed.”

b. “The antidepressants may counteract the chemicals causing your pain.”

c. “You are less likely to become addicted from using antidepressants than you are

from using other types of pain killers.”

d. “The antidepressants also have strong anti-inflammatory properties and can reduce

the pain you have from inflammation.”

ANS: B

Much of the pain and discomfort associated with peripheral neuropathy is caused by changes in

neurotransmitter release at nerve synapses, especially serotonin. Small doses of antidepressants

can inhibit serotonin uptake and provide some degree of analgesia.

45. The nurse monitors for which clinical manifestation of decreased renal function in the client with

a history of diabetes mellitus?

a. Elevated specific gravity

b. The presence of glucose in the urine

c. The presence of ketone bodies in the urine

d. A sustained increase in blood pressure from 130/84 to 150/100 mm Hg

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ANS: D

Hypertension is both a cause of renal dysfunction and a result of renal dysfunction. Glucose and

ketones in the urine are consistent with diabetes mellitus, but are not specific to renal function.

Specific gravity is elevated with dehydration.

46. For the diabetic client with microalbuminuria, the nurse teaches the client to decrease which part

of their dietary intake?

a. Percentage of total calories derived from carbohydrates

b. Percentage of total calories derived from proteins

c. Percentage of total calories derived from fats

d. Total caloric intake

ANS: B

Restriction of dietary protein to 0.8 g/kg body weight/day is recommended for clients with

microalbuminuria to retard progression to renal failure.

47. Which statement made by the diabetic client who has a urinary tract infection indicates that

teaching was effective regarding antibiotic therapy?

a. “If my temperature is normal for 3 days in a row, the infection is gone and I can

stop taking my medicine.”

b. “If my temperature goes above 100°F (37.8° C) for 2 days, I should take twice as

much medicine.”

c. “Even if I feel completely well, I should take the medication until it is gone.”

d. “When my urine no longer burns, I will no longer need to take the antibiotics.”

ANS: C

Antibiotic therapy is most effective when the client takes the prescribed medication for the entire

course and not just when symptoms are present.

48. The home care nurse administers 1/2 cup of orange juice to the client with diabetes who is

experiencing symptoms of a mild hypoglycemic episode. The client’s clinical manifestations

have not changed 5 minutes later. Which is the nurse’s best next action?

a. Administering an additional 1/2 cup of orange juice

b. Documenting the finding as the only action

c. Administering 10 U of regular insulin

d. Notifying the physician

ANS: A

For mild hypoglycemic manifestations, if the symptoms do not resolve immediately, repeat the

treatment.

49. Which precaution should the nurse institute for the client with diabetes who is receiving

intramuscular glucagon caused by hypoglycemia and is unable to swallow?

a. Applying pressure to the injection site for 5 minutes

b. Positioning the client on his or her side

c. Having a padded tongue blade available

d. Elevating the head of the bed

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ANS: B

Glucagon administration often induces vomiting, increasing the client’s risk for aspiration.

50. The nurse monitors for which laboratory disorder in the client receiving IV insulin for

hyperglycemia?

a. Serum chloride level of 90 mmol/L

b. Serum calcium level of 8.0 mg/dL

c. Serum sodium level of 132 mmol/L

d. Serum potassium level of 2.5 mmol/L

ANS: D

Insulin activates the sodium-potassium ATPase pump, increasing the movement of potassium

from the extracellular fluid into the intracellular fluid and resulting in hypokalemia.

51. The nurse includes which information in the teaching plan about management of diabetes during

a period of illness that includes nausea and vomiting?

a. “Continue your prescribed exercise regimen.”

b. “Avoid eating or drinking to reduce vomiting.”

c. “Do not use insulin or take your oral antidiabetic agent.”

d. “Monitor your blood glucose levels at least every 4 hours.”

ANS: D

Treatment decisions and alterations will be made on the basis of blood glucose levels and the

presence of ketone bodies in the urine.

52. The nurse recognizes that ketosis is rare in clients with type 2 diabetes with hyperglycemia

related to which reason?

a. Ketosis is less prevalent among obese adults.

b. People with type 2 diabetes have normal lipid metabolism.

c. There is enough insulin produced by type 2 diabetes to prevent fat catabolism but

not enough to prevent hyperglycemia.

d. Oral antidiabetic agents do not promote the breakdown of fat for fuel (lipolysis),

and exogenous insulin spares carbohydrates at the expense of fats.

ANS: C

Ketosis occurs as a result of fat catabolism when intracellular glucose is unavailable for energy

production. The client with type 1 diabetes becomes ketotic because he or she produces no

insulin and blood glucose cannot enter the cells. In type 2 diabetes, natural insulin production

continues, although at a greatly reduced level. This level is not sufficient to keep blood glucose

levels in the normal range but permits just enough glucose to enter cells for energy production so

that fats are not catabolized for this purpose.

53. Which clinical manifestation indicates to the nurse that the therapy for the client with

hyperglycemic, hyperosmolar, nonketotic syndrome (HHNS) needs to be adjusted?

a. The client’s serum potassium level has increased from 2.8 to 3.2 mEq/L.

b. The client’s blood osmolarity has decreased from 350 to 330 mOsm.

c. The client’s score on the Glasgow Coma Scale is unchanged from 3 hours ago.

d. The client’s urine has remained negative for ketone bodies for the past 3 hours.

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ANS: C

A slow but steady improvement in CNS functioning is the best indicator of therapy effectiveness

for HHNS. Lack of improvement in level of consciousness may indicate inadequate rates of fluid

replacement.

54. The nurse administers 6 U of regular insulin and 10 U NPH insulin at 7 AM. At what time is the

client most susceptible to hypoglycemia related to the NPH insulin?

a. 8 AM

b. 4 PM

c. 8 PM

d. 11 PM

ANS: B

NPH is an intermediate acting insulin with an onset of 1.5 hours, peak of 4 to 12 hours, and

duration of action of 22 hours.

55. Which statement by the client with diabetes mellitus indicates the need for further teaching about

wearing a medical alert bracelet?

a. “I need to wear the bracelet when I am sick or having problems controlling glucose

levels.”

b. “This bracelet can be used to contact the Emergency Management Services in case

of a crisis.”

c. “This bracelet identifies me as a diabetic in case I become unconscious.”

d. “My insulin doses are on the back of this bracelet.”

ANS: C

It is important to encourage clients with diabetes mellitus to wear a medical alert bracelet. This

bracelet is helpful if the client becomes hypoglycemic and is unable to provide self-care.

56. The nurse monitors for which clinical manifestations in the diabetic client admitted with DKA

(diabetic ketoacidosis)?

a. Shallow slow respirations and respiratory alkalosis

b. Decreased urine output and hyperkalemia

c. Tachycardia and orthostatic hypotension

d. Peripheral edema and dependent pulmonary crackles

ANS: C

DKA is the extreme consequence of severe insulin deficiency. Lack of insulin results in the

release of free fatty acids, which leads to ketoacidosis. The lungs attempt to compensate for this

acidosis by increasing the depth and rate of respirations. Increased urinary output (polyuria) is

severe and may lead to tachycardia and orthostatic hypotension related to fluid volume deficit.

57. Which statement by the client recently diagnosed with type 2 diabetes indicates understanding of

the importance of maintaining weight within a prescribed range?

a. “Weight gain may lead to type 1 diabetes.”

b. “I may not need to take medications if my weight is maintained.”

c. “I do not have to check my blood glucose levels if my weight is in the proper

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range.”

d. “My vision may get better if I lose some weight.”

ANS: B

Type 2 diabetes can be prevented or delayed by weight loss and increased physical activity.

Encourage all clients to maintain weight within an appropriate range for height and body build.

Once diagnosed with type 2 diabetes, blood glucose monitoring is indicated, regardless of

whether the client is taking oral antidiabetic medications.

58. Which of the following statements by the client with type 2 diabetes indicates the need for

further teaching about diabetic management and follow-up care?

a. “I need to have an annual appointment, even if my glucose levels are in good

control.”

b. “Because my diabetes is controlled with diet and exercise, I only have to be seen if

I am sick.”

c. “I can still develop complications, even though I do not have to take insulin.”

d. “If I have surgery, I may have to receive insulin if I am unable to take my

medications by mouth.”

ANS: B

Clients with diabetes need to be seen at least annually to monitor for long-term complications,

including visual changes, microalbuminuria, and lipid analysis.

DIF: Cognitive Level: Comprehension REF: p. 1493

OBJ: Learning Outcome 10

TOP: Client Needs Category: Health Promotion and Maintenance (Self-Care)

MSC: Integrated Process: Nursing Process (Evaluation)

59. A client recently diagnosed with type 1 diabetes tells the nurse, “I will never be able to stick

myself with a needle.” Which is the nurse’s best response?

a. “Try not to worry about that. We will give you your injections while you are in the

hospital.”

b. “Everyone gets used to giving themselves injections. It really does not hurt.”

c. “I am really not sure how your disease can be managed if you refuse to give your

injections.”

d. “Tell me what it is about the injections that is concerning you.”

ANS: D

Devote as much teaching time as possible to insulin injection and blood glucose monitoring.

Clients with newly diagnosed diabetes are often fearful of giving themselves injections. After

this technique has been mastered, they become less anxious and are able to attend to other tasks.

60. The nurse is discharging a client recently diagnosed with type 1 diabetes, and refers the client to

the American Diabetes Association. Which statement by the client indicates understanding of

resources available from this organization?

a. “I will contact them when I need insulin and syringes.”

b. “They can help me find a local diabetic nurse educator.”

c. “They will send someone to my house to help me with meals.”

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d. “I will contact them when my blood glucose levels are too high.”

ANS: B

The American Diabetes Association (ADA) will refer a diabetic client to specific agencies or

resources, including the American Association of Diabetes Educators, who can refer a diabetic

client to a local certified diabetes educator.

MULTIPLE RESPONSE

1. In performing health screening in a local mall, the nurse determines that those with which risk

factors are at risk for the development of type 2 diabetes? (Select all that apply.)

a. Hypertension

b. History of pancreatic trauma

c. 30-pound weight gain during pregnancy

d. Body mass index greater than 25 kg/m

e. Triglyceride levels between 150 and 200 mg/dL

f. Delivered baby weighing over 9 pounds

ANS: A, D, F

Risk factors for type 2 diabetes include habitual inactivity, hypertension, delivery of a baby

weighing over 9 pounds, history of vascular disease, body mass index greater than 25 kg/m, and

triglyceride levels over 250 mg/dL.

ORDERING

1. In mixing regular and NPH insulin, the nurse completes the following actions. (Place in correct

order. Separate letters by a comma and space as follows: A, B, C, D.)

a. Inspect bottles for expiration dates.

b. Gently roll bottle of NPH in hands.

c. Wash your hands.

d. Inject air into the regular insulin.

e. Withdraw the NPH insulin.

f. Withdraw the regular insulin.

g. Inject air into the NPH bottle.

h. Clean rubber stoppers with an alcohol swab.

ANS:

C, A, B, H, G, D, F, E

After washing hands, it is important to inspect bottles and then to roll NPH to mix the insulin. It

is important to inject air into the NPH bottle prior to placing the needle in a regular insulin bottle

to avoid mixing of regular and NPH. The shorter acting insulin is always drawn up first.