NUR 2244 RENAL AND ENDOCRINE EXAM. QUESTIONS AND ANSWERS WITH RATIONALES.

20. A male client with a tentative diagnosis of hyperosmolar hyperglycemic nonketotic syndrome (HHNS) has a history of type 2 diabetes that is being controlled with an oral diabetic agent, tolazamide (Tolinase). Which of the following is the most important laboratory test for confirming this disorder? a. Serum potassium level b. Serum sodium level c. Arterial blood gas (ABG) values d. Serum osmolarity Rationale: Serum osmolarity is the most important test for confirming HHNS; it’s also used to guide treatment strategies and determine evaluation criteria. A client with HHNS typically has a serum osmolarity of more than 350 mOsm/L. Serum potassium, serum sodium, and ABG values are also measured, but they aren’t as important as serum osmolarity for confirming a diagnosis of HHNS. A client with HHNS typically has hypernatremia and osmotic diuresis. ABG values reveal acidosis, and the potassium level is variable. 21. A male client has just been diagnosed with type 1 diabetes mellitus. When teaching the client and family how diet and exercise affect insulin requirements, Nurse Joy should include which guideline? a. “You’ll need more insulin when you exercise or increase your food intake.” b. “You’ll need less insulin when you exercise or reduce your food intake.” c. “You’ll need less insulin when you increase your food intake.” d. “You’ll need more insulin when you exercise or decrease your food intake.” Rationale: Exercise, reduced food intake, hypothyroidism, and certain medications decrease the insulin requirements. Growth, pregnancy, greater food intake, stress, surgery, infection, illness, increased insulin antibodies, and certain medications increase the insulin requirements. 22. Nurse Noemi administers glucagon to her diabetic client, then monitors the client for adverse drug reactions and interactions. Which type of drug interacts adversely with glucagon? a. Oral anticoagulants b. Anabolic steroids c. Beta-adrenergic blockers d. Thiazide diuretics Rationale: As a normal body protein, glucagon only interacts adversely with oral anticoagulants, increasing the anticoagulant effects. It doesn’t interact adversely with anabolic steroids, betaadrenergic blockers, or thiazide diuretics. 23. Which instruction about insulin administration should nurse Kate give to a client? a. “Always follow the same order when drawing the different insulins into the syringe.” b. “Shake the vials before withdrawing the insulin.” c. “Store unopened vials of insulin in the freezer at temperatures well below freezing.” d. “Discard the intermediate-acting insulin if it appears cloudy.” Rationale: The client should be instructed always to follow the same order when drawing the different insulins into the syringe. Insulin should never be shaken because the resulting froth prevents withdrawal of an accurate dose and may damage the insulin protein molecules. Insulin also should never be frozen because the insulin protein molecules may be damaged. Intermediate-acting insulin is normally cloudy.