Endocrine System Disorders | Diabetes Mellitus | NCLEX Quiz 104

1. A 39-year-old company driver presents with shakiness. sweating. anxiety. and palpitations and tells the nurse he has Type I Diabetes Mellitus. Which of the follow actions should the nurse do first?

Inject 1 mg of glucagon subcutaneously.

Administer 50 mL of 50% glucose I.V.

Give 4 to 6 oz (118 to 177 mL) of orange juice.

Give the client four to six glucose tablets.

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

Explanation

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

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

A client with an HDL cholesterol level of 40 mg/dl and a triglyceride level of 300 mg/dl

A woman who is at 90% of standard body weight after delivering an eight-pound baby

A middle-aged Caucasian male

An older client who is hypotensive

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

Explanation

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

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

Below 5.7%

Between 12%-15%

Less than 180 mg/dL

Between 90 and 130 mg/dL

A1c measures the percentage of hemoglobin that is glycated and determines average blood glucose during the 2 to 3 months prior to testing. Used as a diagnostic tool. A1C levels of 6.5% or higher on two tests indicate diabetes. A1C of 6% to 6.5% is considered prediabetes.

Explanation

A1c measures the percentage of hemoglobin that is glycated and determines average blood glucose during the 2 to 3 months prior to testing. Used as a diagnostic tool. A1C levels of 6.5% or higher on two tests indicate diabetes. A1C of 6% to 6.5% is considered prediabetes.

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

As long as you only drink two beers and take one aspirin. this should not be a problem

The aspirin is alright but you need to give up drinking any alcoholic beverages

Taking alcohol and/or aspirin with a sulfonylurea drug can cause development of hypoglycemia

Aspirin and alcohol will cause the stomach to bleed more when on a sulfonylurea drug

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

Explanation

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

5. Which of the following if stated by the nurse is correct about Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS)?

This syndrome occurs mainly in people with Type I Diabetes

It has a higher mortality rate than Diabetic Ketoacidosis

The client with HHNS is in a state of overhydration

This condition develops very rapidly

HHNS occurs only in people with Type II Diabetes. It is a medical emergency and has a higher mortality rate than Diabetic Ketoacidosis. This condition develops very slowly over hours or days.

Explanation

HHNS occurs only in people with Type II Diabetes. It is a medical emergency and has a higher mortality rate than Diabetic Ketoacidosis. This condition develops very slowly over hours or days.

6. Nurse Robedee is teaching a thin client about the proper methods/techniques when giving insulin. Which one of the following is proper?

Pinch the skin up and use a 90 degree angle

Use a 45 degree angle with the skin pinched up

Massage the area of injection after injecting the insulin

Warm the skin with a warmed towel or washcloth prior to the injection

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

Explanation

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

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

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 an additional dose from the pump before each meal as needed. Regular insulin is used in an insulin pump. An external pump is not attached surgically to the pancreas.

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 an additional dose from the pump before each meal as needed. Regular insulin is used in an insulin pump. An external pump is not attached surgically to the pancreas.

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

Advanced age

Physical inactivity

Obesity

Smoking

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

Explanation

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

9. During the admission of a client with diabetic ketoacidosis. Nurse Kendra will anticipate the physician ordering which of the following types of intravenous solution if the client cannot take fluids orally?

Lactated Ringer’s solution

0.9 normal saline solution

5% dextrose in water (D5W)

0.45% normal saline solution

0.45% normal saline solution is recommended.

Explanation

0.45% normal saline solution is recommended.

10. Which of the following diabetes drugs acts by decreasing the amount of glucose produced by the liver?

Alpha-glucosidase inhibitors

Biguanides

Meglitinides

Sulfonylureas

Biguanides. such as metformin. lower blood glucose by reducing the amount of glucose produced by the liver. Sulfonylureas and Meglitinides stimulate the beta cells of the pancreas to produce more insulin. Alpha-glucosidase inhibitors block the breakdown of starches and some sugars. which helps to reduce blood glucose levels

Explanation

Biguanides. such as metformin. lower blood glucose by reducing the amount of glucose produced by the liver. Sulfonylureas and Meglitinides stimulate the beta cells of the pancreas to produce more insulin. Alpha-glucosidase inhibitors block the breakdown of starches and some sugars. which helps to reduce blood glucose levels