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Saunders Medsurg Endocrine Revised 20 August 2019
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Saunders Medsurg Endocrine Revised 20 August 2019
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KEY:All un-highlighted questions are required for Medsurg 1
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Saunders Medsurg Endocrine
1. A client is brought to the emergency department in an unresponsive state, and a diagnosis of
hyperosmolar hyperglycemic syndrome is made. The nurse would immediately prepare to initiate which
anticipated health care provider's prescription?
1. Endotracheal intubation
2. 100 units of NPH insulin
3. Intravenous infusion of normal saline
4. Intravenous infusion of sodium bicarbonate
Answer:
3. Intravenous infusion of normal saline
Rationale:
The primary goal of treatment in hyperosmolar hyperglycemic syndrome (HHS) is to rehydrate the client
to restore fluid volume and to correct electrolyte deficiency. Intravenous (IV) fluid replacement is similar
to that administered in diabetic ketoacidosis (DKA) and begins with IV infusion of normal saline. Regular
insulin, not NPH insulin, would be administered. The use of sodium bicarbonate to correct acidosis is
avoided because it can precipitate a further drop in serum potassium levels. Intubation and mechanical
ventilation are not required to treat HHS.
2. An external insulin pump is prescribed for a client with diabetes mellitus. When the client asks the
nurse about the functioning of the pump, the nurse bases the response on which information about the
pump?
1. It is timed to release programmed doses of either short-duration or NPH insulin into the bloodstream
at specific intervals.
2. It continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring
blood glucose levels.
3. It is surgically attached to the pancreas and infuses regular insulin into the pancreas. This releases
insulin into the bloodstream.
4. It administers a small continuous dose of short-duration insulin subcutaneously. The client can self-
administer an additional bolus dose from the pump before each meal.
Answer:
4. It administers a small continuous dose of short-duration insulin subcutaneously. The client can self-
administer an additional bolus dose from the pump before each meal.
Rationale:
,An insulin pump provides a small continuous dose of short-duration (rapid- or short-acting) insulin
subcutaneously throughout the day and night. The client can self-administer an additional bolus dose
from the pump before each meal as needed. Short-duration insulin
3. A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the emergency department.
Which findings support this diagnosis? Select all that apply.
1. Increase in pH
2. Comatose state
3. Deep, rapid breathing
4. Decreased urine output
5. Elevated blood glucose level
Answers:
2. Comatose state
3. Deep, rapid breathing
5. Elevated blood glucose level
Rationale:
Because of the profound deficiency of insulin associated with DKA, glucose cannot be used for energy
and the body breaks down fat as a secondary source of energy. Ketones, which are acid byproducts of fat
metabolism, build up and the client experiences a metabolic ketoacidosis. High serum glucose
contributes to an osmotic diuresis and the client becomes severely dehydrated. If untreated, the client
will become comatose due to severe dehydration, acidosis, and electrolyte imbalance. Kussmaul's
respirations, the deep rapid breathing associated with DKA, is a compensatory mechanism by the body.
The body attempts to correct the acidotic state by blowing off carbon dioxide (CO2), which is an acid. In
the absence of insulin, the client will experience severe hyperglycemia. Option 1 is incorrect because in
acidosis the pH would be low. Option 4 is incorrect because a high serum glucose will result in an
osmotic diuresis and the client will experience polyuria.
4. The nurse teaches a client with diabetes mellitus about differentiating between hypoglycemia and
ketoacidosis. The client demonstrates an understanding of the teaching by stating that a form of glucose
should be taken if which symptom or symptoms develop? Select all that apply.
1. Polyuria
2. Shakiness
3. Palpitations
4. Blurred vision
5. Lightheadedness
6. Fruity breath odor
Answers:
2. Shakiness
3. Palpitations
5. Lightheadedness
,Rationale:
Shakiness, palpitations, and lightheadedness are signs/symptoms of hypoglycemia and would indicate
the need for food or glucose. Polyuria, blurred vision, and a fruity breath odor are manifestations of
hyperglycemia.
5. A client with diabetes mellitus demonstrates acute anxiety when admitted to the hospital for the
treatment of hyperglycemia. What is the appropriate intervention to decrease the client's anxiety?
1. Administer a sedative.
2. Convey empathy, trust, and respect toward the client.
3. Ignore the signs and symptoms of anxiety, anticipating that they will soon disappear.
4. Make sure that the client is familiar with the correct medical terms to promote understanding of what
is happening.
Answer:
2. Convey empathy, trust, and respect toward the client.
Rationale:
Anxiety is a subjective feeling of apprehension, uneasiness, or dread. The appropriate intervention is to
address the client's feelings related to the anxiety. Administering a sedative is not the most appropriate
intervention and does not address the source of the client's anxiety. The nurse should not ignore the
client's anxious feelings. Anxiety needs to be managed before meaningful client education can occur.
6. The nurse provides instructions to a client newly diagnosed with type 1 diabetes mellitus. The nurse
recognizes accurate understanding of measures to prevent diabetic ketoacidosis when the client makes
which statement?
1. "I will stop taking my insulin if I'm too sick to eat."
2. "I will decrease my insulin dose during times of illness."
3. "I will adjust my insulin dose according to the level of glucose in my urine."
4. "I will notify my health care provider (HCP) if my blood glucose level is higher than 250 mg/dL (14.2
mmol/L)."
Answer:
4. "I will notify my health care provider (HCP) if my blood glucose level is higher than 250 mg/dL (14.2
mmol/L)."
Rationale:
During illness, the client with type 1 diabetes mellitus is at increased risk of diabetic ketoacidosis, due to
hyperglycemia associated with the stress response and due to a typically decreased caloric intake. As
part of sick day management, the client with diabetes should monitor blood glucose levels and should
notify the HCP if the level is higher than 250 mg/dL (14.2 mmol/L). Insulin should never be stopped. In
fact, insulin may need to be increased during times of illness. Doses should not be adjusted without the
HCP's advice and are usually adjusted on the basis of blood glucose levels, not urinary glucose readings.
, 7. A client is admitted to a hospital with a diagnosis of diabetic ketoacidosis (DKA). The initial blood
glucose level is 950 mg/dL (54.2 mmol/L). A continuous intravenous (IV) infusion of short-acting insulin is
initiated, along with IV rehydration with normal saline. The serum glucose level is now decreased to 240
mg/dL (13.7 mmol/L). The nurse would next prepare to administer which medication?
1. An ampule of 50% dextrose
2. NPH insulin subcutaneously
3. IV fluids containing dextrose
4. Phenytoin for the prevention of seizures
Answer:
3. IV fluids containing dextrose
Rationale:
Emergency management of DKA focuses on correcting fluid and electrolyte imbalances and normalizing
the serum glucose level. If the corrections occur too quickly, serious consequences, including
hypoglycemia and cerebral edema, can occur. During management of DKA, when the blood glucose level
falls to 250 to 300 mg/dL (14.2 to 17.1 mmol/L), the IV infusion rate is reduced and a dextrose solution is
added to maintain a blood glucose level of about 250 mg/dL (14.2 mmol/L), or until the client recovers
from ketosis. Fifty percent dextrose is used to treat hypoglycemia. NPH insulin is not used to treat DKA.
Phenytoin is not a usual treatment measure for DKA.
8. The nurse is monitoring a client newly diagnosed with diabetes mellitus for signs of complications.
Which sign or symptom, if exhibited in the client, indicates that the client is at risk for chronic
complications of diabetes if the blood glucose is not adequately managed?
1. Polyuria
2. Diaphoresis
3. Pedal edema
4. Decreased respiratory rate
Answer:
1. Polyuria
Rationale:
Chronic hyperglycemia, resulting from poor glycemic control, contributes to the microvascular and
macrovascular complications of diabetes mellitus. Classic symptoms of hyperglycemia include polydipsia,
polyuria, and polyphagia. Diaphoresis may occur in hypoglycemia. Hypoglycemia is an acute
complication of diabetes mellitus; however, it does not predispose a client to the chronic complications
of diabetes mellitus. Therefore, option 2 can be eliminated because this finding is characteristic of
hypoglycemia. Options 3 and 4 are not associated with diabetes mellitus.
9. The nurse is preparing a plan of care for a client with diabetes mellitus who has hyperglycemia. The
nurse places priority on which client problem?
1. Lack of knowledge
2. Inadequate fluid volume
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