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All un-highlighted questions are required for Medsurg 1
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Saunders Medsurg Endocrine
1. The home health nurse visits a client with a diagnosis of type 1 diabetes
mellitus. The client relates a history of vomiting and diarrhea and tells the nurse
that no food has been consumed for the last 24 hours. Which additional
statement by the client indicates a need for further teaching?
1. "I need to stop my insulin."
2. "I need to increase my fluid intake."
3. "I need to monitor my blood glucose every 3 to 4 hours."
4. "I need to call the health care provider (HCP) because of these symptoms."
Answer:
1. "I need to stop my insulin."
Rationale:
When a client with diabetes mellitus is unable to eat normally because of
illness, the client still should take the prescribed insulin or oral medication. The
,client should consume additional fluids and should notify the HCP. The client
should monitor the blood glucose level every 3 to 4 hours. The client should
also monitor the urine for ketones during illness.
2. The nurse is performing an assessment on a client with a diagnosis of
hyperthyroidism. Which assessment finding should the nurse expect to note in this
client?
1. Dry skin
2. Bulging eyeballs
3. Periorbital edema
4. Coarse facial features
Answer:
2. Bulging eyeballs
Rationale:
Hyperthyroidism is clinically manifested by goiter (increase in the size of the
thyroid gland) and exophthalmos (bulging eyeballs). Other clinical manifestations
include nervousness, fatigue, weight loss, muscle cramps, and heat intolerance.
Additional signs found in this disorder include tachycardia; shortness of breath;
excessive sweating; fine muscle tremors; thin, silky hair and thin skin; infrequent
blinking; and a staring appearance.
3. The nurse is caring for a client admitted to the hospital with uncontrolled type
1 diabetes mellitus. In the event that diabetic ketoacidosis (DKA) does occur, the
nurse anticipates that which medication would most likely be prescribed?
1. Glucagon
,2. Glyburide
3. Regular insulin
4. Neutral protamine Hagedorn (NPH) insulin
Answer:
3. Regular insulin
Rationale:
Giving regular insulin by the intravenous route is the treatment of choice for DKA.
A short-acting insulin is the only insulin that can be given intravenously because it
can be titrated to the client's blood glucose levels. Glucagon is used to treat
hypoglycemia because it increases blood glucose levels, and glyburide is an oral
hypoglycemic agent used to treat type 2 diabetes mellitus; both agents are
inappropriate. NPH insulin is an intermediate-acting insulin and therefore is not
appropriate for treatment of DKA.
.
4. A client with type 1 diabetes mellitus is admitted to the hospital with diabetic
ketoacidosis and a serum glucose level of 789 mg/dL (45 mmol/L). The health care
provider (HCP) prescribes 10 units of regular insulin by intravenous (IV) bolus,
followed by a continuous insulin infusion at a rate of 5 units/hr. The pharmacy
sends 500 mL of normal saline solution containing 50 units of regular insulin. After
administering the IV bolus of 10 units of regular insulin, the nurse sets the infusion
pump flow rate of the normal saline solution containing 50 units of regular insulin
to infuse at how many milliliters per hour to deliver 5 units/hr? Fill in the blank.
, Answer:
50 mL
Formula:
H (on hand):
V (vehicle)::(desired dose):X
(unknown) 50 units:500 mL::5
units:X
50X =
2500 X =
50 mL
Rationale:
This is a dosage calculation problem. Because the HCP does not prescribe a
specific IV rate (mL/hr), the nurse needs to determine how many milliliters of the
normal saline solution contain 5 units of insulin.