Nursing Care of Clients with Pancreatic Endocrine Disorders

A nurse participates in a community-wide screening to identify adults who may have undiagnosed
diabetes mellitus.
50. The nurse obtains a blood glucose level using a glucometer. A reading of 106 mg/dL (6.7 mmol/L) is
obtained. Which instruction is appropriate?
[ ] 1. “It is important that you eat complex carbohydrates right away.”
[ ] 2. “The blood sugar is elevated, and you need to drink 8 ounces of water.”
[ ] 3. “I will document the result, which you can show your health care provider.”
[ ] 4. “The result is a critical value which needs to be addressed by a health care provider.”
51. When the nurse instructs on various tests to diagnose diabetes mellitus, what explanation of a glucose
tolerance test is most accurate?
[ ] 1. “You need to eat a large meal just before the test begins.”
[ ] 2. “You need to bring a voided urine specimen to the laboratory.”
[ ] 3. “You are limited to coffee or tea in the morning before the test.”
[ ] 4. “You will be given a sweetened liquid to drink before the test.”
52. If a screening for diabetes includes a measurement of postprandial blood glucose with morning
breakfast consumed at 0800, at which time would the nurse ensure a serum glucose level is obtained?
[ ] 1. 0600
[ ] 2. 1000
[ ] 3. 1145
[ ] 4. 1300
53. What statement indicates that a client with an elevated postprandial blood glucose level understands
the significance of the screening test results?
[ ] 1. “I need to eat less frequently.”
[ ] 2. “I need to stop eating candy.”
[ ] 3. “I need further testing.”
[ ] 4. “I need to begin taking insulin.”

54. What signs and symptoms are most appropriate for the nurse to investigate when screening adults who
have come to have their blood glucose tested?
[ ] 1. Glucosuria, hypertension, and edema
[ ] 2. Neuralgia, anorexia, and fatigue
[ ] 3. Polycholia, polyemia, and polyplegia
[ ] 4. Polyuria, polydipsia, and polyphagia
After the screening test, one client is referred for additional follow-up. Further diagnostic tests confirm
that the client has type 2 diabetes mellitus.
55. When given the news, the client becomes angry, stating there has been a mistake in the tests. What
nursing action is most appropriate at this time?
[ ] 1. Emphasizing the importance of treatment
[ ] 2. Reassuring the client that diabetes is easily managed
[ ] 3. Explaining that many people live with diabetes
[ ] 4. Listening as the client expresses current feelings
The client with newly diagnosed type 2 diabetes mellitus is referred to the diabetes clinic.
56. The nurse prepares a teaching plan for this client. What action is essential before developing the plan?
[ ] 1. Determining the client's preferred learning style
[ ] 2. Finding out how much the client knows about the diagnosis
[ ] 3. Selecting age-appropriate pamphlets for the client
[ ] 4. Including the client's significant other in the teaching
57. When the client asks the nurse why regular exercise is recommended for clients with diabetes, the best
answer is that regular exercise helps to:
[ ] 1. control weight.
[ ] 2. decrease appetite.
[ ] 3. reduce blood glucose levels.
[ ] 4. improve circulation to the feet.
A dietitian explains how to use the American Diabetes Association exchange list.

58. What statement by the client provides the best evidence that the client understands the principle of an
exchange list for meal planning?
[ ] 1. “I can eat one serving from each category on the exchange list per day.”
[ ] 2. “Measured amounts of food in each category are equal to one another.”
[ ] 3. “The number of servings from the exchange list is unlimited.”
[ ] 4. “I need to use the exchange list to determine the nutrition in food.”
59. The nurse assesses the client with diabetes’ understanding of what “free” foods on the exchange list
means if the client eliminates which item from a meal plan?
[ ] 1. Iced tea, sugar substitute
[ ] 2. Flavored water
[ ] 3. Light beer
[ ] 4. Club soda
A 1,500-calorie diet and metformin are prescribed initially to treat the client's type 2 diabetes.
60. The client tells the nurse that she always skips breakfast. What response by the nurse is most
appropriate?
[ ] 1. “If you drink a glass of milk and eat a breakfast bar, that will be sufficient for breakfast.”
[ ] 2. “You should eat each meal and snack at the same time each day.”
[ ] 3. “If you skip breakfast, eat a high-calorie snack at midmorning.”
[ ] 4. “Wait to take your medication until you eat your first meal of the day.”
Before discharge from the diabetes clinic, the client is advised to have laboratory tests every 6 months to
monitor the response to the diet and medication management.
61. At the client’s 6-month checkup, the nurse reviews the laboratory test results of the client with type 2
diabetes. What laboratory finding indicates that the client requires more teaching?
[ ] 1. The fasting blood sugar (FBS) is 100 mg/dL (5.56 mmol/L)
[ ] 2. The urinalysis shows an absence of ketones.
[ ] 3. The glycosylated hemoglobin (A1C) is 8.7%.
[ ] 4. The random blood glucose is 160 mg/dL (8.89 mmol/L)

62. The client reports difficulty controlling blood sugar levels within therapeutic range. What advice
should the nurse provide? Select all that apply.
[ ] 1. Increase the self-administration of oral medications.
[ ] 2. Consult a dietitian to help manage caloric intake.
[ ] 3. Increase activity level, such as walking each day.
[ ] 4. Skip lunch but eat a bigger breakfast.
[ ] 5. Avoid going to buffet-style restaurants.
[ ] 6. Eat more fibrous food items each day.
Emergency medical personnel bring a client who is lethargic and confused to the emergency department
(ED). A tentative diagnosis of type 1 diabetes mellitus and diabetic ketoacidosis (DKA) is made.
63. What assessment findings would the nurse expect to document if the client has diabetic ketoacidosis
(DKA)? Select all that apply.
[ ] 1. The client has a slow pulse.
[ ] 2. The client is hypotensive.
[ ] 3. The client smells of acetone.
[ ] 4. The client feels nauseous.
[ ] 5. The client has cold, pale skin.
[ ] 6. The client reports being thirsty.
64. When the nurse assesses the client with diabetic ketoacidosis (DKA), what pattern of breathing will
the nurse most likely detect?
[ ] 1. Fast, deep, labored respirations
[ ] 2. Shallow respirations, alternating with apnea
[ ] 3. Slow inhalation and exhalation through pursed lips
[ ] 4. Shortness of breath with pauses
65. After receiving initial medical prescriptions, what is the priority nursing action when managing the
care of the client with diabetic ketoacidosis (DKA)?
[ ] 1. Give the client oxygen.
[ ] 2. Insert a nasogastric tube.
[ ] 3. Infuse intravenous fluid.
[ ] 4. Insert a retention catheter.
66. The nurse obtains information from the spouse of the client with diabetic ketoacidosis (DKA). What
information is the most likely contributor to the client's present condition?
[ ] 1. The client has a current urinary infection.
[ ] 2. The client exercises daily for 30 minutes.
[ ] 3. The client recently got a job promotion.
[ ] 4. The client had an asthma attack last week.
67. The nurse plans to monitor the client with diabetic ketoacidosis (DKA) using periodic capillary blood
glucose measurements. What actions are correct when using a glucometer to monitor the client's blood
glucose level? Select all that apply.
[ ] 1. Clean the client's finger with povidone-iodine.
[ ] 2. Take a set of vital signs before the test.
[ ] 3. Pierce the central pad of the client's finger.
[ ] 4. Apply a large drop of blood to a test strip or area.
[ ] 5. Don gloves before piercing the client's finger.
[ ] 6. Check if a quality control test was done.
A sliding scale of regular insulin is prescribed before each meal and at bedtime.
68. The nurse administers 12 units of regular insulin subcutaneously at 0800. At what time will the nurse
reassess for signs of hypoglycemia?
[ ] 1. 0805
[ ] 2. 0830
[ ] 3. 1000
[ ] 4. 1300
69. The nurse delegates checking the client's capillary blood glucose to a certified nursing assistant
(CNA). If the CNA reports the blood glucose measured 40 mg/dL (2.2 mmol/L), what nursing actions are
appropriate at this time? Select all that apply.
[ ] 1. Withhold the client's next meal.
[ ] 2. Assess the client's level of consciousness.
[ ] 3. Recheck the client's capillary glucose level.
[ ] 4. Record the test result in the medical record.
[ ] 5. Administer glucose tablets if the client is alert.
[ ] 6. Ask if the client's breath smells “fruity.”
70. The nurse teaches the client with newly diagnosed diabetes mellitus about hypoglycemia. If the client
experiences the following symptoms, which symptoms identify the need to raise the blood glucose level?
Select all that apply.
[ ] 1. Sleepiness
[ ] 2. Shakiness
[ ] 3. Thirst
[ ] 4. Heart palpitations
[ ] 5. Diaphoresis
[ ] 6. Confusion
The client with poor vision and type 1 diabetes mellitus must learn to combine two insulins—regular and
intermediate acting—and self-administer the injection before being discharged.
71. If the nurse would suggest an option for insulin administration, what item would most ensure the
client's success?
[ ] 1. A low-dose insulin syringe
[ ] 2. A tuberculin syringe
[ ] 3. An insulin pen
[ ] 4. An insulin pump
72. The client must combine 10 units of additive-free (clear) insulin with 20 units of insulin containing an
additive (cloudy) in the same syringe. Place the following actions in correct sequence for combining the
two insulins. Use all options.
1. Instill 20 units of air in the vial of insulin with the additive.
2. Withdraw 20 units of insulin from the vial of insulin with the additive.
3. Instill 10 units of air in the vial of additive-free insulin.
4. Withdraw 10 units of insulin from the vial of additive-free insulin.
73. When the client practices self-administration of the insulin, what action is correct?
[ ] 1. Piercing the skin at a 30-degree angle
[ ] 2. Using a syringe calibrated in milliliters
[ ] 3. Using a 22-gauge needle on the syringe
[ ] 4. Rotating abdominal sites for each injection

74. At the completion of the diabetes teaching by the nurse, what statement indicates the client's
misunderstanding about type 1 diabetes?
[ ] 1. “I may need more insulin during times of stress.”
[ ] 2. “I may need more food when exercising strenuously.”
[ ] 3. “My insulin needs may change as I get older.”
[ ] 4. “My dependence on insulin may stop eventually.”
The nurse reviews the complications of diabetes type 2 with the client.
75. When teaching about each of the following complications, which one does the nurse correlate as a
consequence of neuropathy?
[ ] 1. Blindness
[ ] 2. Renal failure
[ ] 3. Impotence
[ ] 4. Stroke
76. A client has developed foot pain. What recommendations can the nurse make? Select all that apply.
[ ] 1. Wear slippers instead of shoes.
[ ] 2. Investigate current drug therapies.
[ ] 3. Keep your feet elevated.
[ ] 4. Exercise on a stationary bicycle.
[ ] 5. Wear elastic stockings.
[ ] 6. Stop using tobacco products.
77. What statement by the client about foot care indicates to the nurse a need for further teaching?
[ ] 1. “I need to inspect my feet daily.”
[ ] 2. “I should soak my feet each day.”
[ ] 3. “I need to wear shoes whenever I am not sleeping.”
[ ] 4. “I need to schedule regular appointments with the podiatrist.”

After 3 months, the client with type 1 diabetes returns for a follow-up appointment to evaluate the
progress of self-care.
78. What information is most important for the nurse to elicit from the client to effectively evaluate
compliance with the prescribed therapy?
[ ] 1. The dosage and frequency of insulin administration
[ ] 2. The client's glucose monitoring records for the past week
[ ] 3. The client's weight and vital signs before the office interview
[ ] 4. The symptoms experienced in the past month
The client reports researching the use of insulin pumps on the Internet and wants to know the possibility
of being a candidate.
79. When the nurse teaches the client about infusions using an infusion pump, what is the correct
information about where the pump is most often located?
[ ] 1. In a vein within the nondominant hand
[ ] 2. In the muscular tissue of the thigh
[ ] 3. In the abdomen below the belt line
[ ] 4. In an implanted I.V. catheter in the arm
The nurse cares for an older adult client who is insulin dependent and lives in a long-term care facility.
80. What intervention is most appropriate for the nurse to add to the client's care plan?
[ ] 1. Encourage the client to use an electric razor.
[ ] 2. Have a podiatrist cut the client's toenails.
[ ] 3. Soak the client's feet twice each day.
[ ] 4. Advise the client to use deodorant soap when bathing
82. What sign is most suggestive to the nurse that a client with type 2 diabetes is progressing to
hyperosmolar hyperglycemic nonketotic syndrome (HHNS)?
[ ] 1. The client's serum glucose level is 650 mg/dL (35.8 mmol/L).
[ ] 2. The client's urinary output is 3,000 mL/24 hours.
[ ] 3. The client's skin is cool and moist.
[ ] 4. The client's urine contains acetone.

A client with type 1 diabetes mellitus presents to the clinic with reports of persistent bouts of nausea,
vomiting, and diarrhea for the past 4 days. The client has skipped insulin injections because of not being
able to eat or keep anything down.
83. What instruction should the nurse give the client about managing diabetes during periods of illness?
[ ] 1. Monitor blood glucose levels every 2 to 4 hours.
[ ] 2. Eat candy or sugary foods frequently.
[ ] 3. Drink a high-energy beverage daily.
[ ] 4. Continue administering insulin as prescribed.
84. The nurse instructs a client about using a Humulin 70/30 prefilled insulin pen. What statement by the
client needs further clarification?
[ ] 1. “I need to prime the pen before selecting the prescribed insulin dose.”
[ ] 2. “The insulin mix in the pen is the same as what I draw up in my vial.”
[ ] 3. “Since my spouse and I use the same type of insulin mix, we can share the insulin pen.”
[ ] 4. “Needle change is needed prior to administering the next insulin dosage.”
85. During change of shifts, a nurse discovers that a hospitalized client with diabetes received two doses
of intermediate-acting insulin. What nursing action should the nurse take next?
[ ] 1. Complete an incident report.
[ ] 2. Contact the client's health care provider.
[ ] 3. Administer a glass of orange juice.
[ ] 4. Check the client's blood glucose level.