NCLEX-STYLE REVIEW QUESTIONS

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UNIT 13 Alterations in Endocrine Function

NCLEX-STYLE REVIEW QUESTIONS

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8. What are clinical manifestations of hypoglycemia? 1. Severe abdominal pain, accompanied by nausea 2. Cardiac arrhythmias 3. Neurological responses of the parasympathetic nervous system 4. Irritability, increasing confusion, tremors, hunger, sweating, weakness, and visual disturbances 9. Which of the following is true of the dawn phenomena? 1. It manifests itself as morning hypoglycemia. 2. The corresponding hyperglycemia results from predawn release of counter-regulatory hormones. 3. It is best managed by decreasing the administered amounts of insulin. 4. The client is not allowed to take insulin in any form when diagnosed with the dawn phenomena.

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3. Which of the following lab tests offers the best information about glycemic control? 1. HgbA1C 2. Fasting plasma glucose 3. Glucose tolerance test 4. Capillary glucose measurement

7. What is the primary difference between DKA and HHNS? 1. The absence of ketosis is the distinguishing feature. 2. HHNS has much higher blood glucose levels. 3. DKA has associated hyperkalemia. 4. HHNS is usually a reaction to previous conditions of hypoglycemia.

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1. A client has just been admitted to the emergency department after being found disoriented at the grocery store. His medical alert bracelet indicates that he has type 1 diabetes. Which of the following clinical signs do you anticipate finding upon assessment? Check all that apply. 1. Hyperglycemia 2. Fruity odor of breath 3. Tachycardia 4. Hypertension 2. A client with diabetes has just finished the teaching session on mixing insulins. The nurse knows that more teaching is needed when the client: 1. Injects air into the NPH insulin first followed by injecting air into the regular insulin vial 2. Withdraws too much NPH insulin and injects the extra back into the Lente vial 3. Withdraws too much regular insulin and injects the extra back into the regular insulin vial 4. Uses separate syringes to draw up 5 units of regular insulin and 4 units of NPH

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4. A client is admitted to the hospital with DKA. The nurse can anticipate which of the following solutions will be administered initially intravenously? 1. 5% dextrose in water 2. Ringer’s lactate 3. 0.9% NS 4. 5% dextrose in 0.45% NS

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5. Which of the following types of insulin can be administered intravenously? 1. Regular 2. Lente 3. Semi-Lente 4. NPH 6. Diabetes is a chronic condition that requires effective long-term management. This management includes: 1. Initial treatment of all types of diabetes with dietary modifications for a three-month time period 2. Initial treatment of all diabetics with insulin administration to prevent complications 3. Initial treatment of all diabetics with an oral glucose lowering agent and an exercise program 4. Use of a glucose lowering agent, diet, and activity

10. Which of the following is true regarding the autonomic neuropathy conditions associated with diabetic complications? 1. They result in bradycardia and profuse diaphoresis. 2. They are seldom seen in adult-onset diabetic conditions. 3. They lead to bowel and bladder incontinence and delayed gastric emptying. 4. They result in foot ulcers due to a lack of adequate circulation.

CHAPTER 57 Diabetes Mellitus: Nursing Management

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CRITICAL THINKING ACTIVITIES 5. Explain the following symptoms and their causes: polydipsia, polyphagia, and polyuria. 6. Locate a diabetes educator in your area. What are the educational requirements for the position of diabetes educator? Observe some teaching sessions with the diabetic educator and patients. What are some of the teaching strategies utilized, and how do they vary based on the age and education level of the patient? How frequently are patients seen by the diabetic educator, and how is this determined? Is a referral from a health care provider required or can the patients self refer for services? Is there an interdisciplinary team for patients with diabetes? Who makes up that team?

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1. Describe what information is to be included in teaching a patient with newly diagnosed diabetes about sick day management. 2. List information to be included in teaching a patient newly diagnosed with diabetes about foot care. 3. A patient with diabetes is admitted to the emergency department with a blood sugar level of 52. The patient is still conscious. Describe the treatment that you will administer. 4. A patient with type 2 diabetes is admitted to the hospital with a diagnosis of pneumonia and is started on insulin injections. The patient questions the use of insulin, stating that he has been able to control his diabetes with pills and diet. What information should the nurse give to the patient?

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REFERENCES

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American Diabetes Association (AACE). (2007). American Association of Clinical Endocrinologists medical guidelines for clinical practice for the management of diabetes mellitus. Endocrine Practice, 13(Supplement 1), 3–68. ADA. (2008). Position statement: nutrition recommendations and interventions for diabetes. Diabetes Care, 31(1), S61–S78. ADA. (2010a). Position statement: diagnosis and classification of diabetes mellitus. Diabetes Care, 33(Supplement 1), S62–S69. ADA. (2010b). Position statement: standards of medical care in diabetes: 2010. Diabetes Care, 33(Supplement 1), S11–S61. Broyles, B.E., Reiss, B.S., & Evans, M.E. (2007). Pharmacological Aspects of Nursing Care, 7th ed. New York: Delmar Publishers. CDC. (2007). National fact sheet: general information and national estimates on diabetes in the United States. Retrieved February 24, 2010 from http://www.cdc.gov. CDC. (2008). Number of people with Diabetes Increases to 24 Million, estimates of Diagnosed Diabetes Now Available for all U.S. counties. Retrieved January 21, 2010 from http://www.cdc. gov. CDC. (2009). National diabetes fact sheet: general information and national estimates on diabetes in the United States. Atlanta, GA: U.S. Department of Health and Human Services.

Chen, Y., Quick, W.W., Yang, W., Zhang, Y., Baldwin, A., Moran, J., Moore, V., Sahai, N., Dall, T.M. (2009). Cost of gestational diabetes mellitus in the United States in 2007. Population Health Management, 12(3), 168–71. Cochran, E., & Gorden, P. (2008). Use of U-500 insulin in the treatment of severe insulin resistance. Insulin, 3(4), 211–8. Despres, J.P., Lemieux, I., Bergeron, J., Pibarot, P., Mathieu, P., Larose, E., Rodes-Cabau, J., Bertrand, O.F., & Poirier, P. (2008). Abdominal obesity and the metabolic syndrome: contribution to global cardiometabolic risk. Atherosclerosis, Thrombosis and Vascular Biology, 28, 1039–49. doi: 10.1161/ATVBAHA.107.159228. Ferri, F.F. (2009). Ferri’s clinical advisor 2009: diabetes mellitus: basic information, diagnosis, treatment, pearls and consideration, evidence, suggested readings (pp. 5–11). Retrieved February 22, 2010 from http://www.merckmedicus.com. IDF. (2009). The world at a glance. Retrieved February 21, 2010 from At a glance website: http://www.diabetesatlas.org/sites. ISMP. (2007). Humulin R concentrate U-500. (August 2007). Retrieved March 2, 2010 from Institute for Safe Medication Practices website: http://www.ismp.org/. McPhee, S.J., & Papadakis, M.A. (2008). Current Medical Diagnosis and Treatment (47th ed.). New York: McGraw-Hill Companies, Inc.