NCLEX Style Quiz

Question 1

Which of the following causes of HHNS is most common?

Insulin overdose

Removal of the adrenal gland

Undiagnosed, untreated hyperpituitarism

Undiagnosed, untreated diabetes mellitus

Answer 1

Undiagnosed, untreated diabetes mellitus

Question 2

The insulin that has the most rapid onset of action would be:

Lente

Lispro

Ultralente

Humulin N

Answer 2

Lispro

Lispro has an immediate onset, a peak of 30-90 minutes, and duration of 2-4 hours.

Question 3

Insulin forces which of the following electrolytes out of the plasma and into the cells?

Calcium

Magnesium

Phosphorus

Potassium

Answer 3

Potassium

Insulin forces potassium out of the plasma, back into the cells, causing hypokalemia. Potassium is needed to help transport glucose and insulin into the cells. Calcium, magnesium, and phosphorus aren’t affected by insulin.

Question 4

A client with DM demonstrates acute anxiety when first admitted for the treatment of hyperglycemia. The most appropriate intervention to decrease the client’s anxiety would be to:

Administer a sedative

Make sure the client knows all the correct medical terms to understand what is happening

Ignore the signs and symptoms of anxiety so that they will soon disappear

Convey empathy, trust, and respect toward the client

Answer 4

Convey empathy, trust, and respect toward the client

The most appropriate intervention is to address the client’s feelings related to the anxiety. Administering a sedative is not the most appropriate intervention. The nurse should not ignore the client’s anxious feelings. A client will not relate to medical terms, particularly when anxiety exists.

Question 5

A bedtime snack is provided for Albert. This is based on the knowledge that intermediate-acting insulins are effective for an approximate duration of:

6-8 hours

10-14 hours

16-20 hours

24-28 hours

Answer 5

16-20 hours

Question 6

Which of the following methods of insulin administration would be used in the initial treatment of hyperglycemia in a client with diabetic ketoacidosis?

Subcutaneous

Intramuscular

IV bolus only

IV bolus, followed by continuous infusion

Answer 6

IV bolus, followed by continuous infusion

An IV bolus of insulin is given initially to control the hyperglycemia; followed by a continuous infusion, titrated to control blood glucose. After the client is stabilized, subcutaneous insulin is given. Insulin is never given intramuscularly.

Question 7

Albert, a 35-year-old insulin dependent diabetic, is admitted to the hospital with a diagnosis of pneumonia. He has been febrile since admission. His daily insulin requirement is 24 units of NPH. Every morning Albert is given NPH insulin at 0730. Meals are served at 0830, 1230, and 1830. The nurse expects that the NPH insulin will reach its maximum effect (peak) between the hours of:

1130 and 1330

1330 and 1930

1530 and 2130

1730 and 2330

Answer 7

1330 and 1930

Question 8

A client with type 1 DM calls the nurse to report recurrent episodes of hypoglycemia with exercise. Which statement by the client indicated an inadequate understanding of the peak action of NPH insulin and exercise?

“The best time for me to exercise is every afternoon.”

“The best time for me to exercise is right after I eat.”

“The best time for me to exercise is after breakfast.”

“The best time for me to exercise is after my morning snack.”

Answer 8

“The best time for me to exercise is every afternoon.”

A hypoglycemic reaction may occur in the response to increased exercise. Clients should avoid exercise during the peak time of insulin. NPH insulin peaks at 6-14 hours; therefore afternoon exercise will occur during the peak of the medication. Options B, C, and D do not address peak action times.

Question 9

A client’s blood gases reflect diabetic acidosis. The nurse should expect:

Increased pH

Decreased PO2

Increased PCO2

Decreased HCO3

Answer 9

Decreased HCO3

The bicarbonate-carbonic acid buffer system helps maintain the pH of the body fluids; in metabolic acidosis there is a decrease in bicarbonate because of an increase of metabolic acids.

Question 10

A client with type 1 DM has a fingerstick glucose level of 258mg/dl at bedtime. An order for sliding scale insulin exists. The nurse should:

Call the physician

Encourage the intake of fluids

Administer the insulin as ordered

Give the client ½ c. of orange juice

Answer 10

Administer the insulin as ordered

A value of 258mg/dl is above the expected range of 70-105 mg/dl; the nurse should administer the insulin as ordered.

Question 11

Rotating injection sites when administering insulin prevents which of the following complications?

Insulin edema

Insulin lipodystrophy

Insulin resistance

Systemic allergic reactions

Answer 11

Insulin lipodystrophy

Insulin lipodystrophy produces fatty masses at the injection sites, causing unpredictable absorption of insulin injected into these sites.

Question 12

Albert refuses his bedtime snack. This should alert the nurse to assess for:

Elevated serum bicarbonate and a decreased blood pH.

Signs of hypoglycemia earlier than expected.

Symptoms of hyperglycemia during the peak time of NPH insulin.

Sugar in the urine

Answer 12

Signs of hypoglycemia earlier than expected.

Question 13

A client with DM states, “I cannot eat big meals; I prefer to snack throughout the day.” The nurse should carefully explain that the:

Regulated food intake is basic to control

Salt and sugar restriction is the main concern

Small, frequent meals are better for digestion

Large meals can contribute to a weight problem

Answer 13

Regulated food intake is basic to control

An understanding of the diet is imperative for compliance. A balance of carbohydrates, proteins, and fats usually apportioned over three main meals and two-between meals snacks needs to be tailored to the client’s specific needs, with due regard for activity, diet, and therapy.

Question 14

Knowing that gluconeogenesis helps to maintain blood levels, a nurse should:

Document weight changes because of fatty acid mobilization

Evaluate the patient’s sensitivity to low room temperatures because of decreased adipose tissue insulation

Protect the patient from sources of infection because of decreased cellular protein deposits

Do all of the above

Answer 14

Do all of the above

Question 15

A clinical feature that distinguishes a hypoglycemic reaction from a ketoacidosis reaction is:

Blurred vision

Diaphoresis

Nausea

Weakness

Answer 15

Diaphoresis

Question 16

Clinical nursing assessment for a patient with microangiopathy who has manifested impaired peripheral arterial circulation includes all of the following except:

Integumentary inspection for the presence of brown spots on the lower extremities

Observation for paleness of the lower extremities

Observation for blanching of the feet after the legs are elevated for 60 seconds

Palpation for increased pulse volume in the arteries of the lower extremities

Answer 16

Palpation for increased pulse volume in the arteries of the lower extremities

Question 17

The lowest fasting plasma glucose level suggestive of a diagnosis of DM is:

90mg/dl

115mg/dl

126mg/dl

180mg/dl

Answer 17

126mg/dl

Question 18

A nurse is caring for a client admitted to the ER with DKA. In the acute phase the priority nursing action is to prepare to:

Administer regular insulin intravenously

Administer 5% dextrose intravenously

Correct the acidosis

Apply an electrocardiogram monitor

Answer 18

Administer regular insulin intravenously

lack (absolute or relative) of insulin is the primary cause of DK1. Treatment consists of insulin administration (regular insulin), IV fluid administration (normal saline initially), and potassium replacement, followed by correcting acidosis. Applying an electrocardiogram monitor is not a priority action.

Question 19

When a client is in diabetic ketoacidosis, the insulin that would be administered is:

Human NPH insulin

Human regular insulin

Insulin lispro injection

Insulin glargine injection

Answer 19

Human regular insulin

Regular insulin (Humulin R) is a short-acting insulin and is administered via IV with an initial dose of 0.3 units/kg, followed by 0.2 units/kg 1 hour later, followed by 0.2 units/kg every 2 hours until blood glucose becomes

Question 20

Clinical manifestations associated with a diagnosis of type 1 DM include all of the following except:

Hypoglycemia

Hyponatremia

Ketonuria

Polyphagia

Answer 20

Hypoglycemia

Question 21

Rotation sites for insulin injection should be separated from one another by 2.5 cm (1 inch) and should be used only every:

Third day

Week

2-3 weeks

2-4 weeks

Answer 21

2-3 weeks

To prevent lipodystrophy.

Question 22

The nurse knows that glucagon may be given in the treatment of hypoglycemia because it:

Inhibits gluconeogenesis

Stimulates the release of insulin

Increases blood glucose levels

Provides more storage of glucose

Answer 22

Increases blood glucose levels

Glucagon, an insulin antagonist produced by the alpha cells in the islets of langerhans, leads to the conversion of glycogen to glucose in the liver.

Question 23

A client with DM has an above-knee amputation because of severe peripheral vascular disease, Two days following surgery, when preparing the client for dinner, it is the nurse’s primary responsibility to:

Check the client’s serum glucose level

Assist the client out of bed to the chair

Place the client in a high-fowlers position

Ensure that the client’s residual limb is elevated

Answer 23

Check the client’s serum glucose level

Because the client has diabetes, it is essential that the blood glucose level be determined before meals to evaluate the success of control of diabetes and the possible need for insulin coverage.

Question 24

A nurse is preparing a plan of care for a client with DM who has hyperglycemia. The priority nursing diagnosis would be: 1. High risk for d

High risk for deficient fluid volume

Deficient knowledge: disease process and treatment

Imbalanced nutrition: less than body requirements

Disabled family coping: compromised

Answer 24

High risk for deficient fluid volume

Increased blood glucose will cause the kidneys to excrete the glucose on the urine. This glucose is accompanied by fluids and electrolytes, causing osmotic diuresis leading to dehydration. This fluid loss must be replaced when it becomes severe. Options B, C, and D are not related specifically to the issue of the question.

Question 25

When a client is first admitted with hyperglycemic hyperosmolar nonketotic syndrome (HHNS), the nurse’s priority is to provide: Oxygen Carbohydrates Fluid replacement Dietary instruction

Answer 25

Fluid replacement As a result of osmotic pressures created by increased serum glucose, the cells become dehydrated; the client must receive fluid and then insulin.

Question 26

Which of the following chronic complications is associated with diabetes? Dizziness, dyspnea on exertion, and coronary artery disease Retinopathy, neuropathy, and coronary artery disease Leg ulcers, cerebral ischemic events, and pulmonary infarcts Fatigue, nausea, vomiting, muscle weakness, and cardiac arrhythmia’s

Answer 26

Retinopathy, neuropathy, and coronary artery disease These are all chronic complications of diabetes. Dizziness, dyspnea on exertion, and coronary artery disease are symptoms of aortic valve stenosis. Fatigue, nausea, vomiting, muscle weakness, and cardiac arrhythmias are symptoms of hyperparathyroidism. Leg ulcers, cerebral ischemic events, and pulmonary infarcts are complications of sickle cell anemia.

Question 27

A client with diabetes mellitus visits a health care clinic. The client’s diabetes previously had been well controlled with glyburide (Diabeta), 5 mg PO daily, but recently the fasting blood glucose has been running 180-200mg/dl. Which medication, if added to the clients regimen, may have contributed to the hyperglycemia? Prednisone (Deltasone) Atenolol (Tenormin) Phenelzine (Nardil) Allopurinol (Zyloprim)

Answer 27

Prednisone (Deltasone) Prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics, and potassium supplements.

Question 28

Which of the following nursing interventions should be taken for a client who complains of nausea and vomits one hour after taking his glyburide (DiaBeta)? Which of the following nursing interventions should be taken for a client who complains of nausea and vomits one hour after taking his glyburide (DiaBeta)? Give subcutaneous insulin and monitor blood glucose Monitor blood glucose closely, and look for signs of hypoglycemia Monitor blood glucose, and assess for signs of hyperglycemia

Answer 28

Monitor blood glucose closely, and look for signs of hypoglycemia When a client who has taken an oral antidiabetic agent vomits, the nurse would monitor glucose and assess him frequently for signs of hypoglycemic. Most of the medication has probably been absorbed. Therefore, repeating the dose would further lower glucose levels later in the day. Giving insulin would also lower the glucose levels, causing hypoglycemic. The client wouldn’t have hyperglycemia if the glyburide was absorbed.

Question 29

A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the ER. Which finding would a nurse expect to note as confirming this diagnosis? Elevated blood glucose level and a low plasma bicarbonate Decreased urine output Increased respirations and an increase in pH Comatose state

Answer 29

Elevated blood glucose level and a low plasma bicarbonate In diabetic acidiosis the arterial pH is less than 7.35. plasma bicarbonate is less than 15mEq/L, and the blood glucose level is higher than 250mg/dl and ketones are present in the blood and urine. The client would be experiencing polyuria, and Kussmauls respirations would be present. A comatose state may occur if DKA is not treated, but coma would not confirm the diagnosis

Question 30

A client is taking NPH insulin daily every morning. The nurse instructs the client that the most likely time for a hypoglycemic reaction to occur is: 2-4 hours after administration 6-14 hours after administration 16-18 hours after administration 18-24 hours after administration

Answer 30

6-14 hours after administration NPH is intermediate acting insulin. The onset of action is 1-2 hours, it peaks in 6-14 hours, and it’s duration of action is 24 hours. Hypoglycemic reactions most likely occur during peak time.

Question 31

Glucose is an important molecule in a cell because this molecule is primarily used for: Extraction of energy Synthesis of protein Building of genetic material Formation of cell membranes

Answer 31

Extraction of energy Glucose catabolism is the main pathway for cellular energy production.

Question 32

A nurse performs a physical assessment on a client with type 2 DM. Findings include a fasting blood glucose of 120mg/dl, temperature of 101, pulse of 88, respirations of 22, and a bp of 140/84. Which finding would be of most concern of the nurse? Pulse BP Respiration Temperature

Answer 32

Temperature An elevated temperature may indicate infection. Infection is a leading cause of hyperglycemic hyperosmolar nonketotic syndrome or diabetic ketoacidosis.

Question 33

An external insulin pump is prescribed for a client with DM. The client asks the nurse about the functioning of the pump. The nurse bases the response on the information that the pump: Gives small continuous dose of regular insulin subcutaneously, and the client can self-administer a bolus with an additional dosage from the pump before each meal. Is timed to release programmed doses of regular or NPH insulin into the bloodstream at specific intervals. Is surgically attached to the pancreas and infuses regular insulin into the pancreas, which in turn releases the insulin into the bloodstream. Continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels.

Answer 33

Gives small continuous dose of regular insulin subcutaneously, and the client can self-administer a bolus with an additional dosage from the pump before each meal. An insulin pump provides a small continuous dose of regular insulin subcutaneously throughout the day and night, and the client can self-administer a bolus with additional dosage from the pump before each meal as neede4. Regular insulin is used in an insulin pump. An external pump is not attached surgically to the pancreas.

Question 34

Clients with type 1 diabetes may require which of the following changes to their daily routine during periods of infection? No changes Less insulin More insulin Oral antidiabetic agents

Answer 34

More insulin During periods of infection or illness, diabetics may need even more insulin to compensate for increased blood glucose levels.

Question 35

The nurse is admitting a client with hypoglycemia. Identify the signs and symptoms the nurse should expect. Select all that apply. Thirst Palpitations Diaphoresis Slurred speech Hyperventilation

Answer 35

Palpitations Diaphoresis Slurred speech Palpitations, an adrenergic symptom, occur as the glucose levels fall; the sympathetic nervous system is activated and epinephrine and norepinephrine are secreted causing this response. Diaphoresis is a sympathetic nervous system response that occurs as epinephrine and norepinephrine are released. Slurred speech is a neuroglycopenic symptom; as the brain receives insufficient glucose, the activity of the CNS becomes depressed.

Question 36

The nurse expects that a type 1 diabetic may receive ____ of his or her morning dose of insulin preoperatively: 10-20% 25-40% 50-60% 85-90%

Answer 36

50-60%

Question 37

A client is in DKA, secondary to infection. As the condition progresses, which of the following symptoms might the nurse see? Kussmaul’s respirations and a fruity odor on the breath Shallow respirations and severe abdominal pain Decreased respirations and increased urine output Cheyne-stokes respirations and foul-smelling urine

Answer 37

Kussmaul’s respirations and a fruity odor on the breath Coma and severe acidosis are ushered in with Kussmaul’s respirations (very deep but not labored respirations) and a fruity odor on the breath (acetone breath).