Diabetic Treatment
The nurse is administering regular insulin (Humulin R) to a client with type 1 diabetes at 7:30 AM. At what time is this client most at risk for hypoglycemia?
A. 8:00 AM
B. 10:00 AM
C. 2:00 PM
D. 8:00 PM
What is
B. 10:00am Regular insulin peaks 2–4 hours after administration.
The primary difference between DKA and HHS is that in HHS the client usually does not develop this complication.
What is
significant ketoacidosis?
A client with hypothyroidism complains of fatigue, weight gain, and cold intolerance. Which lab finding would confirm the diagnosis?
A. Elevated TSH and low T4
B. Low TSH and high T4
C. Elevated T3 only
D. Low TSH and low T3
What is
A. Elevated TSH and low T4
Which body mass index (BMI) is classified as obese?
A. 18.5–24.9
B. 25–29.9
C. 30–39.9
D. ≥40
What is
C. 30–39.9
A client with hyperparathyroidism presents with kidney stones, constipation, and bone pain. Which lab finding supports this diagnosis?
A. Low serum calcium and high phosphate
B. High serum calcium and low phosphate
C. Low PTH and low calcium
D. Low serum calcium and high PTH
What is
B. High serum calcium and low phosphate
Which oral medication is commonly used as first-line therapy for type 2 diabetes?
A. Glipizide
B. Metformin
C. Pioglitazone
D. Acarbose
What is
B. Metformin
The nurse is teaching a client about insulin glargine (Lantus). Which statement indicates correct understanding?
A. “I will take this insulin at the same time every day.”
B. “I should take this insulin with each meal.”
C. “I will mix this insulin with regular insulin.”
D. “This insulin works right away after injection.”
What is
A. “I will take this insulin at the same time every day.” – Glargine is long-acting, given once daily, not mixed, no pronounced peak.
1. The nurse is caring for a client with DKA who is receiving a continuous IV insulin infusion. Blood glucose has decreased from 420 mg/dL to 210 mg/dL. Which provider order should the nurse anticipate next?
What is
B. Add dextrose 5% to the IV fluids – when glucose falls below ~250 mg/dL, dextrose is added to prevent hypoglycemia and cerebral edema, while insulin infusion continues.
A client with hyperthyroidism reports palpitations, heat intolerance, and weight loss. Which assessment finding is most consistent with this condition?
A. Tachycardia and tremors
B. Bradycardia and lethargy
C. Cold intolerance and weight gain
D. Dry skin and coarse hair
What is
A. Tachycardia and tremors
A nurse is caring for a client post-gastric bypass surgery. Which dietary instruction is most appropriate initially?
A. Encourage high-fat meals to prevent nausea
B. Begin with clear liquids and advance as tolerated
C. Allow unlimited portion sizes to promote healing
D. Eat three large meals per day without snacks
What is
B. Begin with clear liquids and advance as tolerated
A nurse is caring for a client with hypoparathyroidism. Which clinical manifestation should the nurse anticipate?
A. Muscle cramps, tetany, and positive Chvostek’s sign
B. Polyuria and kidney stones
C. Bone pain and fractures
D. Hypertension and tachycardia
What is
A. Muscle cramps, tetany, and positive Chvostek’s sign
A client taking sulfonylureas for type 2 diabetes reports dizziness, sweating, and confusion. Which action should the nurse take first?
A. Administer IV insulin
B. Check blood glucose
C. Give a high-protein snack
D. Hold the next dose of sulfonylurea
What is
B. Check blood glucose
The nurse is preparing to administer a client’s morning insulin. Which action is most appropriate?
A. Draw up NPH insulin first, then regular insulin.
B. Shake the vial of NPH insulin vigorously before drawing up.
C. Draw up regular insulin first, then NPH insulin.
D. Administer regular and NPH insulin in separate syringes.
What is
C. Draw up regular insulin first, then NPH insulin. – “Clear before cloudy.”
The nurse is caring for a client with HHS who is receiving IV insulin. Which finding requires the most immediate action?
What is
B. Serum potassium 2.8 mEq/L – severe hypokalemia is life-threatening and must be corrected before continuing insulin.
The nurse is caring for a client with hypocalcemia following a thyroidectomy. The provider orders 1 gram of IV calcium gluconate. Which nursing action is the most important before administering the medication?
A. Ensure the client has eaten a full meal
B. Check the client’s serum calcium and potassium levels
C. Mix the calcium gluconate with 5% dextrose before infusion
D. Administer the dose as a rapid IV push
What is
B. Check the client’s serum calcium and potassium levels
Rationale:
Serum calcium levels must be assessed prior to IV calcium administration to determine the need and dose.
IV calcium gluconate should be administered slowly, usually over 10–20 minutes, to prevent cardiac dysrhythmias.
Rapid IV push can cause bradycardia, arrhythmias, or hypotension.
It should not be mixed with sodium bicarbonate or incompatible solutions, and meals are not required for IV administration.
A client who had bariatric surgery reports dizziness, palpitations, and nausea 20 minutes after eating. The nurse suspects which complication?
A. Dumping syndrome
B. Hypoglycemia unrelated to surgery
C. Wound infection
D. Gastric outlet obstruction
What is
A. Dumping syndrome
A client is scheduled for a parathyroidectomy due to hyperparathyroidism. Which preoperative priority should the nurse address?
A. Ensure the client’s potassium is within normal limits
B. Monitor and correct calcium imbalances
C. Prepare the client for a low-calcium diet
D. Administer IV insulin
What is
B. Monitor and correct calcium imbalances
A client taking metformin reports nausea, vomiting, and abdominal pain. Which serious complication should the nurse assess for?
A. Hypoglycemia
B. Lactic acidosis
C. Hyperkalemia
D. Ketoacidosis
What is
B. Lactic Acidosis
The nurse is teaching a newly diagnosed diabetic about insulin administration. Which statement by the client requires correction?
A. “I should rotate injection sites within the same anatomical area.”
B. “I will inject my insulin at a 90-degree angle.”
C. “If I skip a meal, I should also skip my insulin dose.”
D. “I will keep unopened insulin vials in the refrigerator.”
What is
C. “If I skip a meal, I should also skip my insulin dose.” – incorrect; skipping insulin may lead to hyperglycemia/DKA, though mealtime rapid-acting insulin may be adjusted with provider guidance.
A nurse caring for a client with HHS expects which laboratory finding?
A. Glucose 180 mg/dL
B. Ketones in urine
C. Serum osmolality >320 mOsm/kg
D. Arterial pH 7.20
What is serum osmolality >320 mOsm/kg?
A client with hypothyroidism is prescribed levothyroxine. Which nursing action is most important?
A. Administer the medication in the morning on an empty stomach
B. Give the medication with breakfast to prevent nausea
C. Double the dose if a dose is missed
D. Stop the medication once energy improves
What is
A. Administer the medication in the morning on an empty stomach
A nurse is assessing a client with a BMI of 36 kg/m². Which health risk should the nurse identify as most closely associated with obesity?
A. Type 2 diabetes mellitus
B. Osteoporosis
C. Hyperthyroidism
D. Hypotension
What is
A. Type 2 diabetes mellitus
A client develops hypocalcemia after a parathyroidectomy. Which intervention is most important for the nurse to implement immediately?
A. Administer IV calcium gluconate as prescribed
B. Place the client on a high-phosphate diet
C. Encourage oral fluids
D. Initiate seizure precautions only if the client convulses
What is
A. Administer IV calcium gluconate as prescribed
Question:
A client is prescribed metformin for type 2 diabetes. Which instruction is most important to include in discharge teaching?
A. Take with food to reduce gastrointestinal upset
B. Limit fluid intake to prevent edema
C. Stop the medication if blood glucose is normal
D. Avoid all forms of exercise
What is
A. Take with food to reduce gastrointestinal upset
A client with type 1 diabetes is admitted with diabetic ketoacidosis (DKA). The provider prescribes a continuous IV regular insulin infusion. The client’s current labs are:
Blood glucose: 280 mg/dL
Potassium: 2.9 mEq/L
Sodium: 134 mEq/L
Bicarbonate: 16 mEq/L
Which action is the priority for the nurse before starting the insulin infusion?
What is administer IV potassium replacement as prescribed?
Rationale:
Insulin drives potassium into cells → worsens hypokalemia.
A potassium level of 2.9 mEq/L is critically low and can cause life-threatening dysrhythmias.
Potassium must be corrected before safely starting IV insulin.
The nurse is caring for a client with diabetic ketoacidosis (DKA) receiving a continuous IV insulin infusion. Which intervention is the nurse’s priority?
A. Monitor for hypokalemia by checking serum potassium and cardiac rhythm
B. Titrate insulin infusion until blood glucose is less than 70 mg/dL
C. Encourage the client to eat a snack every 2 hours
D. Restrict IV fluids to prevent fluid overload
What is
A. Monitor for hypokalemia by checking serum potassium and cardiac rhythm
Rationale:
IV insulin causes potassium to shift into cells, which can lead to life-threatening hypokalemia → dysrhythmias, Insulin infusion should be titrated to maintain safe glucose reduction (not to drop below 70), Clients with DKA are NPO until stable, so snacks are not appropriate, IV fluids are critical for volume replacement, not restricted.
A client is 12 hours post-thyroidectomy and develops stridor, hoarseness, and difficulty breathing. Which action should the nurse take first?
A. Prepare for emergency airway management (tracheostomy) and call rapid response
B. Give acetaminophen for pain relief
C. Elevate the head of the bed and reassure the client
D. Administer the first dose of oral levothyroxine
What is
A. Prepare for emergency airway management (tracheostomy) and call rapid response
A client 2 weeks post-Roux-en-Y gastric bypass reports persistent nausea, vomiting of undigested food, epigastric fullness, and inability to tolerate meals. The provider diagnoses a partial gastric outlet obstruction. Which provider order should the nurse question?
A. Insert a nasogastric tube for gastric decompression
B. Start IV fluids to correct dehydration and electrolyte imbalances
C. Encourage the client to eat solid foods to “stretch the stomach”
D. Prepare the client for possible endoscopic evaluation or revision
What is
C. Encourage the client to eat solid foods to “stretch the stomach”
Rationale:
After bariatric surgery, gastric outlet obstruction can occur due to stricture, edema, or narrowing at the anastomosis site.
Forcing solid foods can worsen obstruction, increase vomiting, and risk aspiration.
Initial management includes NG decompression, IV hydration/electrolytes, and surgical/endoscopic evaluation.
A client with hyperparathyroidism is being discharged home. Which teaching point is most important to prevent complications?
A. Increase fluid intake to reduce risk of kidney stones
B. Avoid weight-bearing exercise to prevent fractures
C. Limit calcium intake in the diet immediately
D. Take daily potassium supplements
What is
A. Increase fluid intake to reduce risk of kidney stones
A client taking metformin is scheduled for a CT scan with contrast. Which nursing action is most appropriate?
A. Administer the usual dose of metformin before the procedure
B. Hold metformin before and 48 hours after contrast to prevent renal injury
C. Increase the dose of metformin to counteract contrast-induced hyperglycemia
D. Encourage extra fluids while continuing metformin
What is
B. Hold metformin before and 48 hours after contrast to prevent renal injury