Saunders NCLEX DM Qs

Saunders NCLEX (DM) Qs The nurse is caring for a client with a diagnosis of diabetic ketoacidosis (DKA). Which assessment findings are consistent with this diagnosis? Select all that apply.

• Polyuria
• Polydipsia
• Polyphagia
• Dry mouth
• Flushed, dry skin
• Moist mucous membranes

Rationale:

Clinical manifestations of DKA include polyuria (frequent urination); polydipsia (excessive thirst); polyphagia (excessive hunger); dry mouth; and flushed, dry skin. The client with DKA experiences dehydration.The emergency department nurse is reviewing the laboratory test results for a client suspected of having diabetic ketoacidosis (DKA). Which laboratory result should the nurse expect to note in this disorder?1 .Serum pH of 9.0 2 .Absent ketones in the urine 3 .Serum bicarbonate of 22 mEq/L (22 mmol/L) 4 .Blood glucose level of 500 mg/dL (28.5 mmol/L)

Rationale:

In the client with DKA, the nurse should expect to note blood glucose levels between 350 and 1500 mg/dL (20 and 85.7 mmol/L), ketonuria, serum pH less than 7.35, and serum bicarbonate less than 15 mEq/L (15 mmol/L).A client with type 2 diabetes mellitus is complaining of polydipsia, polyuria, weight loss, and weakness. Laboratory results indicate a blood glucose level of 800 mg/dL (45.7 mmol/L) and nonketosis. The nurse reviews the health care provider's documentation and expects to note which diagnosis?

• Hypoglycemia
• Pheochromocytoma

• Diabetic ketoacidosis (DKA)
• Hyperosmolar hyperglycemic syndrome (HHS)

A client is admitted to the hospital with a diagnosis of pheochromocytoma. The nurse would check which item to detect the primary manifestation of this disorder?

• Weight
• Urine ketones
• Blood pressure
• Skin temperature

A client newly diagnosed with diabetes mellitus is started on a 2-dose insulin protocol combination of short- and intermediate-acting insulin injected twice daily. What portion of the total dose is given before breakfast, and what portion is given before the evening meal?

• Half before breakfast and half before the evening meal
• Two thirds before breakfast and one third before the evening meal
• One third before breakfast and two thirds before the evening meal
• Three fourths before breakfast and one fourth before the evening meal

The nurse is providing instructions regarding insulin administration for a client newly diagnosed with diabetes mellitus. The health care provider has prescribed a mixture of NPH insulin and regular insulin. The nurse should instruct the client that which is the first step in this procedure?

• Draw up the correct dosage of NPH insulin into the syringe.
• Draw up the correct dosage of regular insulin into the syringe.
• Inject air equal to the amount of NPH insulin prescribed into the vial of NPH

insulin.

• Inject air equal to the amount of regular insulin prescribed into the vial of regular

insulin.

Rationale:

The initial step in preparing an injection of insulin that is a mixture of NPH and regular insulin is to inject air into the NPH insulin bottle equal to the amount of insulin prescribed. The client would then be instructed to inject an amount of air equal to the amount of prescribed insulin into the regular insulin bottle. The regular insulin would then be withdrawn, followed by the NPH insulin. Contamination of regular insulin with NPH insulin will convert part of the regular insulin into a longer acting form.

The home care nurse is visiting a client newly diagnosed with diabetes mellitus. The client tells the nurse that he is planning to eat dinner at a local restaurant this week. The client asks the nurse if eating at a restaurant will affect diabetic control and if this is allowed. Which nursing response is most appropriate?

• "You are not allowed to eat in restaurants."
• "You should order a half-portion meal and have fresh fruit for dessert."
• "If you plan to eat in a restaurant, you need to skip the lunchtime meal."
• "You should increase your daily dose of insulin by half on the day that you plan to

eat in the restaurant." A client is brought to the emergency department in an unresponsive state, and a diagnosis of hyperosmolar hyperglycemic syndrome is made. The nurse would immediately prepare to initiate which anticipated health care provider's prescription?

• Endotracheal intubation
• 100 units of NPH insulin
• Intravenous infusion of normal saline
• Intravenous infusion of sodium bicarbonate

Rationale:

The primary goal of treatment in hyperosmolar hyperglycemic syndrome (HHS) is to rehydrate the client to restore fluid volume and to correct electrolyte deficiency.Intravenous (IV) fluid replacement is similar to that administered in diabetic ketoacidosis (DKA) and begins with IV infusion of normal saline. Regular insulin, not NPH insulin, would be administered.The use of sodium bicarbonate to correct acidosis is avoided because it can precipitate a further drop in serum potassium levels.Intubation and mechanical ventilation are not required to treat HHS.A client is admitted with suspected diabetic ketoacidosis (DKA). Which clinical manifestations best support a diagnosis of DKA?

• Blood glucose 500 mg/dL (27.8 mmol/L); arterial blood gases: pH 7.30, PaCo2 50,

HCO3 – 26.

• Blood glucose 400 mg/dL (22.2 mmol/L); arterial blood gases: pH 7.38, PaCo2 40,

HCO3 – 22.

• Blood glucose 450 mg/dL (25.0 mmol/L); arterial blood gases: pH 7.48, PaCo2 39,

HCO3 – 29.

4. Blood glucose 350 mg/dL (19.4 mmol/L); arterial blood gases: pH 7.28,

PaCo2 30, HCO3 – 14.

Rationale:

DKA is caused by a profound deficiency of insulin and is characterized by hyperglycemia (blood glucose level greater than or equal to 250 mg/dL [13.9 mmol/L]), ketosis (ketones in urine or serum), metabolic acidosis, and dehydration.The correct option is 4, as it represents an elevated blood glucose and the arterial blood gases (ABGs) indicate metabolic acidosis. Option 1 is incorrect, as the ABGs indicate respiratory acidosis; option 2 is incorrect, as the ABG values are within normal; and option 3 is incorrect, as the ABGs indicate metabolic alkalosis.A client with diabetes mellitus who takes insulin is seen in the health care clinic. The client tells the clinic nurse that after the insulin injection, the insulin seems to leak through the skin. The nurse would appropriately determine the problem by asking the client which question?

• "Are you rotating the injection site?"
• "Are you aspirating before you inject the insulin?"
• "Are you using a 1-inch needle to give the injection?"
• "Are you placing an air bubble in the syringe before injection?"

A client with diabetes mellitus has been instructed in the dietary exchange system. The client asks the nurse if bacon is allowed in the diet. Which nursing response is most appropriate?

• "Bacon is not allowed."
• "Bacon is much too high in fat."
• "Bacon may be eaten if you eliminate 1 meat item from your diet."
• "One strip of bacon may be eaten if you eliminate 1 teaspoon of butter."

A client with diabetes mellitus is being discharged following treatment for hyperosmolar hyperglycemic syndrome (HHS) precipitated by acute illness. The client tells the nurse, "I will call the health care provider (HCP) the next time I can't eat for more than a day or so." Which statement reflects the most appropriate analysis of this client's level of knowledge?

1.The client needs immediate education before discharge.

• The client requires follow-up teaching regarding the administration of oral

antidiabetics.