SAUNDERS NCLEX ENDOCRINE
EXAM
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?
1.
Endotracheal intubation
2.
100 units of NPH insulin
3.
Intravenous infusion of normal saline
4.
Intravenous infusion of sodium bicarbonate - CORRECT ANSWER-Intravenous infusion
of normal saline
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.
An external insulin pump is prescribed for a client with diabetes mellitus. When the
client asks the nurse about the functioning of the pump, the nurse bases the response
on which information about the pump?
1.
It is timed to release programmed doses of either short-duration or NPH insulin into the
bloodstream at specific intervals.
2.
It continuously infuses small amounts of NPH insulin into the bloodstream while
regularly monitoring blood glucose levels.
3.
It is surgically attached to the pancreas and infuses regular insulin into the pancreas.
This releases insulin into the bloodstream.
4.
It administers a small continuous dose of short-duration insulin subcutaneously. The
client can self-administer an additional bolus dose from the pump before each meal. -
CORRECT ANSWER-It administers a small continuous dose of short-duration insulin
,subcutaneously. The client can self-administer an additional bolus dose from the pump
before each meal.
An insulin pump provides a small continuous dose of short-duration (rapid- or short-
acting) insulin subcutaneously throughout the day and night. The client can self-
administer an additional bolus dose from the pump before each meal as needed. Short-
duration insulin is used in an insulin pump. An external pump is not attached surgically
to the pancreas.
A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the
emergency department. Which findings support this diagnosis? Select all that apply.
Because of the profound deficiency of insulin associated with DKA, glucose cannot be
used for energy and the body breaks down fat as a secondary source of energy.
Ketones, which are acid byproducts of fat metabolism, build up and the client
experiences a metabolic ketoacidosis. High serum glucose contributes to an osmotic
diuresis and the client becomes severely dehydrated. If untreated, the client will become
comatose due to severe dehydration, acidosis, and electrolyte imbalance. Kussmaul's
respirations, the deep rapid breathing associated with DKA, is a compensatory
mechanism by the body. The body attempts to correct the acidotic state by blowing off
carbon dioxide (CO2), which is an acid. In the absence of insulin, the client will
experience severe hyperglycemia. Option 1 is incorrect because in acidosis the pH
would be low. Option 4 is incorrect because a high serum glucose will result in an
osmotic diuresis and the client will experience polyuria.
The nurse teaches a client with diabetes mellitus about differentiating between
hypoglycemia and ketoacidosis. The client demonstrates an understanding of the
teaching by stating that a form of glucose should be taken if which symptom or
symptoms develop? Select all that apply.
Shakiness, palpitations, and lightheadedness are signs/symptoms of hypoglycemia and
would indicate the need for food or glucose. Polyuria, blurred vision, and a fruity breath
odor are manifestations of hyperglycemia.
A client with diabetes mellitus demonstrates acute anxiety when admitted to the hospital
for the treatment of hyperglycemia. What is the appropriate intervention to decrease the
client's anxiety?
1.
Administer a sedative.
2.
Convey empathy, trust, and respect toward the client.
3.
Ignore the signs and symptoms of anxiety, anticipating that they will soon disappear.
4.
Make sure that the client is familiar with the correct medical terms to promote
understanding of what is happening. - CORRECT ANSWER-Convey empathy, trust,
and respect toward the client.
Anxiety is a subjective feeling of apprehension, uneasiness, or dread. The appropriate
intervention is to address the client's feelings related to the anxiety. Administering a
sedative is not the most appropriate intervention and does not address the source of the
client's anxiety. The nurse should not ignore the client's anxious feelings. Anxiety needs
to be managed before meaningful client education can occur.
, The nurse provides instructions to a client newly diagnosed with type 1 diabetes
mellitus. The nurse recognizes accurate understanding of measures to prevent diabetic
ketoacidosis when the client makes which statement?
1.
"I will stop taking my insulin if I'm too sick to eat."
2.
"I will decrease my insulin dose during times of illness."
3.
"I will adjust my insulin dose according to the level of glucose in my urine."
4.
"I will notify my health care provider (HCP) if my blood glucose level is higher than 250
mg/dL (14.2 mmol/L)." - CORRECT ANSWER-"I will notify my health care provider
(HCP) if my blood glucose level is higher than 250 mg/dL (14.2 mmol/L)."
During illness, the client with type 1 diabetes mellitus is at increased risk of diabetic
ketoacidosis, due to hyperglycemia associated with the stress response and due to a
typically decreased caloric intake. As part of sick day management, the client with
diabetes should monitor blood glucose levels and should notify the HCP if the level is
higher than 250 mg/dL (14.2 mmol/L). Insulin should never be stopped. In fact, insulin
may need to be increased during times of illness. Doses should not be adjusted without
the HCP's advice and are usually adjusted on the basis of blood glucose levels, not
urinary glucose readings.
A client is admitted to a hospital with a diagnosis of diabetic ketoacidosis (DKA). The
initial blood glucose level is 950 mg/dL (54.2 mmol/L). A continuous intravenous (IV)
infusion of short-acting insulin is initiated, along with IV rehydration with normal saline.
The serum glucose level is now decreased to 240 mg/dL (13.7 mmol/L). The nurse
would next prepare to administer which medication?
1.
An ampule of 50% dextrose
2.
NPH insulin subcutaneously
3.
IV fluids containing dextrose
4.
Phenytoin for the prevention of seizures - CORRECT ANSWER-IV fluids containing
dextrose
Emergency management of DKA focuses on correcting fluid and electrolyte imbalances
and normalizing the serum glucose level. If the corrections occur too quickly, serious
consequences, including hypoglycemia and cerebral edema, can occur. During
management of DKA, when the blood glucose level falls to 250 to 300 mg/dL (14.2 to
17.1 mmol/L), the IV infusion rate is reduced and a dextrose solution is added to
maintain a blood glucose level of about 250 mg/dL (14.2 mmol/L), or until the client
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