1. Which of the following patients are at risk for developing Cushing’s Syndrome?

A. A patient with a tumor on the pituitary gland, which is causing too much ACTH to be secreted.

B. A patient taking glucocorticoids for several weeks.

C. A patient with a tuberculosis infection.

D. A patient who is post-opt from an adrenalectomy

2. Addison’s Disease is:

A. Increased secretion of cortisol

B. Increased secretion of aldosterone and cortisol

C. Decreased secretion of cortisol

D. Decreased secretion of aldosterone and cortisol

3. A patient with Addison’s Disease is being discharged home on Prednisone. Which of the following
statements by the patient warrants you to re-educate the patient?

A. “I will notify the doctor if I become sick or experience extra stress.”

B. “I will take this medication as needed when symptoms present.”

C. “I will take this medication at the same time every day.”

D. “My daughter has bought me a Medic-Alert bracelet.”

4. A patient is admitted to the ER. The patient is unconscious on arrival. However, the patient’s family is
with the patient and reports that before the patient became unconscious she was complaining of severe
pain in the abdomen, legs, and back, and has been experiencing worsening confusion. In addition, they
also report the patient has not been taking any medications. The patient was recently discharged from the
hospital for treatment of low cortisol and aldosterone levels. On assessment, you note the patient’s blood
pressure is 70/45. What disorder is this patient most likely experiencing?

A. Addisonian Crisis

B. Cushing Syndrome

C. Thyroid crisis

D. Hashimoto thyroiditis

5. In the scenario above, what medication do you expect the patient to be started on?

A. IV Solu-Cortef

B. PO Prednisone

C. PO Declomycin

D. IV Insulin

6. A patient with Addison’s Disease should consume which of the following diets?

A. High fat and fiber

B. Low potassium and high protein

C. High protein, carbs, and adequate sodium

D. Low carbs, high protein, and increased sodium

7. In Cushing’s Disease and Syndrome there are:

A. Increased cortisol production

B. Low potassium and glucose levels

C. Increased production of aldosterone and cortisol

D. Decreased production of cortisol and aldosterone

8. A patient with Cushing’s syndrome will be undergoing an adrenalectomy. Which of the following will be
included in the patient’s discharge teaching after the procedure?

A. Glucocorticoid replacement therapy

B. Avoiding avocadoes and pears

C. Declomycin therapy

D. Signs and symptoms of Grave’s Disease

9. Which of the following is not a typical sign and symptom of Cushing’s Syndrome?

A. Hyperpigmentation of the skin

B. Hirsutism

C. Purplish striae

D. Moon Face

10. In Cushing’s disease, the _______is secreting too much ACTH (Adrenocorticotropic hormone) which is
causing an increase in cortisol production.

A. Adrenal cortex

B. Pituitary gland

C. Thyroid gland

D. Hypothalamus

The nurse is assessing a client with possible Cushing's syndrome. In a client with Cushing's syndrome, the
nurse would expect to find:

1. Hypotension
2. Thick, coarse skin
3. deposits of adipose tissue in the trunk and dorsocervical area
4. weight gain in arms and legs
Rationale: (3)Because of changes in fat distribution, adipose tissue accumulates in the trunk, face
(moonface), and dorsocervical areas (buffalo hump). Hypertension is caused by fluid retention. Skin
becomes thin and bruises easily because of a loss of collagen. Muscle wasting causes muscle atrophy and
thin extremities.
The nurse is planning care for a 52-year-old male client in acute Addisonian crisis. Which nursing diagnosis
should receive the highest priority?

1. Risk for Infection

2. Decreased cardiac output
3. Impaired physical mobility
4. Imbalanced nutrition: less than body requirement
RATIONALES: (2) An acute addisonian crisis is a life-threatening event, caused by deficiencies of cortisol
and aldosterone. Glucocorticoid insufficiency causes a decrease in cardiac output and vascular tone,
leading to hypovolemia. The client becomes tachycardic and hypotensive and may develop shock and
circulatory collapse. The client with Addison's disease is at risk for infection; however, reducing infection
isn't a priority during an addisonian crisis. Impaired physical mobility is also an appropriate nursing
diagnosis for the client with Addison's disease, but it isn't a priority in a crisis. Imbalanced nutrition: Less
than body requirements is also an important nursing diagnosis for the client with Addison's disease but not
a priority during a crisis.
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During the first 24 hours after a client is diagnosed with Addisonian crisis, which intervention should the
nurse perform frequently?

1. Weigh the client

2. Test urine for ketones
3. Assess vital signs
4. Administer oral hydrocortisone
RATIONALES (3): Because the client in Addisonian crisis is unstable, vital signs and fluid and electrolyte
balance should be assessed every 30 minutes until he's stable. Daily weights are sufficient when assessing
the client's condition. The client shouldn't have ketones in his urine, so there is no need to assess the urine
for their presence. Oral hydrocortisone isn't administered during the first 24 hours in severe adrenal
insufficiency.
A client is admitted to the health care facility for evaluation for Addison's disease. Which laboratory test
result best supports a diagnosis of Addison's disease?

1. BUN level of 12 mg/dl

2. Blood glucose level of 90 mg/dl
3. Serum sodium level of 134 mEq/L
4. Serum potassium level of 5.8 mEq/L
RATIONALES: (4) Addison's disease decreases the production of aldosterone, cortisol, and androgen,
causing urinary sodium and fluid losses, an increased serum potassium level, and hypoglycemia.
Therefore, an elevated serum potassium level of 5.8 mEq/L best supports a diagnosis of Addison's disease.
A BUN level of 12 mg/dl and a blood glucose level of 90 mg/dl are within normal limits. In a client with
Addison's disease, the serum sodium level would be much lower than 134 mEq/L, a nearly normal level.
A client with Addison's disease is scheduled for discharge after being hospitalized for an adrenal crisis.
Which statements by the client would indicate that client teaching has been effective?

1. "I have to take my steroids for 10 days."

2. "I need to weigh myself daily to be sure I don't eat too many calories."
3. "I need to call my doctor to discuss my steroid needs before I have dental work."
4. "I will call the doctor if I suddenly feel profoundly weak or dizzy."
5. "If I feel like I have the flu, I'll carry on as usual because this is an expected response."
6. "I need to obtain and wear a Medic Alert bracelet."
RATIONALES:(3, 4, 6) Dental work can be a cause of physical stress; therefore, the client's physician needs
to be informed about the dental work and an adjusted dosage of steroids may be necessary. Fatigue,
weakness, and dizziness are symptoms of inadequate dosing of steroid therapy; the physician should be
notified if these symptoms occur. A Medic Alert bracelet allows health care providers to access the client's
history of Addison's disease if the client is unable to communicate this information. A client with Addison's
disease doesn't produce enough steroids, so routine administration of steroids is a lifetime treatment.
Daily weights should be monitored to monitor changes in fluid balance, not calorie intake. Influenza is an
added physical stressor and the client may require an increased dosage of steroids. The client shouldn't
"carry on as usual."
When teaching a client with Cushing's syndrome about dietary changes, the nurse should instruct the
client to increase intake of:

1. fresh fruits
2. dairy products
3. processed meats
4. cereals and grains
RATIONALES: (1) Cushing's syndrome causes sodium retention, which increases urinary potassium loss.
Therefore, the nurse should advise the client to increase intake of potassium-rich foods, such as fresh fruit.
The client should restrict consumption of dairy products, processed meats, cereals, and grains because
they contain significant amounts of sodium.
In a 28-year-old female client who is being successfully treated for Cushing's syndrome, the nurse would
expect a decline in:

1. serum glucose level

2. hair loss
3. bone mineralization
4. menstrual flow
RATIONALES: (1) Hyperglycemia, which develops from glucocorticoid excess, is a manifestation of
Cushing's syndrome. With successful treatment of the disorder, serum glucose levels decline. Hirsutism is
common in Cushing's syndrome; therefore, with successful treatment, abnormal hair growth also declines.
Osteoporosis occurs in Cushing's syndrome; therefore, with successful treatment, bone mineralization
increases. Amenorrhea develops in Cushing's syndrome. With successful treatment, the client experiences
a return of menstrual flow, not a decline in it.
The nurse is caring for a client in acute addisonian crisis. Which laboratory data would the nurse expect to
find?

1. hyperkalemia
2. reduced BUN
3. hypernatremia
4. hyperglycemia
RATIONALES (1): In adrenal insufficiency, the client has hyperkalemia due to reduced aldosterone
secretion. BUN increases as the glomerular filtration rate is reduced. Hyponatremia is caused by reduced
aldosterone secretion. Reduced cortisol secretion leads to impaired glyconeogenesis and a reduction of
glycogen in the liver and muscle, causing hypoglycemia.
A client with Addison's disease comes to the clinic for a follow-up visit. When assessing this client, the
nurse should stay alert for signs and symptoms of:

1. calcium and phosphorus abnormalities

2. chloride and magnesium abnormalities
3. sodium and chloride abnormalities
4. sodium and potassium abnormalities
RATIONALES:(4) In Addison's disease, a form of adrenocortical hypofunction, aldosterone secretion is
reduced. Aldosterone promotes sodium conservation and potassium excretion. Therefore, aldosterone
deficiency increases sodium excretion, predisposing the client to hyponatremia, and inhibits potassium
excretion, predisposing the client to hyperkalemia. Because aldosterone doesn't regulate calcium,
phosphorus, chloride, or magnesium, an aldosterone deficiency doesn't affect levels of these electrolytes
directly.
A client with Cushing's syndrome is admitted to the medical-surgical unit. During the admission
assessment, the nurse notes that the client is agitated and irritable, has poor memory, reports loss of
appetite, and appears disheveled. These findings are consistent with which problem?

1. depression
2. neuropathy
3. hypoglycemia
4. hyperthyroidism
RATIONALES (1): Agitation, irritability, poor memory, loss of appetite, and neglect of one's appearance may
signal depression, which is common in clients with Cushing's syndrome. Neuropathy affects clients with
diabetes mellitus — not Cushing's syndrome. Although hypoglycemia can cause irritability, it also produces
increased appetite, rather than loss of appetite. Hyperthyroidism typically causes such signs as goiter,
nervousness, heat intolerance, and weight loss despite increased appetite.
Which nursing diagnosis is most appropriate for a client with Addison's disease?

1. Risk for infection

2. Excessive fluid volume
3. Urinary retention
4. Hypothermia
RATIONALES:(1) Addison's disease decreases the production of all adrenal hormones, compromising the
body's normal stress response and increasing the risk of infection. Other appropriate nursing diagnoses for
a client with Addison's disease include Deficient fluid volume and Hyperthermia. Urinary retention isn't
appropriate because Addison's disease causes polyuria.
A client with a history of Addison's disease and flulike symptoms accompanied by nausea and vomiting
over the past week is brought to the facility. When he awoke this morning, his wife noticed that he acted
confused and was extremely weak. The client's blood pressure is 90/58 mm Hg, his pulse is 116
beats/minute, and his temperature is 101° F (38.3° C). A diagnosis of acute adrenal insufficiency is made.
What would the nurse expect to administer by I.V. infusion?
1. Insulin
2. Hydrocortisone
3. Potassium
4. Hypotonic saline
RATIONALES (2) : Emergency treatment for acute adrenal insufficiency (Addisonian crisis) is I.V. infusion of
hydrocortisone and saline solution. The client is usually given a dose containing hydrocortisone 100 mg I.V.
in normal saline every 6 hours until the client's blood pressure returns to normal. Insulin isn't indicated in
this situation because adrenal insufficiency is usually associated with hypoglycemia. Potassium isn't
indicated because these clients are usually hyperkalemic. The client needs normal — not hypotonic —
saline solution.
The nursing care for the client in addisonian crisis should include which intervention?

1. Encouraging independence with activities of daily living (ADLs)

2. Allowing ambulation as tolerated
3. Offering extra blankets and raising the heat in the room to keep the client warm
4. Placing the client in a private room
RATIONALES(4): The client in addisonian crisis has a reduced ability to cope with stress due to an inability
to produce corticosteroids. Compared to a multibed room, a private room is easier to keep quiet, dimly lit,
and temperature controlled. Also, visitors can be limited to reduce noise, promote rest, and decrease the
risk of infection. The client should be kept on bed rest, receiving total assistance with ADLs to avoid stress
as much as possible. Because extremes of temperature should be avoided, measures to raise the body
temperature, such as extra blankets and turning up the heat, should be avoided.
Before discharge, what should a client with Addison's disease be instructed to do when exposed to periods
of stress?

1. administer hydrocortisone I.M.

2. Drink 8 oz of fluids.
3. Perform capillary blood glucose monitoring four times daily
4. Continue to take his usual dose of hydrocortisone.
RATIONALES: (1) Clients with Addison's disease and their family members should know how to administer
I.M. hydrocortisone during periods of stress. It's important to keep well hydrated during stress, but the
critical component in this situation is to know how and when to use I.M. hydrocortisone. Capillary blood
glucose monitoring isn't indicated in this situation because the client doesn't have diabetes mellitus.
Hydrocortisone replacement doesn't cause insulin resistance.
For a client in addisonian crisis, it would be very risky for a nurse to administer:

1. potassium chloride
2. normal saline solution
3. hydrocortisone
4. fludrocortisone
RATIONALES: (1) Addisonian crisis results in hyperkalemia; therefore, administering potassium chloride is
contraindicated. Because the client will be hyponatremic, normal saline solution is indicated.
Hydrocortisone and fludrocortisone are both useful in replacing deficient adrenal cortex hormones.
The nurse is teaching a client recovering from addisonian crisis about the need to take fludrocortisone
acetate and hydrocortisone at home. Which statement by the client indicates an understanding of the
instructions?

1. "I'll take my hydrocortisone in the late afternoon, before dinner."

2. "I'll take all of my hydrocortisone in the morning, right after I wake up."
3. "I'll take two-thirds of the dose when I wake up and one-third in the late afternoon."
4. "I'll take the entire dose at bedtime."
RATIONALES (3): Hydrocortisone, a glucocorticoid, should be administered according to a schedule that
closely reflects the body's own secretion of this hormone; therefore, two-thirds of the dose of
hydrocortisone should be taken in the morning and one-third in the late afternoon. This dosage schedule
reduces adverse effects.
The nurse is assessing a client with Cushing's syndrome. Which observation should the nurse report to the
physician immediately?

1. pitting edema of the legs

2. an irregular apical pulse
3. dry mucous membranes
4. frequent urination
RATIONALES (2): Because Cushing's syndrome causes aldosterone overproduction, which increases urinary
potassium loss, the disorder may lead to hypokalemia. Therefore, the nurse should immediately report
signs and symptoms of hypokalemia, such as an irregular apical pulse, to the physician. Edema is an
expected finding because aldosterone overproduction causes sodium and fluid retention. Dry mucous
membranes and frequent urination signal dehydration, which isn't associated with Cushing's syndrome.

A 35-year-old female client who complains of weight gain, facial hair, absent menstruation, frequent
bruising, and acne is diagnosed with Cushing's syndrome. Cushing's syndrome is most likely caused by:

1. an ectopic corticotropin-secreting tumor

2. adrenal carcinoma
3. a corticotropin-secreting pituitary adenoma
4. an inborn error of metabolism.
RATIONALES: (3) A corticotropin-secreting pituitary adenoma is the most common cause of Cushing's
syndrome in women ages 20 to 40. Ectopic corticotropin-secreting tumors are more common in older men
and are often associated with weight loss. Adrenal carcinoma isn't usually accompanied by hirsutism. A
female with an inborn error of metabolism wouldn't be menstruating.

Which of the following patients are at risk for developing Cushing's Syndrome?*
A. A patient with a tumor on the pituitary gland, which is causing too much ACTH to be secreted.
B. A patient taking glucocorticoids for several weeks.
C. A patient with a tuberculosis infection.
D. A patient who is post-opt from an adrenalectomy.
B
Addison's Disease is:*
A. Increased secretion of cortisol
B. Increased secretion of aldosterone and cortisol
C. Decreased secretion of cortisol
D. Decreased secretion of aldosterone and cortisol
D
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A patient with Addison's Disease is being discharged home on Prednisone. Which of the following
statements by the patient warrants you to re-educate the patient?*
A. "I will notify the doctor if I become sick or experience extra stress."
B. "I will take this medication as needed when symptoms present."
C. "I will take this medication at the same time every day."
D. "My daughter has bought me a Medic-Alert bracelet."
B
A patient is admitted to the ER. The patient is unconscious on arrival. However, the patient's family is with
the patient and reports that before the patient became unconscious she was complaining of severe pain in
the abdomen, legs, and back, and has been experiencing worsening confusion. In addition, they also report
the patient has not been taking any medications. The patient was recently discharged from the hospital for
treatment of low cortisol and aldosterone levels. On assessment, you note the patient's blood pressure is
70/45. What disorder is this patient most likely experiencing?*
A. Addisonian Crisis
B. Cushing Syndrome
C. Thyroid crisis
D. Hashimoto thyroiditis
A
In the scenario above, what medication do you expect the patient to be started on?*
A. IV Solu-Cortef
B. PO Prednisone
C. PO Declomycin
D. IV Insulin
A
A patient with Addison's Disease should consume which of the following diets?*
A. High fat and fiber
B. Low potassium and high protein
C. High protein, carbs, and adequate sodium
D. Low carbs, high protein, and increased sodium
C
In Cushing's Disease and Syndrome there are:*
A. Increased cortisol production
B. Low potassium and glucose levels
C. Increased production of aldosterone and cortisol
D. Decreased production of cortisol and aldosterone
A
A patient with Cushing's syndrome will be undergoing an adrenalectomy. Which of the following will be
included in the patient's discharge teaching after the procedure?*
A. Glucocorticoid replacement therapy
B. Avoiding avocadoes and pears
C. Declomycin therapy
D. Signs and symptoms of Grave's Disease
A
Which of the following is not a typical sign and symptom of Cushing's Syndrome?*
A. Hyperpigmentation of the skin
B. Hirsutism
C. Purplish striae
D. Moon Face
A
In Cushing's disease, the _______ is secreting too much ACTH (Adrenocorticotropic hormone) which is
causing an increase in cortisol production.*
A. Adrenal cortex
B. Pituitary gland
C. Thyroid gland
D. Hypothalamus
B

Which of the following patients are at risk for developing Cushing’s Syndrome?

A patient with a tumor on the pituitary gland, which is causing too much ACTH to be secreted.

A patient taking glucocorticoids for several weeks.

C. A patient with a tuberculosis infection.

D.A patient who is post-opt from an adrenalectomy

2. In Cushing’s Disease and Syndrome there are:

A. Increased cortisol production

B. Low potassium and glucose levels

C. Increased production of aldosterone and cortisol

D. Decreased production of cortisol and aldosterone

E. 3. A patient with Cushing’s syndrome will be undergoing an adrenalectomy. Which of the following will be
included in the patient’s discharge teaching after the procedure?

A. Glucocorticoid replacement therapy

B. Avoiding avocados and pears

C. Declomycin therapy

D. Signs and symptoms of Grave’s Disease

4. Which of the following is not a typical sign and symptom of Cushing’s Syndrome?
A. Hyperpigmentation of the skin

B. Hirsutism

C. Purplish striae D. Moon Face

5. In Cushing’s disease, the _______is secreting too much ACTH (Adrenocorticotropic hormone) which is
causing an increase in cortisol production.

A. Adrenal cortex

B. Pituitary gland

C. Thyroid gland

D. Hypothalamus

6. The nurse is assessing a client with possible Cushing's syndrome. In a client with Cushing's syndrome,
the nurse would expect to find:

A. Hypotension

B. Thick, coarse skin

C. deposits of adipose tissue in the trunk and dorsocervical area

D. weight gain in arms and legs

7. When teaching a client with Cushing's syndrome about dietary changes, the nurse should instruct the
client to increase intake of:

A. fresh fruits

B. dairy products

C. processed meats

D cereals and grains

8. In a 28-year-old female client who is being successfully treated for Cushing's syndrome, the nurse would
expect a decline in:
9. A. serum glucose level
10. B. hair loss
11. C. bone mineralization
12. D. menstrual flow

9. A client with Cushing's syndrome is admitted to the medical-surgical unit. During the admission
assessment, the nurse notes that the client is agitated and irritable, has poor memory, reports loss of
appetite, and appears disheveled. These findings are consistent with which problem?
10. A. depression
11. B neuropathy
12. C. hypoglycemia
13. D. hyperthyroidism
14. 10. The nurse is assessing a client with Cushing's syndrome. Which observation should the nurse
report to the physician immediately?
15. A. pitting edema of the legs
16. B. an irregular apical pulse
17. C. dry mucous membranes
18. D. frequent urination

1. Which of the following symptoms do NOT present in hyperglycemia?

A. Extreme thirst
B. Hunger
C. Blood glucose <60 mg/dL
D. Glycosuria
The answer is C.

2. Type 1 diabetics typically have the following clinical characteristics:

A. Thin, young with ketones present in the urine
B. Overweight, young with no ketones present in the urine
C. Thin, older adult with glycosuria
D. Overweight, adult-aged with ketones present in the urine
The answer is A.

3. A patient with diabetes has a morning glucose of 50. The patient is sweaty, cold, and clammy. Which of
the following nursing interventions is the MOST important?
A. Recheck the glucose level
B. Give the patient ½ cup (4 oz) of fruit juice
C. Call the doctor
D. Keep the patient nothing by mouth
The answer is B .

4. Which of the following patients is at most risk for Type 2 diabetes?

A. A 6 year old girl recovering from a viral infection with a family history of diabetes.
B. A 28 year old male with a BMI of 49.
C. A 76 year old female with a history of cardiac disease.
D. None of the options provided.
The answer is B. Remember Type 2 diabetes risk factors are related to lifestyle….being obese is a risk
factor (BMI >30 in males is considered obese). So, the 28 year old male with a BMI of 49 is most at risk for
Type 2.

5. The _____ ______ secrete insulin which are located in the _______.
A. Alpha cells, liver
B. Alpha cells, pancreas
C. Beta cells, liver
D. Beta cells, pancreas
The answer is D.

6. A 36-year-old male is newly diagnosed with Type 2 diabetes. Which of the following treatments do you
expect the patient to be started on initially?
A. Diet and exercise regime
B. Metformin BID by mouth
C. Regular insulin subcutaneous
D. None, monitoring at this time is sufficient enough
The answer is A.

7. Which of the following statements are true regarding Type 2 diabetes treatment?
A. Insulin and oral diabetic medications are administered routinely in the treatment of Type 2 diabetes.
B. Insulin may be needed during times of surgery or illness.
C. Insulin is never taken by the Type 2 diabetic.
D. Oral medications are the first line of treatment for newly diagnosed Type 2 diabetics.
The answer is B.

8. What statement or statements are INCORRECT regarding Diabetic Ketoacidosis?

A. DKA occurs mainly in Type 1 diabetics.
B. Ketones are present in the urine in DKA.
C. Cheyne-stokes breathing will always present in DKA.
D. Severe hypoglycemia is a hallmark sign in DKA.
E. Options C & D
The answer is E.

9. A patient who has diabetes is nothing by mouth as prep for surgery. The patient states they feel like
their blood sugar is low. You check the glucose and find it to be 52. The next nursing intervention would be
to:
A. Administer Dextrose 50% IV per protocol
B. Continue to monitor the glucose
C. Give the patient 4 oz of fruit juice
D. None, this is a normal blood glucose reading
The answer is A. This question requires critical thinking because the patient is NPO for surgery and can
NOT eat but is experiencing hypoglycemia. Normally, you could give the patient 15 grams of a simple
carbohydrate like 4 oz of fruit juice or soda, glucose tablets, gel etc. per hypoglycemia protocol However,
the patient can NOT eat due to surgery prep. Therefore the nurse would need to administer Dextrose 50%
IV per protocol to help increase the blood glucose and recheck the glucose level.

10. A Type 2 diabetic may have all the following signs or symptoms EXCEPT:
A. Blurry vision
B. Ketones present in the urine
C. Glycosuria
D. Poor wound healing
The answer is B.

he nurse is reviewing laboratory results for the clinic patients to be seen today. Which patient meets the
diagnostic criteria for diabetes mellitus?

a. A 48-year-old woman with a hemoglobin A1C of 8.4%

b. A 58-year-old man with a fasting blood glucose of 111 mg/dL
c. A 68-year-old woman with a random plasma glucose of 190 mg/dL
d. A 78-year-old man with a 2-hour glucose tolerance plasma glucose of 184 mg/dL
a. A 48-year-old woman with a hemoglobin A1C of 8.4%

Criteria for a diagnosis of diabetes mellitus include a hemoglobin A1C ≥ 6.5%, fasting plasma glucose level
=126 mg/dL, 2-hour plasma glucose level =200 mg/dL during an oral glucose tolerance test, or classic
symptoms of hyperglycemia or hyperglycemic crisis with a random plasma glucose =200 mg/dL.
The nurse teaches a 38-year-old man who was recently diagnosed with type 1 diabetes mellitus about
insulin administration. Which statement by the patient requires an intervention by the nurse?

a. "I will discard any insulin bottle that is cloudy in appearance."

b. "The best injection site for insulin administration is in my abdomen."
c. "I can wash the site with soap and water before insulin administration."
d. "I may keep my insulin at room temperature (75o F) for up to a month."
a. "I will discard any insulin bottle that is cloudy in appearance."

Intermediate-acting insulin and combination premixed insulin will be cloudy in appearance. Routine
hygiene such as washing with soap and rinsing with water is adequate for skin preparation for the patient
during self-injections. Insulin vials that the patient is currently using may be left at room temperature for
up to 4 weeks unless the room temperature is higher than 86° F (30° C) or below freezing (less than 32° F
[0° C]). Rotating sites to different anatomic sites is no longer recommended. Patients should rotate the
injection within one particular site, such as the abdomen.
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The nurse instructs a 22-year-old female patient with diabetes mellitus about a healthy eating plan. Which
statement made by the patient indicates that teaching was successful?

a. "I plan to lose 25 pounds this year by following a high-protein diet."

b. "I may have a hypoglycemic reaction if I drink alcohol on an empty stomach."
c. "I should include more fiber in my diet than a person who does not have diabetes."
d. "If I use an insulin pump, I will not need to limit the amount of saturated fat in my diet."
b. "I may have a hypoglycemic reaction if I drink alcohol on an empty stomach."

The risk for alcohol-induced hypoglycemia is reduced by eating carbohydrates when drinking alcohol.
Intensified insulin therapy, such as the use of an insulin pump, allows considerable flexibility in food
selection and can be adjusted for alterations from usual eating and exercise habits. However, saturated fat
intake should still be limited to less than 7% of total daily calories. Daily fiber intake of 14 g/1000 kcal is
recommended for the general population and for patients with diabetes mellitus. High-protein diets are not
recommended for weight loss.
Which patient with type 1 diabetes mellitus would be at the highest risk for developing hypoglycemic
unawareness?
a. A 58-year-old patient with diabetic retinopathy
b. A 73-year-old patient who takes propranolol (Inderal)
c. A 19-year-old patient who is on the school track team
d. A 24-year-old patient with a hemoglobin A1C of 8.9%
b. A 73-year-old patient who takes propranolol (Inderal)

Hypoglycemic unawareness is a condition in which a person does not experience the warning signs and
symptoms of hypoglycemia until the person becomes incoherent and combative or loses consciousness.
Hypoglycemic awareness is related to autonomic neuropathy of diabetes that interferes with the secretion
of counterregulatory hormones that produce these symptoms. Older patients and patients who use â-
adrenergic blockers (e.g., propranolol) are at risk for hypoglycemic unawareness.
The nurse is teaching a 60-year-old woman with type 2 diabetes mellitus how to prevent diabetic
nephropathy. Which statement made by the patient indicates that teaching has been successful?

a. "Smokeless tobacco products decrease the risk of kidney damage."

b. "I can help control my blood pressure by avoiding foods high in salt."
c. "I should have yearly dilated eye examinations by an ophthalmologist."
d. "I will avoid hypoglycemia by keeping my blood sugar above 180 mg/dL."
b. "I can help control my blood pressure by avoiding foods high in salt."

Diabetic nephropathy is a microvascular complication associated with damage to the small blood vessels
that supply the glomeruli of the kidney. Risk factors for the development of diabetic nephropathy include
hypertension, genetic predisposition, smoking, and chronic hyperglycemia. Patients with diabetes are
screened for nephropathy annually with a measurement of the albumin-to-creatinine ratio in urine; a
serum creatinine is also needed.
A 54-year-old patient admitted with type 2 diabetes asks the nurse what "type 2" means. What is the most
appropriate response by the nurse?

a. "With type 2 diabetes, the body of the pancreas becomes inflamed."

b. "With type 2 diabetes, insulin secretion is decreased, and insulin resistance is increased."
c. "With type 2 diabetes, the patient is totally dependent on an outside source of insulin."
d. "With type 2 diabetes, the body produces autoantibodies that destroy β-cells in the pancreas."
b. "With type 2 diabetes, insulin secretion is decreased, and insulin resistance is increased."

In type 2 diabetes mellitus, the secretion of insulin by the pancreas is reduced, and/or the cells of the body
become resistant to insulin. The pancreas becomes inflamed with pancreatitis. The patient is totally
dependent on exogenous insulin and may have had autoantibodies destroy the β-cells in the pancreas with
type 1 diabetes mellitus.
The nurse caring for a patient hospitalized with diabetes mellitus would look for which laboratory test
result to obtain information on the patient's past glucose control?

a. Prealbumin level
b. Urine ketone level
c. Fasting glucose level
d. Glycosylated hemoglobin level
d. Glycosylated hemoglobin level

A glycosylated hemoglobin level detects the amount of glucose that is bound to red blood cells (RBCs).
When circulating glucose levels are high, glucose attaches to the RBCs and remains there for the life of the
blood cell, which is approximately 120 days. Thus the test can give an indication of glycemic control over
approximately 2 to 3 months. The prealbumin level is used to establish nutritional status and is unrelated
to past glucose control. The urine ketone level will only show that hyperglycemia or starvation is probably
currently occurring. The fasting glucose level only indicates current glucose control.
The nurse has been teaching a patient with diabetes mellitus how to perform self-monitoring of blood
glucose (SMBG). During evaluation of the patient's technique, the nurse identifies a need for additional
teaching when the patient does what?

a. Chooses a puncture site in the center of the finger pad.

b. Washes hands with soap and water to cleanse the site to be used.
c. Warms the finger before puncturing the finger to obtain a drop of blood.
d. Tells the nurse that the result of 110 mg/dL indicates good control of diabetes.
a. Chooses a puncture site in the center of the finger pad

The patient should select a site on the sides of the fingertips, not on the center of the finger pad as this
area contains many nerve endings and would be unnecessarily painful. Washing hands, warming the
finger, and knowing the results that indicate good control all show understanding of the teaching.
The nurse is assigned to the care of a 64-year-old patient diagnosed with type 2 diabetes. In formulating a
teaching plan that encourages the patient to actively participate in management of the diabetes, what
should be the nurse's initial intervention?

a. Assess patient's perception of what it means to have diabetes.

b. Ask the patient to write down current knowledge about diabetes.
c. Set goals for the patient to actively participate in managing his diabetes.
d. Assume responsibility for all of the patient's care to decrease stress level.
a. Assess patient's perception of what it means to have diabetes.

In order for teaching to be effective, the first step is to assess the patient. Teaching can be individualized
once the nurse is aware of what a diagnosis of diabetes means to the patient. After the initial assessment,
current knowledge can be assessed, and goals should be set with the patient. Assuming responsibility for
all of the patient's care will not facilitate the patient's health.
The nurse is beginning to teach a diabetic patient about vascular complications of diabetes. What
information is appropriate for the nurse to include?

a. Macroangiopathy does not occur in type 1 diabetes but rather in type 2 diabetics who have severe
disease.
b. Microangiopathy is specific to diabetes and most commonly affects the capillary membranes of the
eyes, kidneys, and skin.
c. Renal damage resulting from changes in large- and medium-sized blood vessels can be prevented by
careful glucose control.
d. Macroangiopathy causes slowed gastric emptying and the sexual impotency experienced by a majority
of patients with diabetes.
b. Microangiopathy is specific to diabetes and most commonly affects the capillary membranes of the
eyes, kidneys, and skin.

Microangiopathy occurs in diabetes mellitus. When it affects the eyes, it is called diabetic retinopathy.
When the kidneys are affected, the patient has nephropathy. When the skin is affected, it can lead to
diabetic foot ulcers. Macroangiopathy can occur in either type 1 or type 2 diabetes and contributes to
cerebrovascular, cardiovascular, and peripheral vascular disease. Sexual impotency and slowed gastric
emptying result from microangiopathy and neuropathy.
The nurse is evaluating a 45-year-old patient diagnosed with type 2 diabetes mellitus. Which symptom
reported by the patient is considered one of the classic clinical manifestations of diabetes?

a. Excessive thirst
b. Gradual weight gain
c. Overwhelming fatigue
d. Recurrent blurred vision
a. Excessive thirst

The classic symptoms of diabetes are polydipsia (excessive thirst), polyuria, (excessive urine output), and
polyphagia (increased hunger). Weight gain, fatigue, and blurred vision may all occur with type 2 diabetes,
but are not classic manifestations.
A 51-year-old patient with diabetes mellitus is scheduled for a fasting blood glucose level at 8:00 AM. The
nurse instructs the patient to only drink water after what time?

a. 6:00 PM on the evening before the test

b. Midnight before the test
c. 4:00 AM on the day of the test
d. 7:00 AM on the day of the test
b. Midnight before the test

Typically, a patient is ordered to be NPO for 8 hours before a fasting blood glucose level. For this reason,
the patient who has a lab draw at 8:00 AM should not have any food or beverages containing any calories
after midnight.
A patient, who is admitted with diabetes mellitus, has a glucose level of 380 mg/dL and a moderate level
of ketones in the urine. As the nurse assesses for signs of ketoacidosis, which respiratory pattern would
the nurse expect to find?

a. Central apnea
b. Hypoventilation
c. Kussmaul respirations
d. Cheyne-Stokes respirations
c. Kussmaul respirations

In diabetic ketoacidosis, the lungs try to compensate for the acidosis by blowing off volatile acids and
carbon dioxide. This leads to a pattern of Kussmaul respirations, which are deep and nonlabored. Central
apnea occurs because the brain temporarily stops sending signals to the muscles that control breathing,
which is unrelated to ketoacidosis. Hypoventilation and Cheyne-Stokes respirations do not occur with
ketoacidosis.
The nurse is assisting a patient with newly diagnosed type 2 diabetes to learn dietary planning as part of
the initial management of diabetes. The nurse would encourage the patient to limit intake of which foods
to help reduce the percent of fat in the diet?

a. Cheese
b. Broccoli
c. Chicken
d. Oranges
a. Cheese

Cheese is a product derived from animal sources and is higher in fat and calories than vegetables, fruit,
and poultry. Excess fat in the diet is limited to help avoid macrovascular changes.
Laboratory results have been obtained for a 50-year-old patient with a 15-year history of type 2 diabetes.
Which result reflects the expected pattern accompanying macrovascular disease as a complication of
diabetes?

a. Increased triglyceride levels

b. Increased high-density lipoproteins (HDL)
c. Decreased low-density lipoproteins (LDL)
d. Decreased very-low-density lipoproteins (VLDL)
a. Increased triglyceride levels

Macrovascular complications of diabetes include changes to large- and medium-sized blood vessels. They
include cerebrovascular, cardiovascular, and peripheral vascular disease. Increased triglyceride levels are
associated with these macrovascular changes. Increased HDL, decreased LDL, and decreased VLDL are
positive in relation to atherosclerosis development.
The nurse has taught a patient admitted with diabetes, cellulitis, and osteomyelitis about the principles of
foot care. The nurse evaluates that the patient understands the principles of foot care if the patient makes
what statement?

a. "I should only walk barefoot in nice dry weather."

b. "I should look at the condition of my feet every day."
c. "I am lucky my shoes fit so nice and tight because they give me firm support."
d. "When I am allowed up out of bed, I should check the shower water with my toes."
b. "I should look at the condition of my feet every day."

Patients with diabetes mellitus need to inspect their feet daily for broken areas that are at risk for infection
and delayed wound healing. Properly fitted (not tight) shoes should be worn at all times. Water
temperature should be tested with the hands first.
A patient is admitted with diabetes mellitus, malnutrition, and cellulitis. The patient's potassium level is 5.6
mEq/L. The nurse understands that what could be contributing factors for this laboratory result (select all
that apply)?

a. The level may be increased as a result of dehydration that accompanies hyperglycemia.

b. The patient may be excreting extra sodium and retaining potassium because of malnutrition.
c. The level is consistent with renal insufficiency that can develop with renal nephropathy.
d. The level may be raised as a result of metabolic ketoacidosis caused by hyperglycemia.
e. This level demonstrates adequate treatment of the cellulitis and effective serum glucose control.
a. The level may be increased as a result of dehydration that accompanies hyperglycemia.
c. The level is consistent with renal insufficiency that can develop with renal nephropathy.
d. The level may be raised as a result of metabolic ketoacidosis caused by hyperglycemia.

The additional stress of cellulitis may lead to an increase in the patient's serum glucose levels.
Dehydration may cause hemoconcentration, resulting in elevated serum readings. Kidneys may have
difficulty excreting potassium if renal insufficiency exists. Finally, the nurse must consider the potential for
metabolic ketoacidosis since potassium will leave the cell when hydrogen enters in an attempt to
compensate for a low pH. Malnutrition does not cause sodium excretion accompanied by potassium
retention. Thus it is not a contributing factor to this patient's potassium level. The elevated potassium level
does not demonstrate adequate treatment of cellulitis or effective serum glucose control.
The patient received regular insulin 10 units subcutaneously at 8:30 PM for a blood glucose level of 253
mg/dL. The nurse plans to monitor this patient for signs of hypoglycemia at which time related to the
insulin's peak action?

a. 8:40 PM to 9:00 PM
b. 11:30 PM
c. 10:30 PM to 1:30 AM
d. 12:30 AM to 8:30 AM
c. 10:30 PM to 1:30 AM

Regular insulin exerts peak action in 2 to 5 hours, making the patient most at risk for hypoglycemia
between 10:30 PM and 1:30 AM. Rapid-acting insulin's onset is between 10-30 minutes with peak action
and hypoglycemia most likely to occur between 9:00 PM and 11:30 PM. With intermediate acting insulin,
hypoglycemia may occur from 12:30 AM to 8:30 AM.
A college student is newly diagnosed with type 1 diabetes. She now has a headache, changes in her vision,
and is anxious, but does not have her portable blood glucose monitor with her. Which action should the
campus nurse advise her to take?

a. Eat a piece of pizza.

b. Drink some diet pop.
c. Eat 15 g of simple carbohydrates.
d. Take an extra dose of rapid-acting insulin.
c. Eat 15 g of simple carbohydrates.

When the patient with type 1 diabetes is unsure about the meaning of the symptoms she is experiencing,
she should treat herself for hypoglycemia to prevent seizures and coma from occurring. She should also be
advised to check her blood glucose as soon as possible. The fat in the pizza and the diet pop would not
allow the blood glucose to increase to eliminate the symptoms. The extra dose of rapid-acting insulin
would further decrease her blood glucose.
A 65-year-old patient with type 2 diabetes has a urinary tract infection (UTI). The unlicensed assistive
personnel (UAP) reported to the nurse that the patient's blood glucose is 642 mg/dL and the patient is hard
to arouse. When the nurse assesses the urine, there are no ketones present. What collaborative care
should the nurse expect for this patient?

a. Routine insulin therapy and exercise

b. Administer a different antibiotic for the UTI.
c. Cardiac monitoring to detect potassium changes
d. Administer IV fluids rapidly to correct dehydration.
c. Cardiac monitoring to detect potassium changes

This patient has manifestations of hyperosmolar hyperglycemic syndrome (HHS). Cardiac monitoring will
be needed because of the changes in the potassium level related to fluid and insulin therapy and the
osmotic diuresis from the elevated serum glucose level. Routine insulin would not be enough, and exercise
could be dangerous for this patient. Extra insulin will be needed. The type of antibiotic will not affect HHS.
There will be a large amount of IV fluid administered, but it will be given slowly because this patient is
older and may have cardiac or renal compromise requiring hemodynamic monitoring to avoid fluid
overload during fluid replacement.
The newly diagnosed patient with type 2 diabetes has been prescribed metformin (Glucophage). What
should the nurse tell the patient to best explain how this medication works?

a. Increases insulin production from the pancreas.

b. Slows the absorption of carbohydrate in the small intestine.
c. Reduces glucose production by the liver and enhances insulin sensitivity.
d. Increases insulin release from the pancreas, inhibits glucagon secretion, and decreases gastric
emptying.
c. Reduces glucose production by the liver and enhances insulin sensitivity.

Metformin is a biguanide that reduces glucose production by the liver and enhances the tissue's insulin
sensitivity. Sulfonylureas and meglitinides increase insulin production from the pancreas. α-glucosidase
inhibitors slow the absorption of carbohydrate in the intestine. Glucagon-like peptide receptor agonists
increase insulin synthesis and release from the pancreas, inhibit glucagon secretion, and decrease gastric
emptying.
The nurse is teaching a patient with type 2 diabetes mellitus about exercise to help control his blood
glucose. The nurse knows the patient understands when the patient elicits which exercise plan?

a. "I want to go fishing for 30 minutes each day; I will drink fluids and wear sunscreen."
b. "I will go running each day when my blood sugar is too high to bring it back to normal."
c. "I will plan to keep my job as a teacher because I get a lot of exercise every school day."
d. "I will take a brisk 30-minute walk 5 days per week and do resistance training 3 times a week."
d. "I will take a brisk 30-minute walk 5 days per week and do resistance training 3 times a week."

The best exercise plan for the person with type 2 diabetes is for 30 minutes of moderate activity 5 days
per week and resistance training 3 times a week. Brisk walking is moderate activity. Fishing and teaching
are light activity, and running is considered vigorous activity.
A patient with diabetes mellitus who has multiple infections every year needs a mitral valve replacement.
What is the most important preoperative teaching the nurse should provide to prevent a cardiac infection
postoperatively?

a. Avoid sick people and wash hands.

b. Obtain comprehensive dental care.
c. Maintain hemoglobin A1 c below 7%.
d. Coughing and deep breathing with splinting
b. Obtain comprehensive dental care.

A person with diabetes is at high risk for postoperative infections. The most important preoperative
teaching to prevent a postoperative infection in the heart is to have the patient obtain comprehensive
dental care because the risk of septicemia and infective endocarditis increases with poor dental health.
Avoiding sick people, hand washing, maintaining hemoglobin A1c below 7%, and coughing and deep
breathing with splinting would be important for any type of surgery, but not the priority with mitral valve
replacement for this patient.
Polydipsia and polyuria related to diabetes mellitus are primarily due to:

a. the release of ketones from cells during fat metabolism

b. fluid shifts resulting from the osmotic effect of hyperglycemia
c. damage to the kidneys from exposure to high levels of glucose.
d. changes in RBCs resulting from attachment of excessive glucose to hemoglobin.
b. fluid shifts resulting from the osmotic effect of hyperglycemia
Which statement would be correct for a patient with type 2 diabetes who was admitted to the hospital with
pneumonia?

a. the patient must receive insulin therapy to prevent ketoacidosis

b. the patient has islet cell antibodies that have destroyed the pancreas's ability to produce insulin
c. the patient has minimal or absent endogenous insulin secretion and requires daily insulin injections
d. the patient may have sufficient endogenous insulin to prevent ketosis but is at risk for hyperosmolar
hyperglycemic syndrome
d. the patient may have sufficient endogenous insulin to prevent ketosis but is at risk for hyperosmolar
hyperglycemic syndrome
Analyze the following diagnostic findings for your patient with type 2 diabetes. Which result will need
further assessment?

a. A1C 9%
b. BP 126/80
c. FBG 130
d. LDL 100mg
a. A1C 9%
Which statement by the patient with type 2 diabetes is accurate.

a. "I am supposed to have a meal or snack if I drink alcohol"

b. "I am not allowed to eat any sweets because of my diabetes."
c. "I do not need to watch what I eat because my diabetes is not the bad kind."
d. "The amunt of fat in my diet is not important; it is just the carbohydrates that raise my blood sugar."
a. "I am supposed to have a meal or snack if I drink alcohol"

Alcohol should be consumed with food to reduce the risk of hypoglycemia.

You are caring for a patient with newly diagnosed type 1 diabetes. What information is essential to include
in your patient teaching before discharge from the hospital? (select all that apply)

a. insulin administration
b. elimination of sugar from diet
c. need to reduce physical activity
d. use of portable blood glucose monitor
e. hypoglycemia prevention, symptoms, and treatment
a. insulin administration
d. use of portable blood glucose monitor
e. hypoglycemia prevention, symptoms, and treatment
What is the priority action for the nurse to take if the patient with type 2 diabetes complains of blurred
vision and irritability?

a. call the physician

b. administer insulin as ordered
c. check the patient's blood glucose level
d. assess for other neurologic symptoms.
c. check the patient's blood glucose level
A diabetic patient has a serum glucose level of 824 mg/dL and is unresponsive. Following assessment of
the patient, the nurse suspects diabetic ketoacidosis rather than hyperosmolar hyperglycemic syndrome
based on the finding of?

a. polyuria
b. severe dehydration
c. rapid, deep respirations
d. decreased serum potassium
c. rapid, deep respirations
Which are appropriate therapies for patients with diabetes mellitus?

a. Use of statins to treat dyslipidemia

b. use of diuretics to treat nephropathy
c.Use of ACE inhibitors to treat nephropathy
d. use of serotonin agonists to decrease appetite.
e. Use of laser photocoagulation to treat retinopathy
a. Use of statins to treat dyslipidemia
c.Use of ACE inhibitors to treat nephropathy
e. Use of laser photocoagulation to treat retinopathy
Ideally, the goal of patient diabetes education is to:

1. Make all patients responsible for the management of their disease.

2. Involve the patient's family and significant others in the care of the patient.
3. Enable the patient to become the most active participant in the management of the diabetes.
4. Provide the patient with as much information as soon as possible to prevent complications of diabetes.
3. Enable the patient to become the most active participant in the

The goal of diabetes education is to enable the patient to become the most active participant in his or her
own care.
A patient screened for diabetes at a clinic has a fasting plasma glucose of 120 mg/dL (6.7 mmol/L). The
nurse explains to the patient that this value:

1. Is diagnostic for diabetes.

2. Is normal, and diabetes is not a problem.
3. Reflects impaired glucose tolerance, which is an early stage of diabetes.
4. Indicates an intermediate stage between normal glucose use and diabetes.
3. Reflects impaired glucose tolerance, which is an early stage of diabetes.

Impaired fasting glucose (fasting blood glucose level between 100 and 126 mg/dL) and impaired glucose
tolerance (2-hour plasma glucose level between 140 and 199 mg/dL) represent an intermediate stage
between normal glucose homeostasis and diabetes. This stage is called prediabetes
A patient with type 1 diabetes calls the clinic with complaints of nausea, vomiting, and diarrhea. It is most
important that the nurse advise the patient to:

1. Hold the regular dose of insulin.

2. Drink cool fluids with high glucose content.
3. Check the blood glucose level every 2 to 4 hours.
4. Use a less strenuous form of exercise than usual until the illness resolves.
3. Check the blood glucose level every 2 to 4 hours.

If a person with type 1 diabetes mellitus is ill, he or she should test blood glucose levels at least at 2-to-4-
hour intervals to determine the effects of this stressor on the blood glucose level.
Cardiac monitoring is initiated for a patient in diabetic ketoacidosis. The nurse recognizes that this
measure is important to identify:

1. Dysrhythmias resulting from hypokalemia.

2. Fluid overload resulting from aggressive fluid replacement.
3. The presence of hypovolemic shock related to osmotic diuresis.
4. Cardiovascular collapse resulting from the effects of excess glucose on cardiac cells.
1. Dysrhythmias resulting from hypokalemia.

Electrolytes are depleted in diabetic ketoacidosis. Osmotic diuresis occurs with depletion of sodium,
potassium, chloride, magnesium, and phosphate. Hypokalemia may lead to ventricular dysrhythmias such
as premature ventricular complexes and bradycardia.
Case Study:
52-year-old woman was diagnosed with type 2 diabetes 6 years ago.
Did not follow up with recommendations for care
Complaining of weakness in her right foot
Began 1 month ago
Difficult to dorsiflex and feels numb
Also complains of an itching rash in her groin area
Has had rash on and off for many years
Worse when weather is warm
Increased thirst and frequent nighttime urination
Denies other weakness, numbness, changes in vision
She works as a banking executive and gets little exercise.
She has gained 18 pounds over the past year and eats a high-fat diet.
BP 162/98
Sensory exam to light touch, proprioception, and vibration slightly diminished on both feet
Erythematous scaling rash in both inguinal areas and in axillae
Random glucose test 253 mg/dL
Hb A1C 9.1%
Urine dipstick positive for glucose and negative for protein
Wet prep of smear from rash consistent with Candida albicans
ECG with evidence of early ventricular hypertrophy by voltage
------------------------------------
1.She wants to know why all of these changes have been happening to her body. How would you explain
this to her?
2. What is the priority nursing intervention?
3.What teaching should be done with her?
1. Her lack of glucose control has affected multiple other parts of her body, including the nerves in her
lower extremities, cardiovascular function, and ability to fight off infection.
2. Treatment of hyperglycemia, neuropathy, and hypertension, and, more important, patient teaching.
3. Stress the importance of adhering to her medical regimen and monitoring her blood glucose regularly.
Teach her the repercussions if she does not do these things.

NCLEX Questions on Diabetic Ketoacidosis

1. Which of the following is not a sign or symptom of Diabetic Ketoacidosis?

A. Positive Ketones in the urine

B. Oliguria

C. Polydipsia

D. Abdominal Pain

2. A patient is admitted with Diabetic Ketoacidosis. The physician orders intravenous fluids of 0.9% Normal
Saline and 10 units of intravenous regular insulin IV bolus and then to start an insulin drip per protocol. The
patient’s labs are the following: pH 7.25, Glucose 455, potassium 2.5. Which of the following is the most
appropriate nursing intervention to perform next?

A. Start the IV fluids and administer the insulin bolus and drip as ordered

B. Hold the insulin and notify the doctor of the potassium level of 2.5

C. Hold IV fluids and administer insulin as ordered

D. Recheck the glucose level

3. Which patient is MOST likely to develop Diabetic Ketoacidosis?

A. A 25 year old female newly diagnosed with Cushing’s Disease taking glucocorticoids.

B. A 36 year old male with diabetes mellitus who has been unable to eat the past 2 days due to a
gastrointestinal illness and has not been taking insulin.

C. A 35 year old female newly diagnosed with Type 2 diabetes.

D. None of the options are correct.

4. Which of the following statements are INCORRECT about Diabetic Ketoacidoisis?

A. Extreme Hyperglycemia that presents with blood glucose >600 mg/dL

B. Ketones are present in the urine.

C. Metabolic acidosis is present with Kussmaul breathing.

D. Potassium levels should be at least 3.3 or higher during treatment of DKA with insulin therapy.

5. True or False: When priming the tubing for an Insulin infusion it is best practice to waste 50cc to 100cc
of insulin prior to starting the infusion because insulin absorbs into the plastic lining of the tubing.

6. You are providing care to a patient experiencing diabetic ketoacidosis. The patient is on an insulin drip
and their current glucose level is 300. In addition to this, the patient also has 5% Dextroxe 0.45% NS
infusing in the right antecubital vein. Which of the following patient signs/symptoms causes concern?

A. Patient has a potassium level of 2.3

B. Patient complains of thirst.

c. Patient is nauseous.

D. Patient’s skin and mucous membranes are dry.

7. What type of insulin do you expect the doctor to order for treatment of DKA?

A. IV NPH

B. IV Novolog

C. IV Levemir

D. IV Regular Insulin

8. A patient diagnosed with diabetes mellitus is being discharged home and you are teaching them about
preventing DKA. What statement by the patient demonstrates they understood your teaching about this
condition?

A. “I will hold off taking my insulin while I’m sick.”

B. “It is normal for my blood sugar to be 250-350 mg/dL while I’m sick.”

C. “It is important I check my blood glucose every 3-4 hours when I’m sick and consume liquids.”

D. “I should not be alarmed if ketones are present in my urine because this is expected during illness.”

Answer Key:

1. B
2. B
3. B
4. A
5. True
6. A
7. D
8. C

he nurse is teaching a group of young adults regarding nonmodifiable risk factors for the development of
type 1 diabetes mellitus. Which attendee statement indicates a need for further instruction? (Select all that
apply.)
A. "Type 1 diabetes mellitus is caused by exposure to processing of metals and proteins."
B. "Type 1 diabetes mellitus can be passed on from one recessive gene from one parent."
C. "I can develop type 1 diabetes mellitus from bacterial infections."
D. "There are genes such as the HLA-DR3 and HLA-DR4 genes that can cause type 1 diabetes mellitus."
E. "Type 1 diabetes mellitus can be caused by exposure to excessive heat and temperatures."
Answer: A, B, C, E
The individual with type 1 diabetes mellitus usually inherits the risk factor for the disorder from each
parent. Environmental factors such as cold weather and exposure to a virus also contribute to the
development of type 1 diabetes mellitus. The genes HLA-DR3 and HLA-DR4 have been identified in people
with type 1 diabetes mellitus. Exposure to processing of metals contributes to the development of
cirrhosis.
A young client is admitted for lethargy and weight loss. Which clinical manifestation supports the nurse's
suspicion of diagnosis of type 1 diabetes mellitus? (Select all that apply.)
A. Glucosuria
B. Weight gain
C. Polyuria
D. Fever
E. Blurred vision
Answer: A, C, E
Rationale: Manifestations of type 1 diabetes mellitus are caused by the lack of insulin to transport glucose
into the cells for energy. The resulting hyperglycemia leads to polyuria, glucosuria, and blurred vision.
Polyuria occurs because water is drawn into the general circulation, increasing renal blood flow. Once the
blood glucose exceeds the renal threshold, which is 180 mg/dL, glucose will spill into the urine. Blurred
vision is caused by swelling of the lenses of the eyes in response to increased fluid volume. Clients with
type 1 diabetes mellitus usually lose weight, because proteins and fats are metabolized for energy and
water is lost in the urine. In addition, clients with type 1 diabetes mellitus are frequently unable to develop
a fever when cellular fuel stores are depleted because of a lack of insulin.
Brainpower
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A teacher sends a child to the school nurse due to frequent thirst and urination. Upon assessment, the
nurse suspects the child has type 1 diabetes mellitus. Which question should the nurse ask to gain data to
support this suspicion?
A. "How is your appetite?"
B. "Have you noticed any bruises on your legs?"
C. "Do you play outside a lot?"
D "When did you last see your healthcare provider?"
Answer: A
Rationale: Polydipsia, polyuria, and polyphagia are the three hallmark signs of type 1 diabetes mellitus.
Therefore, the nurse would ask about the child's appetite. Playing outside is not related to the onset of
type 1 diabetes mellitus. Asking when the child last saw the healthcare provider is irrelevant to the current
situation. Bruising to the legs can be from injuries or leukemia, not type 1 diabetes mellitus.
The nurse is teaching the parents of a child with a new diagnosis of type 1 diabetes mellitus. Which
information should the nurse include regarding the pathophysiology of the disease?
A. Beta cells need help producing insulin.
B. Delta cell destruction causes type 1 diabetes mellitus.
C. Hyperglycemia happens when 50% of alpha cells are damaged.
D. Beta cells are destroyed.
Answer: D
Rationale: Type 1 diabetes mellitus has a slow onset and symptoms are not evident until 80-90% of beta
cells are destroyed, causing hyperglycemia. Beta cells are functional and need medication to help with
insulin production in type 2 diabetes mellitus. Hyperglycemia happens from beta cell destruction, not
alpha or delta cell destruction.
The nurse is working a health fair and teaching the public about risk factors for type 1 diabetes mellitus.
Which ethnicity would the nurse include as having the highest risk in the United States?
A. Hispanic
B. Caucasian American
C. Asian American
D. African American
Answer: B
Rationale: Caucasian Americans have a higher risk of developing type 1 diabetes mellitus than Asian
Americans, African Americans, or Hispanics.
The nurse is conducting discharge teaching with a client who has been newly diagnosed with type 1
diabetes mellitus. Which statement from the client indicates the need for additional teaching?
A. "I need to stay hydrated during the day."
B "It is important to test my blood sugar at least four times a day."
C. "I need to be alert for infections."
D "As long as I'm in my house, I can walk barefoot."
Answer: D
Rationale: Clients with diabetes should always wear shoes to protect their feet from injury. The client
should be alert for infection or injuries, stay well hydrated, and test the blood sugar four times a day.
The nurse is caring for a child diagnosed with type 1 diabetes mellitus. The nurse should teach the child
and parents that insulin dosing is based on which item?
A. Age
B. Weight
C. Urine output
D. Diet
Answer: D
Rationale: Insulin dose is based on diet, specifically carbohydrate intake. Insulin dose is not based on
weight, age, or urine output.
Which finding in the medical record indicates a client has good control of type 1 diabetes mellitus?
A. Fasting blood sugar 200 mg/dL
B. Hemoglobin A1C 5.4%
C. Blood pressure 150/90 mmHg
D. Free of amputations
Answer: B
Rationale: The finding that the client is maintaining a hemoglobin A1C of less than 6.5% indicates good
diabetic control over the past 3 months. The client not having amputations indicates good peripheral
circulation, but it does not indicate good disease management. Blood pressure of 150/90 mmHg is
elevated, but it does not indicate good diabetes control. The fasting blood sugar should be under 125
mg/dL. The finding of 200 mg/dL is elevated.
The nurse is teaching a group of clients newly diagnosed with type 1 diabetes mellitus. Which information
should the nurse include in the teaching?
A. "Schedule regular ophthalmology visits."
B. "Have routine pedicures performed."
C. "Take beta blockers daily to control blood pressure."
D. "Monitor blood glucose levels weekly."
Answer: A
Rationale: The client with type 1 diabetes mellitus is at high risk for retinal damage. Therefore, the nurse
would teach the client to schedule regular ophthalmology visits to monitor vision. The nurse would not
encourage the client to have regular pedicures due to possible injury that can occur from macrovascular
and microvascular deficits. Blood glucose levels should be monitored several times a day, not once a
week. The client would be prescribed angiotensin-converting enzyme (ACE) inhibitors to protect the
kidneys from vascular damage.
Which statement made by a client with type 1 diabetes mellitus indicates an understanding of instruction
provided regarding disease management? (Select all that apply.)
A. "I should obtain blood glucose levels prior to each insulin injection."
B. "I should maintain my hemoglobin A1C levels at or below 8%."
C. "I should count calories consumed to determine insulin needs for each day."
D. "I should administer insulin during the day in multiple injections."
E. "I should trim my toenails at an angle to prevent cutting the skin."
Answer: A, D
Rationale: For better blood glucose control, the healthcare provider would instruct the client to administer
insulin throughout the day in multiple injections and to obtain blood glucose levels prior to each injection.
Hemoglobin A1C levels should be below 6.5%. The client should be instructed to count carbohydrates, not
calories. Toenails should be cut straight across with a clipper and the edges and corners smoothed with an
emery board. If the client is unable to see his feet or reach them easily, someone else can trim his nails. If
the nails are very thick or ingrown, if toes overlap, or if circulation is poor, then a podiatrist should cut the
client's toenails.
The nurse is caring for a child who is hospitalized for the treatment of diabetic ketoacidosis (DKA). The
child's parents ask why their child is receiving potassium. Which response by the nurse is accurate?
A. "Potassium is administered to treat acidosis."
B. "Potassium is administered to treat cerebral edema."
C. "Potassium is administered to decrease blood glucose levels."
D. "Potassium is administered to treat hypokalemia."
Answer: D
Rationale: Potassium is administered to treat hypokalemia. Insulin, not potassium, is administered to
decrease blood glucose levels. Sodium bicarbonate, not potassium, is administered to treat acidosis.
Mannitol, not potassium, is administered to treat cerebral edema.
A client with type 1 diabetes mellitus is being taught to monitor her blood glucose level. Which factor
affecting accurate glucose monitoring should the nurse include in the instruction? (Select all that apply.)
A. Medication overdoses
B. Low hematocrit level
C. Creatinine level
D. High hematocrit level
E. White blood cell (WBC) count
Answer: A, B, D
Rationale: Factors that affect accurate glucose monitoring include medication overdoses, a low hematocrit
level, and a high hematocrit level. The WBC count and creatinine levels do not affect accurate glucose
monitoring.
The nurse is providing teaching to a client with a new diagnosis of type 1 diabetes mellitus. The nurse
should instruct the client about incorporating which treatment to help manage the disease? (Select all that
apply.)
A. Medication
B. Exercise
C. Daily weight checking
D. Nutrition
E. Fluid restriction
Answer: A, B, D
Clients with type 1 diabetes mellitus are treated with exercise, nutrition, and medication. Fluid restriction
and daily weight checking are not part of the treatment plan for clients with type 1 diabetes mellitus.
The nurse is teaching a child with type 1 diabetes mellitus and his family about sick day guidelines. Which
statement by the family indicates successful teaching?
A. "We will test for ketones when the blood glucose level reaches 160 mg/dL."
B. "We will test for ketones when the blood glucose level reaches 200 mg/dL."
C. "We will test for ketones when the blood glucose level reaches 180 mg/dL."
D. "We will test for ketones when the blood glucose level reaches 240 mg/dL."
Answer: D
Rationale: Blood glucose levels of 160 mg/dL, 180 mg/dL, and 200 mg/dL are elevated, but they would not
require testing for ketones. Once the blood glucose level exceeds 240 mg/dL, the child and family should
test the urine for ketones.
The nurse is developing a teaching plan for carbohydrate counting for a client newly diagnosed with type 1
diabetes mellitus. Which type of carbohydrate should the nurse instruct the client to restrict?
A. Simple sugars
B. Complex carbohydrates
C. Dietary fructose
D. Refined sugars
Answer: D
Rationale: Refined sugars come from sugar cane and are used as natural sweeteners. The client should
restrict the intake of refined sugars. Simple sugars are found in fruit, honey, and dairy products. Dietary
fructose, which comes from dietary fruit and vegetable consumption, causes a slower rise in blood glucose
levels. Complex carbohydrates come from peas, beans, whole grains, and vegetables.
The nurse is taking a health history from a client who has type 1 diabetes mellitus. Which client symptom
may indicate the development of complications? (Select all that apply.)
A. Vision changes
B. Quick wound healing
C. Dizziness
D. Frequent voiding of urine
E. Numbness in the feet
Answer: A, C, D, E
Rationale: Dizziness, vision changes, numbness in the feet, and frequent voiding of urine may indicate that
the client has developed complications of type 1 diabetes mellitus. Clients with type 1 diabetes mellitus
frequently experience prolonged wound healing; therefore, a report of quick wound healing would not
indicate that the client has developed a complication of type 1 diabetes mellitus.
The nurse is caring for a client who received a daily intermediate-acting insulin dose at 8:00 a.m. At which
time of the day should the nurse provide the client a snack to prevent hypoglycemia?
A. 6:00 p.m.
B. 9:00 p.m.
C. 2:00 p.m.
D. 11:00 a.m.
Answer: C
Rationale: Intermediate-acting (NPH) insulin peaks 6dash8 hours after the injection. Therefore, the nurse
would prepare a snack for the client beginning at 2:00 p.m. If the client received shortdashacting insulin
(regular), the snack would be required between 10 a.m. and 11:00 a.m. Giving a snack at 6:00 p.m. or 9:00
p.m. may be appropriate for long-acting insulins, but it is not appropriate for intermediate-acting insulins.
Which action by a parent of a 12-year-old child with a new diagnosis of type 1 diabetes mellitus indicates a
need for further teaching?
A. Discouraging after-school sports
B. Allowing the child to check blood sugars
C. Counting carbohydrates with the child
D. Scheduling a baseline exam with an ophthalmologist
Answer: A
Rationale: Exercise is a part of blood glucose and disease management. Therefore, the nurse should
reeducate the parent to allow after-school sports. The parent should involve the 12-year-old child, so
counting carbohydrates with the child and allowing the child to perform self-blood glucose monitoring is
appropriate. Due to potential retinopathy that can occur with diabetes, it is appropriate for the parent to
schedule an ophthalmic appointment to determine baseline visual acuity.
The nurse is managing care for a client weighing 165 pounds who was admitted for the treatment of
diabetic ketoacidosis (DKA). Which intervention would be most appropriate for the nurse to include in the
plan of care? (Select all that apply.)
A. Provide a high-protein diet.
B. Measure intake and output every hour.
C. Give 100 mL of normal saline bolus.
D. Administer sliding-scale regular insulin.
E. Place the client on a telemetry monitor.
Answer: B, E
Rationale: The nurse would calculate intake and output on an hourly basis to determine fluid needs. The
client would be placed on a telemetry monitor to monitor for dysrhythmias related to shifts in potassium
levels. The client with DKA would be acutely ill and if able to eat, would be placed on a carbohydrate-
controlled diet. The nurse would administer normal saline boluses at 10-20 mL/kg. A volume of 100 mL is
not sufficient. Insulin would be administered intravenously, not sliding scale
The nurse is caring for a client with a long-term history of type 1 diabetes mellitus who has developed
peripheral vascular disease. The nurse is unable to palpate the client's pedal pulses and the skin is cold to
the touch. Which long-term goal is most appropriate for this client?
A. The client's fasting blood glucose levels will stay between 70 and 110 mg/dL.
B. The client will remain free of injury.
C. The client will remain free from infection.
D. The client's skin integrity will remain intact.
Answer: D
Rationale: The client has impaired circulation as evidenced by cold skin and absent pedal pulses that
indicate a risk for impaired skin integrity due to gangrene. There is no evidence the client is at risk for
injury or has an infection. Having fasting blood glucose levels in the normal range indicates good disease
management, but it does not relate to the impaired circulation.

1. Which of the following symptoms do NOT present in hyperglycemia?

A. Extreme thirst
B. Hunger
C. Blood glucose <60 mg/dL
D. Glycosuria
The answer is C.

2. Type 1 diabetics typically have the following clinical characteristics:

A. Thin, young with ketones present in the urine
B. Overweight, young with no ketones present in the urine
C. Thin, older adult with glycosuria
D. Overweight, adult-aged with ketones present in the urine
The answer is A.

3. A patient with diabetes has a morning glucose of 50. The patient is sweaty, cold, and clammy. Which of
the following nursing interventions is the MOST important?
A. Recheck the glucose level
B. Give the patient ½ cup (4 oz) of fruit juice
C. Call the doctor
D. Keep the patient nothing by mouth
The answer is B .

4. Which of the following patients is at most risk for Type 2 diabetes?

A. A 6 year old girl recovering from a viral infection with a family history of diabetes.
B. A 28 year old male with a BMI of 49.
C. A 76 year old female with a history of cardiac disease.
D. None of the options provided.
The answer is B. Remember Type 2 diabetes risk factors are related to lifestyle….being obese is a risk
factor (BMI >30 in males is considered obese). So, the 28 year old male with a BMI of 49 is most at risk for
Type 2.

5. The _____ ______ secrete insulin which are located in the _______.
A. Alpha cells, liver
B. Alpha cells, pancreas
C. Beta cells, liver
D. Beta cells, pancreas
The answer is D.

6. A 36-year-old male is newly diagnosed with Type 2 diabetes. Which of the following treatments do you
expect the patient to be started on initially?
A. Diet and exercise regime
B. Metformin BID by mouth
C. Regular insulin subcutaneous
D. None, monitoring at this time is sufficient enough
The answer is A.

7. Which of the following statements are true regarding Type 2 diabetes treatment?
A. Insulin and oral diabetic medications are administered routinely in the treatment of Type 2 diabetes.
B. Insulin may be needed during times of surgery or illness.
C. Insulin is never taken by the Type 2 diabetic.
D. Oral medications are the first line of treatment for newly diagnosed Type 2 diabetics.
The answer is B.

8. What statement or statements are INCORRECT regarding Diabetic Ketoacidosis?

A. DKA occurs mainly in Type 1 diabetics.
B. Ketones are present in the urine in DKA.
C. Cheyne-stokes breathing will always present in DKA.
D. Severe hypoglycemia is a hallmark sign in DKA.
E. Options C & D
The answer is E.

9. A patient who has diabetes is nothing by mouth as prep for surgery. The patient states they feel like
their blood sugar is low. You check the glucose and find it to be 52. The next nursing intervention would be
to:
A. Administer Dextrose 50% IV per protocol
B. Continue to monitor the glucose
C. Give the patient 4 oz of fruit juice
D. None, this is a normal blood glucose reading
The answer is A. This question requires critical thinking because the patient is NPO for surgery and can
NOT eat but is experiencing hypoglycemia. Normally, you could give the patient 15 grams of a simple
carbohydrate like 4 oz of fruit juice or soda, glucose tablets, gel etc. per hypoglycemia protocol However,
the patient can NOT eat due to surgery prep. Therefore the nurse would need to administer Dextrose 50%
IV per protocol to help increase the blood glucose and recheck the glucose level.

10. A Type 2 diabetic may have all the following signs or symptoms EXCEPT:
A. Blurry vision
B. Ketones present in the urine
C. Glycosuria
D. Poor wound healing
The answer is B

1. Fill in the blank regarding the negative feedback loop for thyroid hormone production: The
______________ produces TRH (Thyrotropin-Releasing Hormone) which causes the anterior pituitary gland to
produce _______________ which in turn causes the thyroid gland to release _______ and _______.
A. Thalamus, CRH (Corticotropin-releasing hormone) TSH (thyroid-stimulating hormone) and T4
B. Hypothalamus, TSH (thyroid-stimulating hormone), T3 and T4
C. Posterior pituitary gland, TSH (thyroid-stimulating hormone), T3 and T4
D. Hypothalamus, CRH (Corticotropin-releasing hormone), TSH (thyroid-stimulating hormone), T3 and TSH
The answer is B: Hypothalamus, TSH (thyroid-stimulating hormone), T3 and T4

2. A patient reports they do not eat enough iodine in their diet. What condition are they most susceptible
to?
A. Pheochromocytoma
B. Hyperthyroidism
C. Thyroid Storm
D. Hypothyroidism
The answer is D: Hypothyroidism…Iodine helps make T3 and T4….if a person does not consume enough
iodine they are at risk for developing HYPOTHYROIDISM.

3. A patient has an extremely high T3 and T4 level. Which of the following signs and symptoms DO NOT
present with this condition?
A. Weight loss
B. Intolerance to heat
C. Smooth skin
D. Hair loss
The answer is D: Hair loss

4. A patient is being discharged home for treatment of hypothyroidism. Which medication is most
commonly prescribed for this condition?
A. Tapazole
B. PTU (Propylthiouracil)
C. Synthroid
D. Inderal
The answer is C: Synthroid is the only medication listed that treats hypothyroidism. All the other
medications are used for hyperthyroidism.

5. You are performing discharge teaching with a patient who is going home on Synthroid. Which statement
by the patient causes you to re-educate the patient about this medication?
A. “I will take this medication at bedtime with a snack.”
B. “I will never stop taking the medication abruptly.”
C. “If I have palpitations, chest pain, intolerance to heat, or feel restless, I will notify the doctor.”
D. “I will not take this medication at the same time I take my Carafate.”
The answer is A: Synthroid is best taken in the MORNING on an empty stomach. All the other statements
are correct about taking Synthroid.

6. The thyroid hormones, T3 and T4, play many roles in the human body. Which of the following functions
are performed by T3 and T4? Note: Select all that apply
A. Storing calories
B. Increasing the Heart Rate
C. Stimulating the Sympathetic Nervous System
D. Decreasing the body’s temperature
E. Regulating TSH produced by the anterior pituitary gland
The answers are B, C, and E. T3 and T4 burn calories (not store them) and increases body temperature
(not decrease).

7. A patient is admitted with complaints of palpations, excessive sweating, and unable to tolerate heat. In
addition, the patient voices concern about how her appearance has changed over the past year. The
patient presents with protruding eyeballs and pretibial myxedema on the legs and feet. Which of the
following is the likely cause of the patient’s signs and symptoms?
A. Thyroiditis
B. Deficiency of iodine consumption
C. Grave’s Disease
D. Hypothyroidism
The answer is C: Grave’s Disease

8. A patient who is in her first trimester of pregnancy is diagnosed with hyperthyroidism. Which medication
do you suspect the patient will be started on?
A. Propylthiouracil (PTU)
B. Radioactive Iodine
C. Tapazole
D. Synthroid
The answer is A: Propylthiouracil (PTU) is the only anti-thyroid medication that can be used during the 1st
trimester of pregnancy.

9. Which of the following are treatment options for hyperthyroidism? Please select all that apply:
A. Thyroidectomy
B. Methimazole
C. Liothyronine Sodium “Cytomel”
D. Radioactive Iodine
The answers are A, B,and D. Liothyronine Sodium “Cytomel” is a treatment for hypothyroidism. All the
other options are for hyperthyroidism.

10. A patient was recently discharged home for treatment of hypothyroidism and was ordered to take
Synthroid for treatment. The patient is re-admitted with signs and symptoms of the following: heart rate
42, blood pressure 70/56, blood glucose 55, and body temperature of 96.8 ‘F. The patient is very fatigued
and drowsy. The family reports the patient has not been taking Synthroid since being discharged home
from the hospital. Which of the following conditions is this patient most likely experiencing?
A. Thryoid Storm
B. Myxedema Coma
C. Iodism
D. Toxic Nodular Goiter
The answer is B: Myxedema Coma…The red flags in this question are the patient’s signs/symptoms and
the report from the family the patient hasn’t been taking the prescribed Synthroid. The patient is showing
signs and symptoms of extreme hypothyroidism known as Myxedema coma (which is life-threatening if not
treated).

11. A patient is being educated on how to take their anti-thyroid medication. Which of the following
statements are INCORRECT?
A. “I will continue taking aspirin daily.”
B. “I will take this medication at the same time every day.”
C. “It may take a while before I notice that the medication is helping my condition.”
D. “I will avoid foods containing high levels of iodine.”
The answer is A: The patient needs to be instructed NOT to take aspirin because it increases thyroid
hormones. All the other statements are correct.

12. A patient with hypothyroidism is having pain 6 on 1-10 scale in the right hip due to recent hip surgery.
Which of the following medications are NOT appropriate for this patient? Select all that apply:
A. Fentanyl
B. Tylenol
C. Morphine
D. Dilaudid
The answers are A, C, and D. Patients who have hypothyroidism are very sensitive to narcotics and should
take NON-NARCOTICS for pain relief. Fentanyl, Morphine, and Dilaudid are all narcotics, whereas, Tylenol is
not.

13. A patient is 6 hours post-opt from a thyroidectomy. The surgical site is clean, dry and intact with no
excessive swelling noted. What position is best for this patient to be in?
A. Fowler’s
B. Prone
C. Trendelenburg
D. Semi-Fowler’s
The answer is D: Semi-Fowler’s

14. Which of the following signs and symptoms causes concern and requires nursing intervention for a
patient who recently had a thyroidectomy?
A. Heart rate of 120, blood pressure 220/102, temperature 103.2 ‘F
B. Heart rate of 35, blood pressure 60/43, temperature 95.3 ‘F
C. Soft hair, irritable, diarrhea
D. Constipation, drowsiness, goiter
The answer is A. A patient is at risk for experiencing thyroid storm after a thyroidectomy because of
manipulation of the thryroid gland that could cause excessive T3 and T4 to enter into the bloodstream
during removal of the gland. Therefore, heart rate of 120, blood pressure 220/102, temperature 103.2 ‘F
are classic signs of thyroid storm and this requires nursing intervention.

15. ___________ is an autoimmune disorder where the body attacks the thyroid gland that causes it to stop
releasing T3 and T4. The patient is likely to have the typical signs/symptoms of hypothyroidism, however,
they may present with what other sign as well?
A. Myxedema coma; joint pain
B. Thyroid storm; memory loss
C. Hashimoto’s Thyroiditis; goiter
D. Toxic nodular goiter (TNG); goiter
The answer is C: Hashimoto’s Thyroiditis; goiter
16. Which of the following side effects are possible for a patient taking an anti-thyroid medication?
A. Agranulocytosis and aplastic anemia
B. Tachycardia
C. Skin discoloration
D. Joint pain and eczema
The answer is A: Agranulocytosis and aplastic anemia

17. A patient is receiving radioactive iodine treatment for hyperthyroidism. What will you include in your
patient education to this patient about this type of treatment?
A. Taste changes and swollen salivary glands
B. Constipation
C. Excessive thirst
D. Sun protection
The answer is A: taste changes and swollen salivary glands