Diabetes Nclex Style Questions

Diabetes Nclex Style Questions travisjacob2013Teacher Save Pharm Quiz 2 Retake Teacher 49 terms Michaela_Harrison76 Preview Practice Questions 20 terms mirber1212Preview Saunders DM NCLEX questions Teacher 14 terms Angela_Mangaro Preview Pharm 25 terms Kat The home care nurse visits a client recently diagnosed with diabetes mellitus who is taking Humulin NPH insulin daily. The client asks the nurse how to store the unopened vials of insulin. The nurse should tell the client to take which action?

• Store the insulin in a dark, dry place
• Refrigerate the insulin
• Freeze the insulin
• Keep in the insulin at room temperature
• Refrigerate the insulin

The nurse is teaching a client how to mix regular insulin and NPH insulin in the same syringe. Which action, if performed by the client, indicates the need for further teaching?

• Withdraws the regular insulin first
• Injects air into NPH insulin vial first
• Injects an amount of air equal to the desired dose of insulin into each vial
• Withdraws the NPH insulin first

Withdraws the NPH insulin first

The nurse is preparing a plan of care for a client with diabetes mellitus who has hyperglycemia. The nurse places highest priority on which client problem?

• Lack of knowledge
• Inadequate consumption of nutrients
• Inadequate fluid volume
• Compromised family coping

Inadequate fluid volume

Rationale:

An increased blood glucose level will cause the kidneys to excrete the glucose in the urine. This glucose is accompanied by fluids and electrolytes, causing an osmotic diuresis leading to dehydration. This fluid loss must be replaced when it becomes severe. Options 1, 3, and 4 are not related specifically to the subject of the question.The nurse is monitoring a client newly diagnosed with diabetes mellitus for signs of complications. Which sign, if exhibited in the client, would indicate hyperglycemia?

• Hypertension
• Increased pulse rate
• Polyuria
• Diaphoresis

Polyuria Diabetes insipidus is characterized by hyposecretion of antidiuretic hormone, and the kidney tubules fail to reabsorb water. Polydipsia and polyuria are classic symptoms of diabetes insipidus. The urine is pale, and the specific gravity is low. Anorexia and weight loss occur. Option 1 is a vague symptom. Options 2 and 4 are not specific to this disorder.A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the emergency department. Which findings would the nurse expect to note as confirming this diagnosis? Select all that apply

• Decreased urine output
• Low plasma bicarbonate level
• Elevated blood glucose level
• Increase in pH
• Comatose state
• Deep, rapid breathing

b, c, f Rationale:In DKA, the arterial pH is lower than 7.35, plasma bicarbonate is lower than 15 mEq/L, the blood glucose level is higher than 250 mg/dL, and ketones are present in the blood and urine. The client would be experiencing polyuria, and Kussmaul's respirations (deep and rapid breathing pattern) would be present. A comatose state may occur if DKA is not treated, but coma would not confirm the diagnosis.

The home health nurse visits a client with a diagnosis of type 1 diabetes mellitus. The client relates a history of vomiting and diarrhea and tells the nurse that no food has been consumed for the last 24 hours. Which additional statement by the client indicates a need for further teaching?"I need to monitor my blood glucose every 3 to 4 hours." "I need to stop my insulin." "I need to increase my fluid intake." "I need to call the health care provider (HCP) because of these symptoms." "I need to stop my insulin."

Rationale:

When a client with diabetes mellitus is unable to eat normally because of illness, the client still should take the prescribed insulin or oral medication. The client should consume additional fluids and should notify the HCP. The client should monitor the blood glucose level every 3 to

• hours. The client should also monitor the urine for ketones.

A client with type 1 diabetes mellitus calls the nurse to report recurrent episodes of hypoglycemia with exercising. Which statement by the client indicates an inadequate understanding of the peak action of NPH insulin and exercise?"The best time for me to exercise is after breakfast." "The best time for me to exercise is mid- to late afternoon." "The best time for me to exercise is after I eat." "The best time for me to exercise is after my morning snack." "The best time for me to exercise is mid- to late afternoon." The nurse is caring for a client admitted to the emergency department with diabetic ketoacidosis (DKA). In the acute phase, the nurse plans for which priority intervention?

• Administer short-duration insulin intravenously
• Correct the acidosis
• Administer 5% dextrose intravenously
• Apply a monitor for an electrocardiogram
• Administer short-duration insulin intravenously

Rationale:Lack (absolute or relative) of insulin is the primary cause of DKA. Treatment consists of insulin administration (short or rapid-acting), intravenous fluid administration (normal saline initially), and potassium replacement, followed by correcting acidosis. Applying an electrocardiogram monitor is not the priority action.Glimepiride (Amaryl) is prescribed for a client with diabetes mellitus. The nurse instructs the client to avoid consuming which food while taking this medication?

• Organ meat
• Whole-grain cereals
• Carbonated beverages
• Alcohol
• Alcohol
• When alcohol is combined with glimepiride, a disulfiram-like reaction may occur. This syndrome includes flushing, palpitations and nausea.

alcohol can also potentiate hypoglycemic effects of the medication. Clients need to be instructed to avoid alcohol consumption while taking this medication. The items in options b.c and d do not need to be avoided.

The nurse is monitoring a client who was diagnosed with type 1 diabetes mellitus and is being treated with NPH and regular insulin. Which client complaint(s) would alert the nurse to the presence of a possible hypoglycemic reaction? Select all that apply.

• Tremors
• Muscle cramps
• Anorexia
• Hot, dry skin
• Irritability
• Nervousness

a, e, f Decreased blood glucose levels produce autonomic nervous system symptoms, which are manifested classically as nervousness, irritability, and tremors. Option 5 is more likely to occur with hyperglycemia. Options 2 and 6 are unrelated to the manifestations of hypoglycemia. In hypoglycemia, usually the client feels hunger.A client is taking Humulin NPH insulin and regular insulin every morning. The nurse should provide which instructions to the client? Select all that apply.

• The NPH insulin should be drawn into the syringe first, then the regular insulin
• The insulin should be administered at room temperature
• The insulin vial needs to be shaken vigorously to break up the precipitates
• The insulin dose should be decreased if illness occurs
• Hypoglycemia may be experienced before dinnertime
• Hypoglycemia may be experienced before dinnertime

The health care provider (HCP) prescribes exanatide (Byetta) for a client with type 1 diabetes mellitus who takes insulin. The nurse should plan to take which most appropriate intervention?

• Withhold the medication and call the HCP, questioning the prescription for the client
• Administer the medication within 60 minutes before the morning and evening meal
• Monitor the client for gastrointestinal side effects after administering the medication
• Withdraw the insulin from the prefilled pen into an insulin syringe to prepare for administration
• Withhold the medication and call the HCP, questioning the prescription for the client

Exenatide (Byetta) is an incretin mimetic used for type 2 diabetes mellitus ONLY. It is not recommended for clients taking insulin. Hence, the nurse should withhold the medication and question the HCP regarding this prescription. Although options b and c are correct statements about the medication, in this situation the medication should not be administered. The mediation is packaged in prefilled pens ready for injection without the need for drawing it up into another syringe.