Endocrine System Disorders | NCLEX Quiz 97

1. A client with diabetes mellitus visits a health care clinic. The client's 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?

Prednisone (Deltasone)

Atenolol (Tenormin)

Phenelzine (Nardil)

Allopurinol (Zyloprim)

Prednisone may decrease the effect of oral hypoglycemics. insulin. diuretics. and potassium supplements.

Explanation

Prednisone may decrease the effect of oral hypoglycemics. insulin. diuretics. and potassium supplements.

2. Glucose is an important molecule in a cell because this molecule is primarily used for:

Extraction of energy

Synthesis of protein

Building of genetic material

Formation of cell membranes.

Glucose catabolism is the main pathway for cellular energy production.

Explanation

Glucose catabolism is the main pathway for cellular energy production.

3. 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?

Elevated blood glucose level and a low plasma bicarbonate

Decreased urine output

Increased respirations and an increase in pH

Comatose state

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 Kussmaul’s respirations would be present. A comatose state may occur if DKA is not treated. but coma would not confirm the diagnosis

Explanation

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 Kussmaul’s respirations would be present. A comatose state may occur if DKA is not treated. but coma would not confirm the diagnosis

4. 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:

2-4 hours after administration

6-14 hours after administration

16-18 hours after administration

18-24 hours after administration

NPH is intermediate acting insulin. The onset of action is 1-2 hours. it peaks in 6-14 hours. and it’s duration of action is 24 hours. Hypoglycemic reactions most likely occur during peak time.

Explanation

NPH is intermediate acting insulin. The onset of action is 1-2 hours. it peaks in 6-14 hours. and it’s duration of action is 24 hours. Hypoglycemic reactions most likely occur during peak time.

5. A client with DM demonstrates acute anxiety when first admitted for the treatment of hyperglycemia. The most appropriate intervention to decrease the client's anxiety would be to:

Administer a sedative

Make sure the client knows all the correct medical terms to understand what is happening.

Ignore the signs and symptoms of anxiety so that they will soon disappear

Convey empathy. trust. and respect toward the client.

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

Explanation

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

6. 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:

Administer regular insulin intravenously

Administer 5% dextrose intravenously

Correct the acidosis

Apply an electrocardiogram monitor.

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.

Explanation

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.

7. 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?

Pulse

BP

Respiration

Temperature

An elevated temperature may indicate infection. Infection is a leading cause of hyperglycemic hyperosmolar nonketotic syndrome or diabetic ketoacidosis.

Explanation

An elevated temperature may indicate infection. Infection is a leading cause of hyperglycemic hyperosmolar nonketotic syndrome or diabetic ketoacidosis.

8. A nurse is preparing a plan of care for a client with DM who has hyperglycemia. The priority nursing diagnosis would be:

High risk for deficient fluid volume

Deficient knowledge: disease process and treatment

Imbalanced nutrition: less than body requirements

Disabled family coping: compromised.

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.

Explanation

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.

9. 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:

Is timed to release programmed doses of regular or NPH insulin into the bloodstream at specific intervals.

Continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels.

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.

Explanation

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.

10. 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?

“The best time for me to exercise is every afternoon.”

“The best time for me to exercise is right after I eat.”

“The best time for me to exercise is after breakfast.”

“The best time for me to exercise is after my morning snack.”

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.

Explanation

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.