Nclex Endocrine Reviewer

1.
When evaluating the laboratory results for a patient with increased secretion of the anterior pituitary
hormones, the nurse
would expect to find
a. decreased serum thyroxine levels.
b. elevated serum aldosterone levels.
c. an increase in urinary free cortisol.
d. low urinary excretion of catecholamines.
2. When the nurse is obtaining the health history, which statement by a patient indicates further
assessment of thyroid function may be necessary?
a. “I notice my breasts are tender lately.”
b. “I am so thirsty that I drink all day long.”
c. “I get up several times at night to urinate.”
d. “I feel a lump in my throat when I swallow.”
3. A patient is admitted with a serum sodium level of 118 mEq/L. The nurse will anticipate the need for
which diagnostic test?
a. Urinary 17-ketosteroids
b. Antidiuretic hormone level
c. Growth hormone stimulation test
d. Adrenocorticotropic hormone level
4. The nurse is interviewing a patient who has a possible thyroid disorder. Which question will provide
the most useful information?
a. “What methods do you use to help cope with stress?”
b. “Have you experienced any blurring or double vision?”
c. “Do you have to get up at night to empty your bladder?”
d. “Have you had any recent unplanned weight gain or loss?”

5. When a patient in the outpatient clinic has an order for blood cortisol testing, which instruction will
the nurse provide for the patient?
a. “Avoid adding any salt to your foods for 24 hours before the test.”
b. “You will need to lie down for 30 minutes before the blood is drawn.”
c. “Come to the laboratory to have the blood drawn early in the morning.”
d. “Do not have anything to eat or drink before the blood test is obtained.”
6. A patient has a total serum calcium level of 13.3 mg/dL (3.3 mmol/L). The nurse will anticipate the
need to teach the patient about testing for
a. calcitonin levels.
b. catecholamine levels.
c. thyroid hormone levels.
d. parathyroid hormone levels.
7. During a physical examination, the nurse finds that a patient’s thyroid gland cannot be palpated. The
most appropriate action by the nurse is to
a. palpate the patient’s neck more deeply.
b. document that the thyroid was nonpalpable.
c. notify the health care provider immediately.
d. teach the patient about thyroid hormone testing.
8. When a patient has clinical manifestations of hypothyroidism, which laboratory value should the
nurse review to determine whether the hypothyroidism is caused by a problem with the anterior
pituitary gland or with the thyroid gland?
a. Thyroxine (T4) level
b. Triiodothyronine (T3) level
c. Thyroid-stimulating hormone (TSH) level
d. Thyrotropin-releasing hormone (TRH) level

9. When working with a patient who has diabetes mellitus, the nurse reviews the results of testing for
glycosylated hemoglobin (HbA1C) to evaluate for
a. glucose levels 2 hours after a meal.
b. circulating, nonfasting glucose levels.
c. glucose control over the past 3 months.
d. hypoglycemic episodes in the past 90 days.
10. When a patient is taking spironolactone (Aldactone), a drug that blocks the action of aldosterone on
the kidney, the nurse will monitor for
a. decreased urinary output.
b. evidence of fluid overload.
c. increased serum sodium levels.
d. elevated serum potassium levels.
11. Which information about a patient with newly diagnosed diabetes mellitus will be most useful to the
nurse in developing strategies for successful adaptation to this disease?
a. Ideal weight
b. Value system
c. Activity level
d. Visual changes
12. A patient is scheduled for a growth hormone stimulation test. In preparation for the test, the nurse
will obtain a
a. basin of ice.
b. cardiac monitor.
c. vial of glargine insulin.
d. vial of 50% dextrose solution.

13. The nurse will plan patient care that will decrease the patient’s physical and emotional stress when
the patient is undergoing
a. a water deprivation test.
b. testing for serum T3 and T4 levels.
c. a 24-hour urine test for free cortisol.
d. a radioactive iodine (I-131) uptake test.
14. A patient is scheduled for a 24-hour urine collection for 17-ketosteroids. The nurse will need to
a. keep the specimen on ice.
b. insert a retention catheter.
c. have the patient void and save that specimen to start the collection.
d. encourage the patient to drink 2 to 3 L of fluid during the 24 hours.
15. When reviewing the laboratory results for a patient’s total calcium level, which information will the
nurse need to consider?
a. The blood glucose is elevated.
b. The phosphate level is normal.
c. The serum albumin level is low.
d. The magnesium level is normal.
16. When the nurse is caring for a patient who was admitted with tetany, which laboratory value should
be monitored?
a. Total protein
b. Blood glucose
c. Ionized calcium
d. Serum phosphate
17. Which information about a patient who is scheduled for an oral glucose tolerance test should be
reported to the health care provider before starting the test?
a. The patient reports having occasional orthostatic dizziness.
b. The patient has had a 10-pound weight gain in the last month.
c. The patient drank several glasses of water an hour previously.
d. The patient takes oral corticosteroids for rheumatoid arthritis.
18. After the nurse manager at the endocrine clinic has completed the orientation of a new RN, which
action by the new RN who is caring for a patient with a goiter and possible hyperthyroidism indicates the
charge nurse needs to do more teaching?
a. The RN palpates the neck to check thyroid size.
b. The RN checks the blood pressure on both arms.
c. The RN orders nonmedicated eye drops to lubricate the patient’s eyes.
d. The RN lowers the thermostat to decrease the temperature in the room.
19. When caring for a patient having a water deprivation test, which finding is most important for the
nurse to communicate to the health care provider?
a. The patient complains of intense thirst.
b. The patient has a 5-lb (2.3 kg) weight loss.
c. The patient feels dizzy when sitting up on the edge of the bed.
d. The patient’s urine osmolality does not change after antidiuretic hormone (ADH) is given.
20. A patient with a possible pituitary adenoma is scheduled for a computed tomography (CT) scan with
contrast media.
Which patient information is most important for the nurse to communicate to the health care provider
before the test?
a. Bilateral poor peripheral vision
b. Allergies to iodine and shellfish
c. Recent weight loss of 20 pounds
d. Complaints of ongoing headaches

Chapter 50: Nursing Management: Endocrine Problems
1. A patient with suspected acromegaly is seen at the clinic. To assist in making the diagnosis, which
question should the nurse ask?
a. “Have you had a recent head injury?”
b. “Do you have to wear larger shoes now?”
c. “Are you experiencing tremors or anxiety?”
d. “Is there any family history of acromegaly?”
2. During preoperative teaching for a patient scheduled for transsphenoidal hypophysectomy for
treatment of a pituitary
adenoma, the nurse instructs the patient about the need to
a. cough and deep breathe every 2 hours postoperatively.
b. remain on bed rest for the first 48 hours after the surgery.
c. be positioned flat with sandbags at the head postoperatively.
d. avoid brushing the teeth for at least 10 days after the surgery.
3. Which nursing action will be included in the postoperative plan of care for a patient who has had a
transsphenoidal resection of a pituitary tumor?
a. Monitor urine output every hour.
b. Palpate extremities for dependent edema.
c. Check hematocrit hourly for first 12 hours.
d. Obtain continuous pulse oximetry for 24 hours.
4. A patient is suspected of having a pituitary tumor causing panhypopituitarism. During assessment of

the patient, the nurse would expect to find
a. high blood pressure.
b. elevated blood glucose.
c. tachycardia and cardiac palpitations.
d. changes in secondary sex characteristics.

5. Which information will the nurse include when teaching a patient about use of somatropin
(Genotropin)?
a. The medication will improve vaginal dryness.
b. Inject the medication subcutaneously every day.
c. Blood glucose levels will decrease when taking the medication.
d. Stop taking the medication if swelling of the hands or feet occurs.
6. A patient is treated with demeclocycline (Declomycin) to control the symptoms of syndrome of

inappropriate antidiuretic hormone (SIADH). The nurse determines that the demeclocycline is effective
upon finding that the
a. peripheral edema is decreased.
b. patient’s weight has increased.
c. urine specific gravity is increased.
d. patient’s urinary output is increased.
7. When teaching a patient with chronic syndrome of inappropriate antidiuretic hormone (SIADH) about
long-term management of the disorder, the nurse determines that additional instruction is needed
when the patient says,
a. “I should weigh myself daily and report any sudden weight loss or gain.”
b. “I need to limit my fluid intake to no more than 1 quart of liquids a day.”
c. “I will eat foods high in potassium because the diuretics cause potassium loss.”
d. “I need to shop for foods that are low in sodium and avoid adding salt to foods.”
8. A patient is hospitalized with possible syndrome of inappropriate antidiuretic hormone (SIADH). The
patient is confused and reports a headache, muscle cramps, and twitching. The nurse would expect the
initial laboratory results to include
a. an elevated hematocrit.
b. a decreased serum sodium.
c. an increased serum chloride.
d. a low urine specific gravity.

9. A patient with symptoms of diabetes insipidus is admitted to the hospital for evaluation and
treatment of the condition. An appropriate nursing diagnosis for the patient is
a. insomnia related to frequent waking at night to void.
b. impaired gas exchange related to fluid retention in lungs.
c. excess fluid volume related to intake greater than output.
d. risk for impaired skin integrity related to generalized edema.
10. Which information will the nurse include when teaching a patient who has been newly diagnosed
with Graves’ disease?
a. Exercise is contraindicated to avoid increasing metabolic rate.
b. Restriction of iodine intake is needed to reduce thyroid activity.
c. Surgery will eventually be required to remove the thyroid gland.
d. Antithyroid medications may take several weeks to have an effect.
11. A few hours after returning to the surgical nursing unit, a patient who has undergone a subtotal
thyroidectomy develops laryngeal stridor and a cramp in the right hand. Which action will the nurse
anticipate taking next?
a. Infuse IV calcium gluconate.
b. Suction the patient’s airway.
c. Prepare for endotracheal intubation.
d. Assist with emergency tracheostomy.
12. A patient with Graves’ disease has exophthalmos. Which nursing action will be included in the plan
of care?
a. Apply eye patches to protect the cornea from irritation.
b. Place cold packs on the eyes to relieve pain and swelling.
c. Elevate the head of the patient’s bed to reduce periorbital fluid.
d. Teach the patient to blink every few seconds to lubricate the cornea.
13. A patient with hyperthyroidism is treated with radioactive iodine (RAI) at a clinic. Before the patient
is discharged, the nurse instructs the patient
a. that symptoms of hyperthyroidism should be relieved in about a week.
b. that symptoms of hypothyroidism may occur as the RAI therapy takes effect.
c. to discontinue the antithyroid medications taken before the radioactive therapy.
d. about radioactive precautions to take with urine, stool, and other body secretions.
14. A 72-year-old patient is diagnosed with hypothyroidism and levothyroxine (Synthroid) is prescribed.
Which assessment is most important for the nurse to make during initiation of thyroid replacement?
a. Apical pulse rate
b. Nutritional intake
c. Intake and output
d. Orientation and alertness
15. A 78-year-old patient in a long-term care facility has these medications prescribed. After the patient
is diagnosed with hypothyroidism, the nurse will need to consult with the health care provider before
administration of
a. docusate (Colace).
b. diazepam (Valium).
c. ibuprofen (Motrin).
d. cefoxitin (Mefoxin).
16. When planning teaching for a patient who was admitted with myxedema coma and diagnosed with
hypothyroidism, which strategy will be best for the nurse to use?
a. Delay teaching until patient discharge.
b. Ensure privacy by asking visitors to leave.
c. Provide written handouts of all information.
d. Offer multiple options for management of therapies.

17. A patient with primary hyperparathyroidism has a serum calcium level of 14 mg/dL (3.5 mmol/L) and
a phosphorus of 1.7 mg/dL (0.55 mmol/L). Which nursing action should be included in the plan of care?
a. Institute routine seizure precautions.
b. Monitor for positive Chvostek’s sign.
c. Encourage the patient to remain on bed rest.
d. Encourage 3000 to 4000 mL of oral fluids daily.
18. Following a parathyroidectomy, a patient develops tingling of the lips and a positive Trousseau’s
sign. Which action should the nurse take first?
a. Administer the ordered muscle relaxant.
b. Give the ordered oral calcium supplement.
c. Start the PRN oxygen at 2 L/min per cannula.
d. Have the patient rebreathe using a paper bag.
19. After radical neck surgery, a patient develops hypoparathyroidism. The nurse should plan to teach
the patient about
a. use of bisphosphonates to reduce bone demineralization.
b. including whole grains in the diet to prevent constipation.
c. calcium supplementation to normalize serum calcium levels.
d. having a high fluid intake to decrease risk for nephrolithiasis.
20. Which assessment finding for a patient who takes levothyroxine (Synthroid) to treat hypothyroidism
indicates that the nurse should contact the health care provider before administering the medication?
a. Increased thyroxine (T4) level
b. Blood pressure 102/62 mm Hg
c. Distant and difficult to hear heart sounds
d. Elevated thyroid stimulating hormone level

21. When caring for a patient with a diagnosis of Cushing syndrome, which data will the nurse expect to
find during the admission assessment?
a. Chronically low blood pressure
b. Bronzed appearance of the skin
c. Decreased axillary and pubic hair
d. Purplish red streaks on the abdomen
22. A patient with Cushing syndrome who is admitted for adrenalectomy has a nursing diagnosis of
disturbed body image related to changes in appearance caused by the effects of the disease. Which
intervention by the nurse will be most helpful?
a. Reassure the patient that the physical changes are very common in patients with Cushing syndrome.
b. Discuss the use of diet and exercise in controlling the weight gain associated with Cushing syndrome.
c. Teach the patient that most of the physical changes caused by Cushing syndrome will resolve after
surgery.
d. Remind the patient that the metabolic impact of Cushing syndrome is of more importance than
appearance.
23. When a patient is hospitalized with acute adrenal insufficiency, which assessment finding by the
nurse indicates that the
prescribed therapies are effective?
a. Increasing serum sodium levels
b. Decreasing blood glucose levels
c. Decreasing serum chloride levels
d. Increasing serum potassium levels
24. A patient is admitted to the hospital in Addisonian crisis. Which patient statement supports the
nursing diagnosis of ineffective self-health management related to lack of knowledge about
management of Addison’s disease?
a. “I double my dose of hydrocortisone on the days that I go for a run.”
b. “I frequently eat at restaurants, and so my food has a lot of added salt.”
c. “I had the stomach flu earlier this week and couldn’t take the hydrocortisone.”
d. “I take twice as much hydrocortisone in the morning as I do in the afternoon.”

25. A patient with systemic lupus erythematosus has a prescription for 2 weeks of high-dose prednisone
therapy. When teaching the patient about the prednisone, which information is most important for the
nurse to include?
a. Call the doctor if you experience any mood alterations with the prednisone.
b. Do not stop taking the prednisone suddenly; it should be decreased gradually.
c. A weight-bearing exercise program will help minimize the risk for osteoporosis.
d. Weigh yourself daily to monitor for weight gain caused by water or increased fat.
26. When caring for a patient who has an adrenocortical adenoma, causing hyperaldosteronism, the
nurse should
a. provide a potassium-restricted diet.
b. monitor the blood pressure every 4 hours.
c. monitor blood glucose level every 4 hours.
d. relieve edema by elevating the extremities.
27. A patient admitted to the hospital with hypertension is diagnosed with a pheochromocytoma. The
nurse will plan to monitor the patient for
a. flushing.
b. headache.
c. bradycardia.
d. hypoglycemia.
28. After a patient with a pituitary adenoma has had a hypophysectomy, the nurse will plan to do
discharge teaching about the need for
a. oral corticosteroids to replace endogenous cortisol.
b. chemotherapy to prevent reoccurrence of the tumor.
c. insulin use to maintain blood glucose at normal levels.
d. sodium restriction to prevent fluid retention and hypertension.

29. When developing a plan of care for a patient with syndrome of inappropriate antidiuretic hormone
(SIADH), which interventions will the nurse include?
a. Encourage fluids to 2000 mL/day.
b. Offer patient hard candies to suck on.
c. Monitor for increased peripheral edema.
d. Keep head of bed elevated to 30 degrees.
30. Which action should the nurse take first when caring for a patient who has just arrived on the unit
after a thyroidectomy?
a. Check the dressing for bleeding.
b. Assess respiratory rate and effort.
c. Take the blood pressure and pulse.
d. Support the patient’s head with pillows.
31. A patient with Cushing syndrome returns to the surgical unit following an adrenalectomy. During the
initial postoperative period, the nurse gives the highest priority to
a. monitoring for infection.
b. protecting the patient’s skin.
c. maintaining fluid and electrolyte status.
d. preventing severe emotional disturbances.
32. Which information obtained by the nurse when caring for a patient who has diabetes insipidus (DI)
is most important to report to the health care provider?
a. The patient had a recent head injury.
b. The patient is confused and lethargic.
c. The patient has a urine output of 400 mL/hr.
d. The patient’s urine specific gravity is 1.003.

33. A patient with Graves’ disease is admitted to the emergency department with thyroid storm. Which
of these prescribed medications should the nurse administer first?
a. propranolol (Inderal)
b. propylthiouracil (PTU)
c. methimazole (Tapazole)
d. iodine (Lugol’s solution)
34. Which assessment finding for a 24-year-old patient admitted with Graves’ disease requires the most
rapid intervention by the nurse?
a. BP 166/100 mm Hg
b. Bilateral exophthalmos
c. Heart rate 136 beats/minute
d. Temperature 104.8° F (40.4° C)
35. While assessing a patient who has just arrived in the postanesthesia recovery unit (PACU) after a
thyroidectomy, the nurse obtains these data. Which information is most important to communicate to
the surgeon?
a. The patient is sleepy and hard to arouse.
b. The patient has increasing swelling of the neck.
c. The patient is complaining of 7/10 incisional pain.
d. The patient’s cardiac monitor shows a heart rate of 112.
36. When providing postoperative care for a patient who had a bilateral adrenalectomy, which
assessment information requires the most rapid action by the nurse?
a. The blood glucose is 176 mg/dL.
b. The lungs have bibasilar crackles.
c. The patient’s BP is 88/50 mm Hg.
d. The patient has 5/10 incisional pain.

37. Which of these nursing actions in the plan of care for a patient who has diabetes insipidus will be
most appropriate for the RN to delegate to an experienced LPN/LVN?
a. Titrate the infusion of 5% dextrose in water.
b. Teach patient how to use DDAVP nasal spray.
c. Assess patient’s hydration status every 8 hours.
d. Administer subcutaneous desmopressin (DDAVP).
38. A patient is admitted with possible syndrome of inappropriate antidiuretic hormone (SIADH). Which
information obtained
by the nurse is most important to communicate rapidly to the health care provider?
a. The patient complains of dyspnea with activity.
b. The patient has a urine specific gravity of 1.025.
c. The patient has a recent weight gain of 8 lb.
d. The patient has a serum sodium level of 119 mEq/L.
39. After receiving change-of-shift report about the following four patients, which patient should the
nurse assess first?
a. A 31-year-old with Cushing syndrome and a blood glucose level of 244 mg/dL
b. A 22-year-old admitted with syndrome of inappropriate antidiuretic hormone (SIADH) who has a
serum sodium level of 130 mEq/L
c. A 70-year-old who recently started taking levothyroxine (Synthroid) and has an irregular pulse of 134
d. A 53-year-old who has Addison’s disease and is due for a scheduled dose of hydrocortisone (Solu-
Cortef).
40. Which question will the nurse in the endocrine clinic ask to help determine a patient’s risk for goiter?
a. "How much milk do you drink?"
b. "What medications are you taking?"
c. "Are your immunizations up to date?"
d. "Have you had any recent neck injuries?"
41. Which finding by the nurse when assessing a patient with a large pituitary adenoma is most
important to report to the health care provider?
a. Changes in visual field
b. Milk leaking from breasts
c. Blood glucose 150 mg/dL
d. Nausea and projectile vomiting
42.Which finding by the nurse when assessing a patient with Hashimoto's thyroiditis and a goiter will
require the most immediate action?
a. New-onset changes in the patient's voice
b. Elevation in the patient's T3 and T4 levels
c. Resting apical pulse rate 112 beats/minute
d. Bruit audible bilaterally over the thyroid gland
43. Which information obtained by the nurse in the endocrine clinic about a patient who has been
taking prednisone 40 mg daily for 3 weeks is most important to report to the health care provider?
a. Patient's blood pressure is 148/94 mm Hg.
b. Patient has bilateral 2+ pitting ankle edema.
c. Patient stopped taking the medication 2 days ago.
d. Patient has not been taking the prescribed vitamin D.
44. The cardiac telemetry unit charge nurse receives status reports from other nursing units about four
patients who need cardiac monitoring. Which patient should be transferred to the cardiac unit first?
a. Patient with Hashimoto's thyroiditis and a heart rate of 102
b. Patient with tetany who has a new order for IV calcium chloride
c. Patient with Cushing syndrome and a blood glucose of 140 mg/dL
d. Patient with Addison's disease who takes hydrocortisone twice daily
45. After obtaining the information shown in the accompanying figure regarding a patient with Addison's
disease, which prescribed action will the nurse take first?
a. Give 4 oz of fruit juice orally.
b. Recheck the blood glucose level.
c. Infuse 5% dextrose and 0.9% saline.
d. Administer O2 therapy as needed.
Chapter 49: Nursing Management: Diabetes Mellitus

1. A patient with newly diagnosed type 2 diabetes mellitus asks the nurse what “type 2” means in
relation to diabetes. Which statement by the nurse about type 2 diabetes is correct?
a. Insulin is not used to control blood glucose in patients with type 2 diabetes.
b. Complications of type 2 diabetes are less serious than those of type 1 diabetes.
c. Type 2 diabetes is usually diagnosed when the patient is admitted with a hyperglycemic coma.
d. Changes in diet and exercise may be sufficient to control blood glucose levels in type 2 diabetes.
2. A patient screened for diabetes at a clinic has a fasting plasma glucose level of 120 mg/dL (6.7
mmol/L). The nurse will plan to teach the patient about
a. self-monitoring of blood glucose.
b. use of low doses of regular insulin.
c. lifestyle changes to lower blood glucose.
d. effects of oral hypoglycemic medications.
3. Which action by a type 1 diabetic patient indicates that the nurse should implement teaching about
exercise and glucose
control?
a. The patient always carries hard candies when engaging in exercise.
b. The patient goes for a vigorous walk when the glucose is 200 mg/dL.
c. The patient has a peanut butter sandwich before going for a bicycle ride.
d. The patient increases daily exercise when ketones are present in the urine.
4. When assessing the patient experiencing the onset of symptoms of type 1 diabetes, which question is
most appropriate for
the nurse to ask?
a. “Have you lost any weight lately?”
b. “How long have you felt anorexic?”
c. “Is your urine unusually dark colored?”
d. “Do you crave fluids containing sugar?”

5. To evaluate the effectiveness of treatment for a patient with type 2 diabetes who is scheduled for a
follow-up visit in the
clinic, which test will the nurse plan to schedule for the patient?
a. Urine dipstick for glucose
b. Oral glucose tolerance test
c. Fasting blood glucose level
d. Glycosylated hemoglobin level
6. A patient who has just been diagnosed with type 2 diabetes has a nursing diagnosis of imbalanced
nutrition: more than
body requirements. Which patient goal is most important for this patient?
a. The patient will have a glycosylated hemoglobin level of less than 7%.
b. The patient will have a diet and exercise plan that results in weight loss.
c. The patient will choose a diet that distributes calories throughout the day.
d. The patient will state the reasons for eliminating simple sugars in the diet.
7. A patient who has type 1 diabetes plans to take a swimming class daily at 1:00 PM. The clinic nurse
will plan to teach the
patient to
a. check glucose level before, during, and after swimming.
b. delay eating the noon meal until after the swimming class.
c. increase the morning dose of neutral protamine Hagedorn (NPH) insulin.
d. time the morning insulin injection so that the peak occurs while swimming.
8. An 18-year-old with newly diagnosed type 1 diabetes has received diet instruction. The nurse
determines a need for
additional instruction when the patient says,
a. “I may have an occasional alcoholic drink if I include it in my meal plan.”
b. “I will need a bedtime snack because I take an evening dose of NPH insulin.”
c. “I may eat whatever I want, as long as I use enough insulin to cover the calories.”
d. “I will eat meals as scheduled, even if I am not hungry, to prevent hypoglycemia.”
9. Which action is most important for the nurse to take in order to assist a diabetic patient to engage in
moderate daily
exercise?
a. Remind the patient that exercise will improve self-esteem.
b. Determine what type of exercise activities the patient enjoys.
c. Give the patient a list of activities that are moderate in intensity.
d. Teach the patient about the effects of exercise on glucose level.
10. The nurse has been teaching the patient to administer a dose of 10 units of regular insulin and 28
units of NPH insulin. The
statement by the patient that indicates a need for additional instruction is,
a. “I need to rotate injection sites among my arms, legs, and abdomen each day.”
b. “I will buy the 0.5 mL syringes because the line markings will be easier to see.”
c. “I should draw up the regular insulin first after injecting air into the NPH bottle.”
d. “I do not need to aspirate the plunger to check for blood before injecting insulin.”
11. After the nurse has finished teaching a patient about self-administration of the prescribed aspart
(NovoLog) insulin, which
patient action indicates good understanding of the teaching?
a. The patient avoids injecting the insulin into the upper abdominal area.
b. The patient cleans the skin with soap and water before insulin administration.
c. The patient places the insulin back in the freezer after administering the prescribed insulin dose.
d. The patient pushes the plunger down and immediately removes the syringe from the injection site.
12. A patient receives aspart (NovoLog) insulin at 8:00 AM. Which time will it be most important for the
nurse to monitor for
symptoms of hypoglycemia?
a. 9:00 AM
b. 11:30 AM
c. 4:00 PM
d. 8:00 PM
13. Which patient action indicates a good understanding of the nurse’s teaching about the use of an
insulin pump?
a. The patient changes the site for the insertion site every week.
b. The patient programs the pump to deliver an insulin bolus after eating.
c. The patient takes the pump off at bedtime and starts it again each morning.
d. The patient states that diet will be less flexible when using the insulin pump.
14. When teaching a diabetic patient who has just been started on intensive insulin therapy about
mealtime coverage, which ype of insulin will the nurse need to discuss?
a. glargine (Lantus)
b. lispro (Humalog)
c. detemir (Levemir)
d. NPH (Humulin N)
15. Which information will the nurse include when teaching a patient who has type 2 diabetes about
glyburide (Micronase, DiaBeta, Glynase)?
a. Glyburide decreases glucagon secretion from the pancreas.
b. Glyburide stimulates insulin production and release from the pancreas.

c. Glyburide should be taken even if the morning blood glucose level is low.
d. Glyburide should not be used for 48 hours after receiving IV contrast media.
16. Which patient statement after the nurse has completed teaching a patient with type 2 diabetes
about taking glipizide
(Glucotrol) indicates a need for additional teaching?
a. “Other medications besides the Glucotrol may affect my blood sugar.”
b. “If I overeat at a meal, I will still take just the usual dose of medication.”
c. “When I become ill, I may have to take insulin to control my blood sugar.”
d. “My diabetes is not as likely to cause complications as if I needed to take insulin.”
17. A patient with type 2 diabetes that is well-controlled with metformin (Glucophage) develops an
allergic rash to an
antibiotic and the health care provider prescribes prednisone (Deltasone). The nurse will anticipate that
the patient may
a. need a diet higher in calories while receiving prednisone.
b. require administration of insulin while taking prednisone.
c. develop acute hypoglycemia while taking the prednisone.
d. have rashes caused by metformin-prednisone interactions.
18. A hospitalized diabetic patient who received 34 U of NPH insulin at 7:00 AM is away from the nursing
unit, awaiting
diagnostic testing when lunch trays are distributed. To prevent hypoglycemia, the best action by the
nurse is to
a. save the lunch tray to be provided upon the patient’s return to the unit.
b. call the diagnostic testing area and ask that a 5% dextrose IV be started.
c. ensure that the patient drinks a glass of milk or orange juice at noon in the diagnostic testing area.
d. request that the patient be returned to the unit to eat lunch if testing will not be completed promptly.
19. A patient with type 1 diabetes has been using self-monitoring of blood glucose (SMBG) as part of
diabetes management.
During evaluation of the patient’s technique of SMBG, the nurse identifies a need for additional teaching
when the patient
a. washes the puncture site using soap and warm water.
b. chooses a puncture site in the center of the finger pad.
c. hangs the arm down for a minute before puncturing the site.
d. says the result of 130 mg indicates good blood sugar control.
20. Which action should the nurse take first when teaching a patient who is newly diagnosed with type 2
diabetes about home
management of the disease?
a. Ask the patient’s family to participate in the diabetes education program.
b. Assess the patient’s perception of what it means to have diabetes mellitus.
c. Demonstrate how to check glucose using capillary blood glucose monitoring.
d. Discuss the need for the patient to actively participate in diabetes management.
21. A diagnosis of hyperglycemic hyperosmolar nonketotic coma (HHNC) is made for a patient with type
2 diabetes who is
brought to the emergency department in an unresponsive state. The nurse will anticipate the need to
a. give 50% dextrose as a bolus.
b. insert a large-bore IV catheter.
c. initiate oxygen by nasal cannula.
d. administer glargine (Lantus) insulin.
22. A patient with type 1 diabetes who uses glargine (Lantus) and lispro (Humalog) insulin develops a
sore throat, cough, and fever. When the patient calls the clinic to report the symptoms and a blood
glucose level of 210 mg/dL, the nurse advises the patient to
a. use only the lispro insulin until the symptoms of infection are resolved.
b. monitor blood glucose every 4 hours and notify the clinic if it continues to rise.
c. decrease intake of carbohydrates until glycosylated hemoglobin is less than 7%.
d. limit intake of calorie-containing liquids until the glucose is less than 120 mg/dL.
23. The health care provider suspects the Somogyi effect in a patient whose 7:00 AM blood glucose is
220 mg/dL. Which
action will the nurse plan to take?
a. Check the patient’s blood glucose at 3:00 AM.
b. Administer a larger dose of long-acting insulin.
c. Educate about the need to increase the rapid-acting insulin dose.
d. Remind the patient about the need to avoid snacking at bedtime.
24. Intramuscular glucagon is administered to an unresponsive patient for treatment of hypoglycemia.

Which action should the nurse take after the patient regains consciousness?
a. Assess the patient for symptoms of hyperglycemia.
b. Give the patient a snack of crackers and peanut butter.
c. Have the patient drink a glass of orange juice or nonfat milk.
d. Administer a continuous infusion of 5% dextrose for 24 hours.
25. Which question by the nurse will help identify autonomic neuropathy in a diabetic patient?
a. “Have you observed any recent skin changes?”
b. “Do you notice any bloating feeling after eating?”
c. “Do you need to increase your insulin dosage when you are stressed?”
d. “Have you noticed any painful new ulcerations or sores on your feet?”
26. A patient with type 2 diabetes has sensory neuropathy of the feet and legs and peripheral arterial
disease. Which
information will the nurse include in patient teaching?
a. Choose flat-soled leather shoes.
b. Set heating pads on a low temperature.
c. Buy callus remover for corns or calluses.

d. Soak the feet in warm water for an hour every day.
27. The nurse obtains the following information about a patient before administration of metformin
(Glucophage). Whichfinding indicates a need to contact the health care provider before giving the
metformin?
a. The patient’s blood glucose level is 166 mg/dL.
b. The patient’s blood urea nitrogen (BUN) level is 60 mg/dL.
c. The patient is scheduled for a chest x-ray in an hour.
d. The patient has gained 2 lb (0.9 kg) since yesterday.
28. Amitriptyline (Elavil) is prescribed for a diabetic patient who has burning foot pain at night. Which
information should the
nurse include when teaching the patient about the new medication?
a. Amitriptyline will decrease the depression caused by your foot pain.
b. Amitriptyline will correct some of the blood vessel changes that cause pain.
c. Amitriptyline will improve sleep and make you less aware of nighttime pain.
d. Amitriptyline will help prevent the transmission of pain impulses to the brain.
29. A patient with type 2 diabetes is admitted for an outpatient coronary arteriogram. Which
information obtained by the nurse
is most important to report to the health care provider before the procedure?
a. The patient’s admission blood glucose is 128 mg/dL.
b. The patient’s most recent Hb A1C was 6.5%.
c. The patient took the prescribed metformin (Glucophage) today.
d. The patient took the prescribed captopril (Capoten) this morning.
30. After the home health nurse has taught a patient and family about how to use glargine and regular
insulin safely, which
action by the patient indicates that the teaching has been successful?
a. The patient administers the glargine 30 to 45 minutes before eating each meal.
b. The patient’s family fills the syringes weekly and stores them in the refrigerator.
c. The patient draws up the regular insulin and then the glargine in the same syringe.
d. The patient disposes of the open vials of glargine and regular insulin after 4 weeks.
31. The nurse teaches the diabetic patient who rides a bicycle to work every day to administer morning
insulin into the
a. arm.
b. thigh.
c. buttock.
d. abdomen.
32. Which information about a patient who receives rosiglitazone (Avandia) is most important for the
nurse to report
immediately to the health care provider?
a. The patient’s blood pressure is 154/92.
b. The patient has a history of emphysema.
c. The patient’s noon blood glucose is 86 mg/dL.
d. The patient has chest pressure when ambulating.
33. A pregnant patient who has no personal history of diabetes, but does have a parent who is diabetic
is scheduled for the first
prenatal visit. Which action will the nurse plan to take on this initial visit?
a. Teach about appropriate use of regular insulin.
b. Discuss the need for a fasting blood glucose level.
c. Schedule an oral glucose tolerance test for the twenty fourth week of pregnancy.
d. Provide education about increased risk for fetal problems with gestational diabetes.
34. A patient is admitted with diabetic ketoacidosis (DKA) and has a serum potassium level of 2.9 mEq/L.
Which action
prescribed by the health care provider should the nurse take first?
a. Infuse regular insulin at 20 U/hr.
b. Place the patient on a cardiac monitor.
c. Administer IV potassium supplements.
d. Obtain urine glucose and ketone levels.
35. A diabetic patient is admitted with ketoacidosis and the health care provider writes these orders.
Which order should the nurse implement first?
a. Administer regular IV insulin 30 U.
b. Infuse 1 liter of normal saline per hour.
c. Give sodium bicarbonate 50 mEq IV push.
d. Start an infusion of regular insulin at 50 U/hr.
36. When the nurse is assessing a patient who is recovering from an episode of diabetic ketoacidosis,
the patient reports feeling
anxious, nervous, and sweaty. Which action should the nurse take first?
a. Administer 1 mg glucagon subcutaneously.
b. Obtain a glucose reading using a finger stick.
c. Have the patient drink 4 ounces of orange juice.
d. Give the scheduled dose of lispro (Humalog) insulin.
37. Which information from the patient’s health history is most important for the nurse to communicate
to the health care
provider when a patient has an order for an oral glucose tolerance test?
a. The patient uses oral contraceptives.
b. The patient runs several days a week.
c. The patient has a family history of diabetes.
d. The patient had a viral illness 2 months ago.
38. Which of these laboratory values, noted by the nurse when reviewing the chart of a hospitalized
diabetic patient, indicates
the need for rapid assessment of the patient?
a. Hb A1C of 5.8%
b. Noon blood glucose of 52 mg/dL
c. Hb A1Cof 6.9%
d. Fasting blood glucose of 130 mg/dL
39. The nurse and LPN/LVN are caring for a type 2 diabetic patient who is admitted for gallbladder
surgery. Which nursing
action can the nurse delegate to the LPN/LVN?
a. Communicate the blood glucose and insulin dose to the circulating nurse in surgery.
b. Discuss the reason for the use of insulin therapy during the immediate postoperative period.
c. Administer the prescribed lispro (Humalog) insulin before transferring the patient to surgery.
d. Plan strategies to minimize the risk for hypo- or hyperglycemia during the postoperative
hospitalization.
A patient with newly diagnosed type 2 diabetes mellitus asks the nurse what "type 2"
means in relation to diabetes. The nurse explains to the patient that type 2 diabetes
differs from type 1 diabetes primarily in that with type 2 diabetes
a.
the patient is totally dependent on an outside source of insulin.
b.
there is decreased insulin secretion and cellular resistance to insulin that is produced.
c.
the immune system destroys the pancreatic insulin-producing cells.
d.
the insulin precursor that is secreted by the pancreas is not activated by the liver.
Correct Answer: B
Rationale: In type 2 diabetes, the pancreas produces insulin, but the insulin is
insufficient for the body's needs or the cells do not respond to the insulin appropriately.
The other information describes the physiology of type 1 diabetes.
Cognitive Level: Application Text Reference: p. 1255

Nursing Process: Implementation NCLEX: Physiological Integrity
A patient screened for diabetes at a clinic has a fasting plasma glucose level of 120
mg/dl (6.7 mmol/L). The nurse will plan to teach the patient about
a.
use of low doses of regular insulin.
b.
self-monitoring of blood glucose.
c.
oral hypoglycemic medications.
d.
maintenance of a healthy weight.
Correct Answer: D
Rationale: The patient's impaired fasting glucose indicates prediabetes and the patient
should be counseled about lifestyle changes to prevent the development of type 2
diabetes. The patient with prediabetes does not require insulin or the oral
hypoglycemics for glucose control and does not need to self-monitor blood glucose.

Nursing Process: Planning NCLEX: Physiological Integrity
During a diabetes screening program, a patient tells the nurse, "My mother died of
complications of type 2 diabetes. Can I inherit diabetes?" The nurse explains that
a.
as long as the patient maintains normal weight and exercises, type 2 diabetes can be
prevented.
b.
the patient is at a higher than normal risk for type 2 diabetes and should have periodic
blood glucose level testing.
c.
there is a greater risk for children developing type 2 diabetes when the father has type 2
diabetes.
d.
although there is a tendency for children of people with type 2 diabetes to develop
diabetes, the risk is higher for those with type 1 diabetes.
Correct Answer: B
Rationale: Offspring of people with type 2 diabetes are at higher risk for developing type
2 diabetes. The risk can be decreased, but not prevented, by maintenance of normal
weight and exercising. The risk for children of a person with type 1 diabetes to develop
diabetes is higher when it is the father who has the disease. Offspring of people with
type 2 diabetes are more likely to develop diabetes than offspring of those with type 1
diabetes.

A program of weight loss and exercise is recommended for a patient with impaired
fasting glucose (IFG). When teaching the patient about the reason for these lifestyle
changes, the nurse will tell the patient that
a.
the high insulin levels associated with this syndrome damage the lining of blood
vessels, leading to vascular disease.
b.
although the fasting plasma glucose levels do not currently indicate diabetes, the
glycosylated hemoglobin will be elevated.
c.
the liver is producing excessive glucose, which will eventually exhaust the ability of the
pancreas to produce insulin, and exercise will normalize glucose production.
d.
the onset of diabetes and the associated cardiovascular risks can be delayed or
prevented by weight loss and exercise.
Correct Answer: D
Rationale: The patient with IFG is at risk for developing type 2 diabetes, but this risk can
be decreased with lifestyle changes. Glycosylated hemoglobin levels will not be
elevated in IFG and the Hb A1C test is not included in prediabetes testing. Elevated
insulin levels do not cause the damage to blood vessels that can occur with IFG. The
liver does not produce increased levels of glucose in IFG.
When assessing the patient experiencing the onset of symptoms of type 1 diabetes,
which question should the nurse ask?
a.
"Have you lost any weight lately?"
b.
"Do you crave fluids containing sugar?"
c.
"How long have you felt anorexic?"
d.
"Is your urine unusually dark-colored?"
Correct Answer: A
Rationale: Weight loss occurs because the body is no longer able to absorb glucose
and starts to break down protein and fat for energy. The patient is thirsty but does not
necessarily crave sugar- containing fluids. Increased appetite is a classic symptom of
type 1 diabetes. With the classic symptom of polyuria, urine will be very dilute.
Cognitive Level: Application Text Reference: pp. 1255, 1258

Nursing Process: Assessment NCLEX: Physiological Integrity
During a clinic visit 3 months following a diagnosis of type 2 diabetes, the patient reports
following a reduced-calorie diet. The patient has not lost any weight and did not bring
the glucose-monitoring record. The nurse will plan to obtain a(n)
a.
fasting blood glucose level.
b.
urine dipstick for glucose.
c.
glycosylated hemoglobin level.
d.
oral glucose tolerance test.
Correct Answer: C
Rationale: The glycosylated hemoglobin (Hb A1C) test shows the overall control of
glucose over 90 to 120 days. A fasting blood level indicates only the glucose level at
one time. Urine glucose testing is not an accurate reflection of blood glucose level and
does not reflect the glucose over a prolonged time. Oral glucose tolerance testing is
done to diagnose diabetes, but is not used for monitoring glucose control once diabetes
has been diagnosed.
Cognitive Level: Application Text Reference: pp. 1258-1259

A patient who has just been diagnosed with type 2 diabetes is 5 ft 4 in (160 cm) tall and
weighs 182 pounds (82 kg). A nursing diagnosis of imbalanced nutrition: more than
body requirements is developed. Which patient outcome is most important for this
patient?
a.
The patient will have a diet and exercise plan that results in weight loss.
b.
The patient will state the reasons for eliminating simple sugars in the diet.
c.
The patient will have a glycosylated hemoglobin level of less than 7%.
d.
The patient will choose a diet that distributes calories throughout the day.
Correct Answer: C
Rationale: The complications of diabetes are related to elevated blood glucose, and the
most important patient outcome is the reduction of glucose to near-normal levels. The
other outcomes are also appropriate but are not as high in priority.

A college student who has type 1 diabetes normally walks each evening as part of an
exercise regimen. The student now plans to take a swimming class every day at 1:00
PM. The clinic nurse teaches the patient to
a.
delay eating the noon meal until after the swimming class.
b.
increase the morning dose of neutral protamine Hagedorn (NPH) insulin on days of the
swimming class.
c.
time the morning insulin injection so that the peak occurs while swimming.
d.
check glucose level before, during, and after swimming.
Correct Answer: D
Rationale: The change in exercise will affect blood glucose, and the patient will need to
monitor glucose carefully to determine the need for changes in diet and insulin
administration. Because exercise tends to decrease blood glucose, patients are advised
to eat before exercising. Increasing the morning NPH or timing the insulin to peak
during exercise may lead to hypoglycemia, especially with the increased exercise.

Nursing Process: Implementation
NCLEX: Health Promotion and Maintenance
A patient with type 1 diabetes has received diet instruction as part of the treatment plan.
The nurse determines a need for additional instruction when the patient says,
a.
"I may have an occasional alcoholic drink if I include it in my meal plan."
b.
"I will need a bedtime snack because I take an evening dose of NPH insulin."
c.
"I will eat meals as scheduled, even if I am not hungry, to prevent hypoglycemia."
d.
"I may eat whatever I want, as long as I use enough insulin to cover the calories."
Correct Answer: D
Rationale: Most patients with type 1 diabetes need to plan diet choices very carefully.
Patients who are using intensified insulin therapy have considerable flexibility in diet
choices but still should restrict dietary intake of items such as fat, protein, and alcohol.
The other patient statements are correct and indicate good understanding of the diet
instruction.

Nursing Process: Evaluation NCLEX: Physiological Integrity
A 1200-calorie diet and exercise are prescribed for a patient with newly diagnosed type
2 diabetes. The patient tells the nurse, "I hate to exercise! Can't I just follow the diet to
keep my glucose under control?" The nurse teaches the patient that the major purpose
of exercise for diabetics is to
a.
increase energy and sense of well-being, which will help with body image.
b.
facilitate weight loss, which will decrease peripheral insulin resistance.
c.
improve cardiovascular endurance, which is important for diabetics.
d.
set a successful pattern, which will help in making other needed changes.
Correct Answer: B
Rationale: Exercise is essential to decrease insulin resistance and improve blood
glucose control. Increased energy, improved cardiovascular endurance, and setting a
pattern of success are secondary benefits of exercise, but they are not the major
reason.

The nurse has been teaching the patient to administer a dose of 10 units of regular
insulin and 28 units of NPH insulin. The statement by the patient that indicates a need
for additional instruction is,
a.
"I need to rotate injection sites among my arms, legs, and abdomen each day."
b.
"I will buy the 0.5-ml syringes because the line markings will be easier to see."
c.
"I should draw up the regular insulin first after injecting air into the NPH bottle."
d.
"I do not need to aspirate the plunger to check for blood before I inject the insulin."
Correct Answer: A
Rationale: Rotating sites is no longer necessary because all insulin is now purified
human insulin, and the risk for lipodystrophy is low. The other patient statements are
accurate and indicate that no additional instruction is needed.

Nursing Process: Evaluation
A patient with type 1 diabetes has an unusually high morning glucose measurement,
and the health care provider wants the patient evaluated for possible Somogyi effect.
The nurse will plan to
a.
administer an increased dose of NPH insulin in the evening.
b.
obtain the patient's blood glucose at 3:00 in the morning.
c.
withhold the nighttime snack and check the glucose at 6:00 AM.
d.
check the patient for symptoms of hypoglycemia at 2:00 to 4:00 AM.
Correct Answer: B
Rationale: In the Somogyi effect, the patient's blood glucose drops in the early morning
hours (in response to excess insulin administration), which causes the release of
hormones that result in a rebound hyperglycemia. It is important to check the blood
glucose in the early morning hours to detect the initial hypoglycemia. An increased
evening NPH dose or holding the nighttime snack will further increase the risk for early
morning hypoglycemia. Information about symptoms of hypoglycemia will not be as
accurate as checking the patient's blood glucose in determining whether the patient has
the Somogyi effect.

A patient receives a daily injection of 70/30 NPH/regular insulin premix at 7:00 AM. The
nurse expects that a hypoglycemic reaction is most likely to occur between
a.
8:00 and 10:00 AM.
b.
4:00 and 6:00 PM.
c.
7:00 and 9:00 PM.
d.
10:00 PM and 12:00 AM.
Correct Answer: B
Rationale: The greatest insulin effect with this combination occurs mid afternoon. The
patient is not at a high risk at the other listed times, although hypoglycemia may occur.
Cognitive Level: Comprehension Text Reference: p. 1260

A patient using a split mixed-dose insulin regimen asks the nurse about the use of
intensive insulin therapy to achieve tighter glucose control. The nurse should teach the
patient that
a.
intensive insulin therapy requires three or more injections a day in addition to an
injection of a basal long-acting insulin.
b.
intensive insulin therapy is indicated only for newly diagnosed type 1 diabetics who
have never experienced ketoacidosis.
c.
studies have shown that intensive insulin therapy is most effective in preventing the
macrovascular complications characteristic of type 2 diabetes.
d.
an insulin pump provides the best glucose control and requires about the same amount
of attention as intensive insulin therapy.
Correct Answer: A
Rationale: Patients using intensive insulin therapy must check their glucose level four to
six times daily and administer insulin accordingly. A previous episode of ketoacidosis is
not a contraindication for intensive insulin therapy. Intensive insulin therapy is not
confined to type 2 diabetics and would prevent microvascular changes as well as
macrovascular changes. Intensive insulin therapy and an insulin pump are comparable
in glucose control.

A diabetic patient is started on intensive insulin therapy. The nurse will plan to teach the
patient about mealtime coverage using _____ insulin.
a.
NPH
b.
lispro
c.
detemir
d.
glargine
Correct Answer: B
Rationale: Rapid or short acting insulin is used for mealtime coverage for patients
receiving intensive insulin therapy. NPH, glargine, or detemir will be used as the basal
insulin.
Glyburide (Micronase, DiaBeta, Glynase) is prescribed for a patient whose type 2
diabetes has not been controlled with diet and exercise. When teaching the patient
about glyburide, the nurse explains that
a.
glyburide stimulates insulin production and release from the pancreas.
b.
the patient should not take glyburide for 48 hours after receiving IV contrast media.
c.
glyburide should be taken even when the blood glucose level is low in the morning.
d.
glyburide decreases glucagon secretion.
Correct Answer: A
Rationale: The sulfonylureas stimulate the production and release of insulin from the
pancreas. If the glucose level is low, the patient should contact the health care provider
before taking the glyburide, since hypoglycemia can occur with this category of
medication. Metformin should be held for 48 hours after administration of IV contract,
but this is not necessary for glyburide.

When teaching a patient with type 2 diabetes about taking glipizide (Glucotrol), the
nurse determines that additional teaching about the medication is needed when the
patient says,
a.
"Since I can take oral drugs rather than insulin, my diabetes is not serious and won't
cause many complications."
b.
"If I overeat at a meal, I will still take just the usual dose of medication."
c.
"If I become ill, I may have to take insulin to control my blood sugar."
d.
"I should check with my doctor before taking any other medications because there are
many that will affect glucose levels."
Correct Answer: A
Rationale: The patient should understand that type 2 diabetes places the patient at risk
for many complications and that good glucose control is as important when taking oral
agents as when using insulin. The other statements are accurate and indicate good
understanding of the use of glipizide.

A patient with type 2 diabetes that is controlled with diet and metformin (Glucophage)
also has severe rheumatoid arthritis (RA). During an acute exacerbation of the patient's
arthritis, the health care provider prescribes prednisone (Deltasone) to control
inflammation. The nurse will anticipate that the patient may
a.
require administration of insulin while taking prednisone.
b.
develop acute hypoglycemia during the RA exacerbation.
c.
have rashes caused by metformin-prednisone interactions.
d.
need a diet higher in calories while receiving prednisone.
Correct Answer: A
Rationale: Glucose levels increase when patients are taking corticosteroids, and insulin
may be required to control blood glucose. Hypoglycemia is not a complication of RA
exacerbation or prednisone use. Rashes are not an adverse effect caused by taking
metformin and prednisone simultaneously. The patient is likely to have an increased
appetite when taking prednisone, but it will be important to avoid weight gain for the
patient with RA.
Cognitive Level: Application Text Reference: pp. 1258, 1267

A hospitalized diabetic patient receives 12 U of regular insulin mixed with 34 U of NPH
insulin at 7:00 AM. The patient is away from the nursing unit for diagnostic testing at
noon, when lunch trays are distributed. The most appropriate action by the nurse is to
a.
save the lunch tray to be provided upon the patient's return to the unit.
b.
call the diagnostic testing area and ask that a 5% dextrose IV be started.
c.
ensure that the patient drinks a glass of milk or orange juice at noon in the diagnostic
testing area.
d.
request that the patient be returned to the unit to eat lunch if testing will not be
completed promptly.
correct Answer: D
Rationale: Consistency for mealtimes assists with regulation of blood glucose, so the
best option is for the patient to have lunch at the usual time. Waiting to eat until after the
procedure is likely to cause hypoglycemia. Administration of an IV solution is
unnecessarily invasive for the patient. A glass of milk or juice will keep the patient from
becoming hypoglycemic but will cause a rapid rise in blood glucose because of the
rapid absorption of the simple carbohydrate in these items.
Cognitive Level: Analysis Text Reference: p. 1268

A patient with type 1 diabetes has been using self-monitoring of blood glucose (SMBG)
as part of diabetes management. During evaluation of the patient's technique of SMBG,
the nurse identifies a need for additional teaching when the patient
a.
chooses a puncture site in the center of the finger pad.
b.
washes the puncture site using soap and water.
c.
says the result of 130 mg indicates good blood sugar control.
d.
hangs the arm down for a minute before puncturing the site.
Correct Answer: A
Rationale: The patient is taught to choose a puncture site at the side of the finger pad.
The other patient actions indicate that teaching has been effective.

A 63-year-old patient is newly diagnosed with type 2 diabetes. When developing an
education plan, the nurse's first action should be to
a.
assess the patient's perception of what it means to have type 2 diabetes.
b.
demonstrate how to check glucose using capillary blood glucose monitoring.
c.
ask the patient's family to participate in the diabetes education program.
d.
discuss the need for the patient to actively participate in diabetes management.
Correct Answer: A
Rationale: Before planning education, the nurse should assess the patient's interest in
and ability to self-manage the diabetes. After assessing the patient, the other nursing
actions may be appropriate, but planning needs to be individualized to each patient.
Cognitive Level: Application Text Reference: p.1264

Nursing Process: Planning
Cardiac monitoring is initiated for a patient in diabetic ketoacidosis (DKA). The nurse
recognizes that this measure is important to identify
a.
electrocardiographic (ECG) changes and dysrhythmias related to hypokalemia.
b.
fluid overload resulting from aggressive fluid replacement.
c.
the presence of hypovolemic shock related to osmotic diuresis.
d.
cardiovascular collapse resulting from the effects of hyperglycemia.
Correct Answer: A
Rationale: The hypokalemia associated with metabolic acidosis can lead to potentially
fatal dysrhythmias such as ventricular tachycardia and ventricular fibrillation, which
would be detected with ECG monitoring. Fluid overload, hypovolemia, and
cardiovascular collapse are possible complications of DKA, but cardiac monitoring
would not detect theses.

A diabetic patient is admitted with ketoacidosis and the health care provider writes all of
the following orders. Which order should the nurse implement first?
a.
Start an infusion of regular insulin at 50 U/hr.
b.
Give sodium bicarbonate 50 mEq IV push.
c.
Infuse 1 liter of normal saline per hour.
d.
Administer regular IV insulin 30 U.
Correct Answer: C
Rationale: The most urgent patient problem is the hypovolemia associated with DKA,
and the priority is to infuse IV fluids. The other actions can be accomplished after the
infusion of normal saline is initiated.

A diagnosis of hyperglycemic hyperosmolar nonketotic coma (HHNC) is made for a
patient with type 2 diabetes who is brought to the emergency department in an
unresponsive state. The nurse will anticipate the need to
a.
administer glargine (Lantus) insulin.
b.
initiate oxygen by nasal cannula.
c.
insert a large-bore IV catheter.
d.
give 50% dextrose as a bolus.
Correct Answer: C
Rationale: HHNC is initially treated with large volumes of IV fluids to correct
hypovolemia. Regular insulin is administered, not a long-acting insulin. There is no
indication that the patient requires oxygen. Dextrose solutions will increase the patient's
blood glucose and would be contraindicated.

A patient with type 1 diabetes who uses glargine (Lantus) and lispro (Humalog) insulin
develops a sore throat, cough, and fever. When the patient calls the clinic to report the
symptoms and a blood glucose level of 210 mg/dl, the nurse advises the patient to
a.
use only the lispro insulin until the symptoms of infection are resolved.
b.
monitor blood glucose every 4 hours and notify the clinic if it continues to rise.
c.
decrease intake of carbohydrates until glycosylated hemoglobin is less than 7%.
d.
limit intake to non-calorie-containing liquids until the glucose is within the usual range.
Correct Answer: B
Rationale: Infection and other stressors increase blood glucose levels and the patient
will need to test blood glucose frequently, treat elevations appropriately with insulin, and
call the health care provider if glucose levels continue to be elevated. Discontinuing the
glargine will contribute to hyperglycemia and may lead to DKA. Decreasing
carbohydrate or caloric intake is not appropriate as the patient will need more calories
when ill. Glycosylated hemoglobins are not used to test for short-term alterations in
blood glucose.

While hospitalized and recovering from an episode of diabetic ketoacidosis, the patient
calls the nurse and reports feeling anxious, nervous, and sweaty. Based on the patient's
report, the nurse should
a.
obtain a glucose reading using a finger stick.
b.
administer 1 mg glucagon subcutaneously.
c.
have the patient eat a candy bar.
d.
have the patient drink 4 ounces of orange juice.
Correct Answer: A
Rationale: The patient's clinical manifestations are consistent with hypoglycemia and
the initial action should be to check the patient's glucose with a finger stick or order a
stat blood glucose. If the glucose is low, the patient should ingest a rapid-acting
carbohydrate, such as orange juice. Glucagon might be given if the patient's symptoms
become worse or if the patient is unconscious. Candy bars contain fat, which would
slow down the absorption of sugar and delay the response to treatment.

A patient recovering from DKA asks the nurse how acidosis occurs. The best response
by the nurse is that
a.
insufficient insulin leads to cellular starvation, and as cells rupture they release organic
acids into the blood.
b.
when an insulin deficit causes hyperglycemia, then proteins are deaminated by the liver,
causing acidic by-products.
c.
excess glucose in the blood is metabolized by the liver into acetone, which is acidic.
d.
an insulin deficit promotes metabolism of fat stores, which produces large amounts of
acidic ketones.
Correct Answer: D
Rationale: Ketoacidosis is caused by the breakdown of fat stores when glucose is not
available for intracellular metabolism. The other responses are inaccurate.

intramuscular glucagon is administered to an unresponsive patient for treatment of
hypoglycemia. Which action should the nurse take after the patient regains
consciousness?
a.
Give the patient a snack of cheese and crackers.
b.
Have the patient drink a glass of orange juice or nonfat milk.
c.
Administer a continuous infusion of 5% dextrose for 24 hours.
d.
Assess the patient for symptoms of hyperglycemia.
Correct Answer: A
Rationale: Rebound hypoglycemia can occur after glucagon administration, but having a
meal containing complex carbohydrates plus protein and fat will help prevent
hypoglycemia. Orange juice and nonfat milk will elevate blood sugar rapidly, but the
cheese and crackers will stabilize blood sugar. Administration of glucose intravenously
might be used in patients who were unable to take in nutrition orally. The patient should
be assessed for symptoms of hypoglycemia after glucagon administration.

A type 1 diabetic patient who was admitted with severe hypoglycemia and treated tells
the nurse, "I did not have any of the usual symptoms of hypoglycemia." Which question
by the nurse will help identify a possible reason for the patient's hypoglycemic
unawareness?
a.
"Do you use any calcium-channel blocking drugs for blood pressure?"
b.
"Have you observed any recent skin changes?"
c.
"Do you notice any bloating feeling after eating?"
d.
"Have you noticed any painful new ulcerations or sores on your feet?"
Correct Answer: C
Rationale: Hypoglycemic unawareness is caused by autonomic neuropathy, which
would also cause delayed gastric emptying. Calcium-channel blockers are not
associated with hypoglycemic unawareness, although β-adrenergic blockers can
prevent patients from having symptoms of hypoglycemia. Skin changes can occur with
diabetes, but these are not associated with autonomic neuropathy. If the patient can feel
painful areas on the feet, neuropathy has not occurred.

A patient with type 2 diabetes has sensory neuropathy of the feet and legs and
peripheral vascular disease evidenced by decreased peripheral pulses and dependent
rubor. The nurse teaches the patient that
a.
the feet should be soaked in warm water on a daily basis.
b.
flat-soled leather shoes are the best choice to protect the feet from injury.
c.
heating pads should always be set at a very low temperature.
d.
over-the-counter (OTC) callus remover may be used to remove callus and prevent
pressure.
Correct Answer: B
Rationale: The patient is taught to avoid high heels and that leather shoes are preferred.
The feet should be washed, but not soaked, in warm water daily. Heating pad use
should be avoided. Commercial callus and corn removers should be avoided; the
patient should see a specialist to treat these problems.

A newly diagnosed type 1 diabetic patient likes to run 3 miles several mornings a week.
Which teaching will the nurse implement about exercise for this patient?
a.
"You should not take the morning NPH insulin before you run."
b.
"Plan to eat breakfast about an hour before your run."
c.
"Afternoon running is less likely to cause hypoglycemia."
d.
"You may want to run a little farther if your glucose is very high."
Correct Answer: B
Rationale: Blood sugar increases after meals, so this will be the best time to exercise.
NPH insulin will not peak until mid-afternoon and is safe to take before a morning run.
Running can be done in either the morning or afternoon. If the glucose is very elevated,
the patient should postpone the run.
32. Amitriptyline (Elavil) is prescribed for a diabetic patient with peripheral neuropathy
who has burning foot pain occurring mostly at night. Which information should the nurse
include when teaching the patient about the new medication?
a.
Amitriptyline will help prevent the transmission of pain impulses to the brain.
b.
Amitriptyline will improve sleep and make you less aware of nighttime pain.
c.
Amitriptyline will decrease the depression caused by the pain.
d.
Amitriptyline will correct some of the blood vessel changes that cause pain.
Correct Answer: A
Rationale: Tricyclic antidepressants decrease the transmission of pain impulses to the
spinal cord and brain. Tricyclics also improve sleep quality and are used for depression,
but that is not the major purpose for their use in diabetic neuropathy. The blood vessel
changes that contribute to neuropathy are not affected by tricyclics.

A patient with type 2 diabetes is scheduled for an outpatient coronary arteriogram.
Which information obtained by the nurse when admitting the patient indicates a need for
a change in the patient's regimen?
a.
The patient's most recent hemoglobin A1C was 6%.
b.
The patient takes metformin (Glucophage) every morning.
c.
The patient uses captopril (Capoten) for hypertension.
d.
The patient's admission blood glucose is 128 mg/dl.
Correct Answer: B
Rationale: To avoid lactic acidosis, metformin should not be used for 48 hours after IV
contrast media are administered. The other patient data indicate that the patient is
managing the diabetes appropriately.

34. The health care provider orders oral glucose tolerance testing for a patient seen in
the clinic. Which information from the patient's health history is most important for the
nurse to communicate to the health care provider?
a.
The patient had a viral illness 2 months ago.
b.
The patient uses oral contraceptives.
c.
The patient runs several days a week.
d.
The patient has a family history of diabetes.
Correct Answer: B
Rationale: Oral contraceptive use may falsely elevate oral glucose tolerance test
(OGTT) values. A viral 2 months previously illness may be associated with the onset of
type 1 diabetes but will not falsely impact the OGTT. Exercise and a family history of
diabetes both can affect blood glucose but will not lead to misleading information from
the OGTT.

Which of these laboratory values noted by the nurse when reviewing the chart of a
diabetic patient indicates the need for further assessment of the patient?
a.
Fasting blood glucose of 130 mg/dl
b.
Noon blood glucose of 52 mg/dl
c.
Glycosylated hemoglobin of 6.9%
d.
Hemoglobin A1C of 5.8%
Correct Answer: B
Rationale: The nurse should assess the patient with a blood glucose level of 52 mg/dl
for symptoms of hypoglycemia, and give the patient some carbohydrate-containing
beverage such as orange juice. The other values are within an acceptable range for a
diabetic patient.

After the home health nurse has taught a patient and family about how to use glargine
and regular insulin safely, which action by the patient indicates that the teaching has
been successful?
a.
The patient disposes of the open insulin vials after 4 weeks.
b.
The patient draws up the regular insulin in the syringe and then draws up the glargine.
c.
The patient stores extra vials of both types of insulin in the freezer until needed.
d.
The patient's family prefills the syringes weekly and stores them in the refrigerator.
Correct Answer: A
Rationale: Insulin can be stored at room temperature for 4 weeks. Glargine should not
be mixed with other insulins or prefilled and stored. Freezing alters the insulin molecule
and should not be done.

The nurse teaches the diabetic patient who rides a bicycle to work every day to
administer morning insulin into the
a.
thigh.
b.
buttock.
c.
arm.
d.
abdomen.
Correct Answer: D
Rationale: Patients should be taught not to administer insulin into a site that will be
exercised because exercise will increase the rate of absorption. The thigh, buttock, and
arm are all exercised by riding a bicycle.

A diabetic patient has a new order for inhaled insulin (Exubera). Which information
about the patient indicates that the nurse should contact the patient before
administering the Exubera?
a.
The patient has a history of a recent myocardial infarction.
b.
The patient's blood glucose is 224 mg/dl.
c.
The patient uses a bronchodilator to treat emphysema.
d.
The patient's temperature is 101.4° F.
Correct Answer: C
Rationale: Exubera is not recommended for patients with emphysema. The other data
do not indicate any contraindication to using Exubera.


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1.

would expect to find

a. decreased serum thyroxine levels.

b. elevated serum aldosterone levels.

c. an increase in urinary free cortisol.

d. low urinary excretion of catecholamines.

a. “I notice my breasts are tender lately.”

b. “I am so thirsty that I drink all day long.”

c. “I get up several times at night to urinate.”

d. “I feel a lump in my throat when I swallow.”

b. Antidiuretic hormone level

c. Growth hormone stimulation test

d. Adrenocorticotropic hormone level

a. “What methods do you use to help cope with stress?”

b. “Have you experienced any blurring or double vision?”

c. “Do you have to get up at night to empty your bladder?”

d. “Have you had any recent unplanned weight gain or loss?”

c. thyroid hormone levels.

d. parathyroid hormone levels.

a. palpate the patient’s neck more deeply.

b. document that the thyroid was nonpalpable.

c. notify the health care provider immediately.

d. teach the patient about thyroid hormone testing.

a. Thyroxine (T4) level

b. Triiodothyronine (T3) level

c. Thyroid-stimulating hormone (TSH) level

d. Thyrotropin-releasing hormone (TRH) level

a. glucose levels 2 hours after a meal.

b. circulating, nonfasting glucose levels.

c. glucose control over the past 3 months.

d. hypoglycemic episodes in the past 90 days.

a. decreased urinary output.

b. evidence of fluid overload.

c. increased serum sodium levels.

d. elevated serum potassium levels.

c. vial of glargine insulin.

d. vial of 50% dextrose solution.

a. a water deprivation test.

b. testing for serum T3 and T4 levels.

c. a 24-hour urine test for free cortisol.

d. a radioactive iodine (I-131) uptake test.

a. keep the specimen on ice.

b. insert a retention catheter.

d. encourage the patient to drink 2 to 3 L of fluid during the 24 hours.

a. The blood glucose is elevated.

b. The phosphate level is normal.

c. The serum albumin level is low.

d. The magnesium level is normal.

a. The patient reports having occasional orthostatic dizziness.

c. The patient drank several glasses of water an hour previously.

d. The patient takes oral corticosteroids for rheumatoid arthritis.

a. The RN palpates the neck to check thyroid size.

b. The RN checks the blood pressure on both arms.

c. The RN orders nonmedicated eye drops to lubricate the patient’s eyes.

d. The RN lowers the thermostat to decrease the temperature in the room.

a. The patient complains of intense thirst.

b. The patient has a 5-lb (2.3 kg) weight loss.

a. Bilateral poor peripheral vision

b. Allergies to iodine and shellfish

c. Recent weight loss of 20 pounds

d. Complaints of ongoing headaches

a. “Have you had a recent head injury?”