Deck 40: Nursing Care of Patients With Disorders of the Endocrine Pancreas

Question 1

The nurse is caring for a patient with diabetes. Which of the following symptoms would be most concerning?

A)Fatigue
B)Diaphoresis
C)Heartburn
D)Muscle cramps

Answer 1

Diaphoresis

Question 2

The nurse is caring for a patient admitted to the emergency department in acute distress. Data collection reveals rapid deep breathing, fruity odor, lethargy, and weight loss. Laboratory results include a blood glucose of 720 mg/dL. Which of the patient's symptoms indicates type 1 diabetes mellitus?

A)Lethargy
B)Thirst
C)Hunger
D)Fruity odor

Answer 2

Fruity odor

Question 3

What precaution should a nurse teach a female patient who is taking glyburide (DiaBeta) once daily for control of blood glucose?

A)"Do not take it if you skip a meal."
B)"Be sure it is discontinued before any tests involving contrast dye."
C)"Avoid drinking alcohol."
D)"You will need to use two forms of birth control."

Answer 3

"Avoid drinking alcohol."

Question 4

What is the most important action for a patient to take to prevent or delay long-term complications of diabetes?

A)Carefully control blood glucose.
B)Regularly inspect feet.
C)Limit fluids to prevent stress to kidneys.
D)Keep orange juice with sugar available at all times.

Question 5

The nurse is providing care for a marathon runner who is newly diagnosed with diabetes mellitus. What explanation about exercise is best for the nurse to provide?

A)"You will need to avoid regular exercise since it will lower your blood sugar."
B)"You can still exercise, but running is too strenuous for someone with diabetes."
C)"You should always take some emergency glucose with you when you are running."
D)"Exercise is best done when insulin is peaking, so it is important to know the onset and peak of your type of insulin."

Question 6

A patient develops a small sore on the sole of the left foot. The nurse notifies the physician and implements a standard care plan for impaired skin integrity. What action by the nurse would help evaluate the effectiveness of the plan?

A)Assess and document the wound condition daily.
B)Monitor and record blood glucose levels daily.
C)Assess the patient's understanding of preventive foot care.
D)Observe the patient's ability to change the dressing.

Question 7

The nurse is caring for a patient with diabetes who has peripheral neuropathy. What is the best way to prevent related complications?

A)Soak feet in soap and water for 20 minutes daily.
B)Avoid wearing shoes as much as possible.
C)Wash, dry, and inspect feet daily.
D)Use a lubricating lotion on feet daily.

Question 8

A nurse notes a glycohemoglobin of 14% in a patient attending a follow-up visit at a diabetes outpatient clinic. On what conclusion does the nurse base further assessment?

A)The patient has not been following the treatment regimen at home.
B)The patient generally adheres to the treatment regimen but has had increased carbohydrate intake in the last 3 months.
C)The patient's blood glucose levels have been elevated for the last 2 to 3 months.
D)The patient may have had numerous hypoglycemic episodes during the last month.

Question 9

The nurse is assisting with nutrition teaching for a patient who voices concern over coping with a diabetic diet. What response about medical nutrition therapy is correct?

A)"You will have a well-balanced, individualized meal plan that will be healthy for your whole family."
B)"You will need to avoid sugars and fats, but the dietitian will assist you in finding acceptable alternatives."
C)"Medical nutrition therapy stresses high protein and low carbohydrate intake, but most people readily adapt to these restrictions."
D)"Your diabetes will require special foods, but many stores now stock a variety of choices for people with diabetes."

Question 10

A patient is admitted to the hospital with hyperosmolar hyperglycemia. The patient is 40% overweight and has a blood glucose value of 987 mg/dL. What is the priority nursing diagnosis for this patient?

A)Noncompliance related to diabetes self-care regimen
B)Deficient Fluid Volume related to osmotic diuresis
C)Ineffective Self Health Management
D)Imbalanced Nutrition: More Than Body Requirements

Question 11

The nurse is assisting with teaching a patient with newly diagnosed type 1 diabetes. The patient asks what caused the fruity odor that was present at diagnosis. How should the nurse respond?

A)"The excess sugar in the blood is metabolized to fructose and excreted via the lungs."
B)"In the absence of available sugar, the body breaks down fat into ketones, which have a fruity odor."
C)"The proteins in the blood are metabolized to a substance that has a fruity odor."
D)"Excess sugar is excreted in the urine, which causes the fruity odor."

Question 12

What is a major factor in the development of type 1 diabetes?

A)A high-fat diet
B)A diet high in concentrated carbohydrates
C)An autoimmune response
D)Obesity

Question 13

A patient is newly diagnosed with type 1 diabetes mellitus. How should the nurse respond when the patient asks how long the insulin injections will be necessary?

A)"Once your pancreas recovers, you may be able to discontinue the injections."
B)"You will need insulin injections for the rest of your life."
C)"If you follow your diet closely, your blood sugar may be controlled by just taking insulin pills."
D)"You may be able to stop the injections if you exercise regularly and adhere to the prescribed diet."

Question 14

The nurse teaches a patient to self-administer insulin. How can the nurse best evaluate whether the patient understands the instructions?

A)Have the patient list the steps of the procedure for insulin administration.
B)Ask the patient an open-ended question about feelings related to the procedure.
C)Ask the patient to repeat the information in the insulin pamphlet that was provided.
D)Observe as the patient prepares and injects a dose of insulin.

Question 15

The nurse is assisting with a group class on complications of diabetes. Which information should the nurse include as factors that can precipitate hyperglycemia?

A)Stress or illness
B)Skipping meals
C)Drinking too much water
D)Frequent urination

Question 16

A patient on an American Diabetes Association (ADA) exchange list diet receives a dinner meal tray and does not wish to eat the rice. Which of the following foods can the nurse substitute for the rice?

A)A slice of bread
B)A half cup of cottage cheese
C)A half cup of custard
D)A 4-oz glass of juice

Question 17

Many long-term complications of diabetes are related to underlying damage to which structure(s)?

A)Heart
B)Liver
C)Brain
D)Blood vessels

Question 18

The nurse is caring for a nondiabetic individual. Which of the following glucose results would the nurse expect on routine laboratory work?

A)45 mg/dL
B)88 mg/dL
C)115 mg/dL
D)270 mg/dL

Question 19

The nurse is reinforcing teaching for a patient who is on four injections of regular insulin daily. About how many hours after each injection of insulin should the nurse teach the patient to be alert for symptoms of hypoglycemia?

A)1/2 hour
B)3 hours
C)8 hours
D)12 hours

Question 20

An LPN answers the call light of a patient with diabetes. The patient has a mild tremor and slight diaphoresis and is fully oriented. What should the nurse do?

A)Administer 4 oz of orange juice with one packet of sugar.
B)Check the patient's blood glucose level.
C)Call the laboratory for a STAT glucose level.
D)Call the RN to administer dextrose 50% intravenously.

Question 21

The American Diabetes Association recommends a preprandial blood glucose goal of 70 to ________________mg/dL for most patients.

Question 22

The nurse is teaching a patient at an outpatient clinic whose laboratory tests include an HbA1c. Which of the following client statements indicates teaching has been effective? (Select all that apply.?

A)"This test can be used to help diagnose diabetes."
B)"If I eat anything with sugar in it the day before the test, it will show up on the test."
C)"The test shows long-term blood sugar control."
D)"The test looks back at blood sugar averages over the past 6 months."
E)"This test can help determine if my treatment plan is managing my diabetes effectively."
F)"The test can be done in the physician's office while I'm waiting."

Question 23

Which of the following are signs or symptoms of diabetic ketoacidosis (DKA)? (Select all that apply.?

A)Kussmaul's respirations
B)Hypertension
C)Flulike symptoms
D)Edema associated with fluid overload
E)Dehydration
F)Cheyne-Stokes respirations

Question 24

Critically ill hospitalized patients should have blood glucose levels maintained between 140 and ________________mg/dL at all times to prevent complications and optimize outcomes.

Question 25

A student nurse is preparing to administer insulin. Which of the following injection sites is acceptable? (Select all that apply.?

A)Posterior aspect of the arm
B)Forearm
C)Ventrogluteus
D)Abdomen
E)Buttocks
F)Anterior thigh

Question 26

The nurse is providing teaching to a patient with reactive hypoglycemia. Which of the following instructions related to glucose monitoring should be provided? (Select all that apply.?

A)"You should check your blood sugar when you get up in the morning."
B)"It is important to check blood sugar 1 hour before meals."
C)"Two hours before each meal is the best time to check your blood sugar."
D)"It is important to check your blood sugar at bedtime."
E)"You will need to check your blood sugar 2 hours after meals."
F)"Checking your blood sugar once a day, at the same time each day, is sufficient."

Question 27

A patient being treated with rosiglitazone (Avandia) for type 2 diabetes mellitus is receiving a routine follow-up assessment. In addition to hemoglobin A1c and a fasting plasma glucose test, which other laboratory test is important in the patient receiving rosiglitazone?

A)Liver function tests
B)Complete blood count (CBC)
C)Blood lipids
D)Urine for microalbumin
Multiple Response
Identify one or more choices that best complete the statement or answer the question.

Question 28

Goals and recommendations of the American Diabetes Association (ADA) include which of the following? (Select all that apply.?

A)Statin therapy for patients over 40 years old
B)Aspirin therapy
C)Peak postprandial capillary glucose less than 180 mg/dL
D)Hemoglobin A1c less than 7%
E)Yearly flu vaccine
F)Blood pressure less than 140/90 mm Hg

Question 29

Hypoglycemia is usually defined as a blood glucose level less than ________________mg/dL.

Question 30

Which of the following is important for the nurse to assess and monitor in a patient prescribed metformin (Glucophage)? (Select all that apply.?

A)Weight gain
B)Presence of congestive heart failure (CHF)
C)Need for diagnostic tests involving use of contrast dyes
D)Fluid retention
E)Presence of renal or hepatic disease
F)Family history of glaucoma

Question 31

While providing care for a patient with type 2 diabetes, the nurse recognizes which of the following symptoms may indicate the patient could be experiencing a Somogyi effect? (Select all that apply.?

A)Fasting morning glucose is 80 mg/dL.
B)Fasting morning glucose is 264 mg/dL.
C)Patient reports night sweats.
D)Bedtime glucose is 110 mg/dL.
E)Patient complains of headaches in the morning.
F)Blood glucose is rising despite increased doses of insulin.Completion
Complete each statement.

Question 32

A patient whose blood glucose level usually is 150 to 200 mg/dL has an episode of hypoglycemia. Which of the following activities the patient engaged in before the episode was most likely the cause of the hypoglycemia?

A)Went to a birthday party
B)Took a bicycle ride
C)Received news of a pay raise
D)Took a nap

Question 33

What are characteristics of insulin glargine (Lantus)? (Select all that apply.?

A)It has no peak action time.
B)It has a duration of 24 hours.
C)It cannot be mixed with other insulins.
D)It is not injectable.
E)It can be inhaled.

Question 34

A patient at home with type 1 diabetes has a glucose level of 324 mg/dL. It is usually less than 150 mg/dL. What should the patient do first?

A)Have a glass of orange juice.
B)Call the physician.
C)Check the urine for ketones and drink water.
D)Exercise and recheck glucose level in 2 hours.