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

Question 1

The nurse is caring for a patient who has not been diagnosed with diabetes.Which serum glucose result should the nurse expect on routine laboratory work?

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

Answer 1

88 mg/dL

Question 2

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

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

Answer 2

Observe as the patient prepares and injects a dose of insulin.

Question 3

The nurse is caring for a patient with diabetes.For which symptom should the nurse be the most concerned?

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

Answer 3

Diaphoresis

Question 4

A patient with diabetes has peripheral neuropathy.What should the nurse do to prevent related complications?

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

Question 5

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

A) "You will need insulin injections for the rest of your life."
B) "Once your pancreas recovers, you may be able to discontinue the injections."
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 6

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) "Your diabetes will require special foods, but many stores now stock a variety of choices for people with diabetes."
D) "Medical nutrition therapy stresses high protein and low carbohydrate intake, but most people readily adapt to these restrictions."

Question 7

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 food should the nurse substitute for the rice?

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

Question 8

A standard care plan for impaired skin integrity has been implemented for a patient with a small sore on the sole of the left foot.What action should the nurse use to evaluate the effectiveness of the plan?

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

Question 9

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

Question 10

A patient asks what can be done to prevent long-term complications of diabetes.What should the nurse respond to this patient's question?

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

Question 11

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 12

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

Question 13

A patient with type 1 diabetes mellitus asks what caused the fruity odor that was present at diagnosis.How should the nurse respond?

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

Question 14

A patient is experiencing rapid deep breathing,fruity odor,lethargy,and weight loss.Laboratory results include a blood glucose of 720 mg/dL.Which symptom should indicate to the nurse that the patient has type 1 diabetes mellitus?

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

Question 15

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

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

Question 16

The nurse is preparing to discuss long-term complications of diabetes with a patient newly diagnosed with the disorder.Which structure should the nurse identify as causing complications because of underlying damage?

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

Question 17

A female patient is prescribed glyburide (DiaBeta)for control of blood glucose.What precaution should the nurse teach the patient about this medication?

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

Question 18

A patient being seen for diabetes at an outpatient clinic has a hemoglobin A?c level of 14%.On what conclusion should the nurse base further assessment?

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

Question 19

The nurse is reviewing the causes for the development of type 1 diabetes mellitus with a patient who is newly diagnosed with the disorder.What major factor in the development of this disease should the nurse include?

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

Question 20

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 21

A patient diagnosed with prediabetes asks what can be done to prevent the development of the disease.What should the nurse recommend to this patient? (Select all that apply.)

A) Exercise
B) Lose weight
C) Stop smoking
D) Eliminate all starches from the diet
E) Avoid red meat and root vegetables

Question 22

The nurse is reviewing the goals and recommendations of the American Diabetes Association (ADA)prior to planning a patient's care.What should the nurse keep in mind for this patient? (Select all that apply.)

A) Aspirin therapy
B) Yearly flu vaccine
C) Hemoglobin A1c less than 7%
D) Blood pressure less than 150/90 mm Hg
E) Statin therapy for patients over 40 years old
F) Peak postprandial capillary glucose less than 180 mg/dL

Question 23

A patient whose blood glucose level ranges between 150 to 200 mg/dL has an episode of hypoglycemia.Which patient activity most likely caused the hypoglycemia?

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

Question 24

The nurse is caring for a patient with type 2 diabetes mellitus.Which symptoms should the nurse recognize as indicating the patient is experiencing a Somogyi effect? (Select all that apply.)

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

Question 25

A patient with type 2 diabetes mellitus is prescribed metformin (Glucophage).What should the nurse assess and monitor in this patient? (Select all that apply.)

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

Question 26

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 should the nurse expect to be monitored in this patient?

A) Blood lipids
B) Liver function tests
C) Urine for microalbumin
D) Complete blood count ( CB C )

Question 27

The nurse is teaching a patient about the HbA?c laboratory test.Which patient statements indicates teaching has been effective? (Select all that apply.)

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

Question 28

The nurse is preparing to administer insulin to a patient with type 1 diabetes mellitus.Which sites should the nurse consider for this injection? (Select all that apply.)

A) Forearm
B) Buttocks
C) Abdomen
D) Anterior thigh
E) Ventrogluteus
F) Edema associated with fluid overload

Question 29

The nurse is caring for a patient in the critical care unit.What should the nurse identify as a goal for this patient's blood glucose levels?

A) 50 to 100 mg/dL
B) 100 to 150 mg/dL
C) 140 to 180 mg/dL
D) 180 to 240 mg/dL

Question 30

After completing a health interview the nurse is concerned that a patient is at risk for developing type 2 diabetes mellitus.What information did the nurse use to make this determination? (Select all that apply.)

A) BMI 33
B) Belongs to a book club
C) Mother has type 2 diabetes mellitus
D) Recently was downsized from employment
E) First cousin killed in an automobile crash

Question 31

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

Question 32

A patient is upset to learn that a recent hemoglobin A?c level is 10.3%.What should the nurse provide as the patient's average blood glucose level based upon this percentage if the equation 28.7 ´ HbA?c - 46.7 is used? (Round to the nearest whole number.)

Question 33

A patient is diagnosed with hypoglycemia.What glucose level should the nurse expect when monitoring the capillary blood glucose?

A) 65 mg/dL
B) 100 mg/dL
C) 138 mg/dL
D) 200 mg/dL

Question 34

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

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

Question 35

A patient comes into the clinic with complaints of extreme thirst,extreme urination,and ongoing hunger.Which blood glucose level should the nurse use to determine if the patient has diabetes?

A) 110 mg/dL
B) 126 mg/dL
C) 185 mg/dL
D) 210 mg/dL

Question 36

The nurse is reinforcing teaching on diet therapy provided to a patient with type 2 diabetes mellitus.Which patient explanations about create your plate indicate that teaching has been effective? (Select all that apply.)

A) Half the plate is protein
B) Divide the plate into 4 quarters
C) One quarter of the plate is fruit
D) One 8 ounce glass of low-fat milk
E) Half the plate is non-starchy vegetables

Question 37

A patient is diagnosed with diabetic ketoacidosis (DKA).Which manifestations should the nurse expect to observe in this patient? (Select all that apply.)

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

Question 38

A patient with type 1 diabetes mellitus is prescribed insulin glargine (Lantus).What should the nurse instruct the patient about this medication? (Select all that apply.)

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

Question 39

The nurse is reviewing goals for blood glucose monitoring with a patient newly diagnosed with type 2 diabetes mellitus.What pre-prandial blood glucose goal should the nurse instruct the patient to achieve?

A) 50 to 100 mg/dL
B) 60 to 100 mg/dL
C) 70 to 130 mg/dL
D) 80 to 150 mg/dL