Question 5271)
A client is diagnosed as having insulin-dependent diabetes mellitus (IDDM). She
received regular insulin at 7:30 A.M. When is she most apt to develop a hypoglycemic reaction?
A. Mid-morning
B. Mid-afternoon
C. Early evening
D. During the night
Answer: A
Explanation: Hypoglycemic reactions occur at peak action time. Peak action time for regular insulin is two to four
hours after injection, which would be midmorning.
Question 5272)
The nurse is teaching a client to self-administer insulin. The instructions should
include teaching the client to:
A. inject the needle at a 90-degree angle into the muscle.
B. vigorously massage the area after injecting the insulin.
C. rotate injection sites.
D. keep the open bottle of insulin in the refrigerator.
Answer: C
Explanation: Injection sites should be rotated to prevent tissue damage. Insulin is injected at a 90-degree angle into
the deep subcutaneous tissue, not the muscle. Insulin does not need to be refrigerated. The open vial should be
kept in the box to protect it from light. Insulin should not be kept at temperature extremes, such as the glove
compartment of the car on a hot day.
Question 5273)
An adolescent with IDDM is learning about a diabetic diet. He asks the nurse if he
will ever be able to go out to eat with his friends again. What is the most appropriate answer for
the nurse to give?
A. “You can go out with them, but you should take your own snack with you.”
B. “Yes. You will learn what foods are allowed so you can eat with your friends.”
C. “When you get food out in a restaurant, be sure to order diet soft drinks.”
D. “Eating out will not be possible on a diabetic diet. Why don’t you plan to invite your friends to your house?”
Answer: B
Explanation: Eating out with friends is very important to an adolescent. Snacks will be allowed on his diet. He
should be taught how to use the exchange lists in managing his diet.
Question 5274)
At 10 A.M., a client with Type 1 diabetes becomes very irritable and starts to yell
at the nurse. Which initial nursing assessment should take priority?
A. Blood pressure and pulse
B. Color and temperature of skin
C. Reflexes and muscle tone
D. Serum electrolytes and glucose
Answer: B
Explanation: The nurse should immediately assess the skin. Behavior change and irritability suggest hypoglycemia.
The nurse could also do a finger stick and check the glucose level. If the client is hypoglycemic, the client will have
pale, cold, clammy skin and will need treatment (ingestion of a rapid-acting carbohydrate) at once.
Question 5275)
An elderly woman has been recently diagnosed as having Type 2 diabetes. Which
of the following complaints that she has is most likely to be related to the diagnosis of diabetes
mellitus?
A. Pruritus vulvae
B. Cough
C. Eructation
D. Singultus
Answer: A
Explanation: Pruritus vulvae (itching of the vulva) frequently accompanies diabetes. Monilial infections are common
due to the change in pH. Eructation is belching or burping, and singultus is hiccups. Neither of these is particularly
related to diabetes.
Question 5276)
A client has a transsphenoidal hypophysectomy to remove a pituitary tumor. When
the client returns to the nursing unit following surgery, the head of the bed is elevated 30
degrees. What is the primary purpose for placing the client in this position?
A. To promote respiratory effort
B. To reduce pressure on the sella turcica
C. To prevent acidosis
D. To promote oxygenation
Answer: B
Explanation: Slight head elevation will reduce pressure on the sella turcica, where the pituitary gland is located,
and edema formation in the area. This position may help promote respiratory effort; however, that is not the
primary reason in this client. This position does not prevent acidosis or promote oxygenation.
Question 5277)
The nurse is discussing discharge plans with a client who had a transsphenoidal
hypophysectomy. Which statement made by the client indicates a need for more teaching?
A. “I won’t brush my teeth until the doctor removes the stitches.”
B. “I will wear loafers instead of tie shoes.”
C. “Where can I get a Medic-Alert bracelet?”
D. “I will take all these new medicines until I feel better.”
Answer: D
Explanation: Because the pituitary or master gland was removed, the client will need to take life-long medications,
not just until the client feels better. All of the other actions are appropriate. The client should not bend over to tie
shoes because this increases intracranial pressure. Answer 1 is correct. Remember, the client had a
transsphenoidal procedure in which the incision is in the mouth above the gum line. The client must take
medications daily for the rest of his/her life, so a Medic-Alert bracelet is appropriate.
Question 5278)
A woman with a tumor of the adrenal cortex says to the nurse, “Will I always look
this ugly? I hate having a beard.” What is the best response for the nurse to make?
A. “After surgery, you will not develop any more symptoms, but the changes you have now will linger.”
B. “That varies from person to person. You should ask your physician.”
C. “After surgery, your appearance should gradually return to normal.”
D. “Electrolysis and plastic surgery should make your appearance normal.”
Answer: C
Explanation: Gradual return to normal will occur after adrenalectomy when there are no longer abnormal amounts
of steroids being produced.
Question 5279)
A client develops hypoparathyroidism after a total thyroidectomy. What treatment
should the nurse anticipate?
A. Emergency tracheostomy
B. Administration of calcium
C. Oxygen administration
D. Administration of potassium
Answer: B
Explanation: Hypoparathyroidism causes a decrease in calcium, which is manifested by tetany.
Question 5280)
A woman with newly diagnosed Type I diabetes mellitus says she wants to have
children. She asks if she will be able to have children and if they will be normal, What will be best
answer from Nurse?
A. “Women with diabetes should not get pregnant because it is very difficult to control diabetes during pregnancy.”
B. “Babies born to diabetic mothers are very apt to have severe and noncorrectable birth defects.”
C. “You should be able to safely have a baby if you go to your doctor regularly during pregnancy.”
D. “You should consult carefully with a geneticist before getting pregnant to determine how to prevent your baby
from developing diabetes.”
Answer: C
Explanation: Most diabetic women can safely have babies if they receive good medical supervision during
pregnancy. There is a slightly higher incidence of fetal loss and malformations in babies of diabetic mothers but not
enough to preclude the chance of a normal baby. There is no way to prevent the child from later developing
diabetes. Diabetes is an inherited condition.
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