1. D

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 is used in an insulin pump. An external pump is not attached surgically to the pancreas.

Test-Taking Strategy: Focus on the subject, use of an insulin pump. Recalling that short-duration insulin is used in an insulin pump will assist in eliminating options A and B. Noting the word external in the question will assist in eliminating option C.

Review: Insulin pumps and insulin therapy
Level of Cognitive Ability: Applying
Client Needs: Physiological Integrity
Integrated Process: Teaching and Learning
Content Area: Adult Health—Endocrine
Priority Concepts: Client Education; Glucose Regulation
References: Lewis et al. (2014), pp. 1161–1162, 1168; Perry, Potter, Ostendorf (2019).

2. B, C, E.

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 A is incorrect because in acidosis the pH would be low. Option D is incorrect because a high serum glucose will result in an osmotic diuresis and the client will experience polyuria.

Test-Taking Strategy: Focus on the subject, findings associated with DKA. Recall that the pathophysiology of DKA is the breakdown of fats for energy. The breakdown of fats leads to a state of acidosis. The high serum glucose contributes to an osmotic diuresis. Knowing the pathophysiology of DKA will aid in identification of the correct answer.

Review: Diabetic ketoacidosis (DKA)
Level of Cognitive Ability: Analyzing
Client Needs: Physiological Integrity
Integrated Process: Nursing Process—Assessment
Content Area: Adult Health—Endocrine
Priority Concepts: Clinical Judgment; Glucose Regulation
Reference: Lewis et al. (2014), p. 1176.

3. B, C, E.

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.

Test-Taking Strategy: Focus on the subject, the treatment of hypoglycemia. Think about its pathophysiology and the manifestations that occur. Recalling the signs and symptoms of hypoglycemia will direct you to the correct option.

Review: Signs of hypoglycemia
Level of Cognitive Ability: Evaluating
Client Needs: Physiological Integrity
Integrated Process: Nursing Process—Evaluation
Content Area: Adult Health—Endocrine
Priority Concepts: Client Education; Glucose Regulation
Reference: Ignatavicius, Workman (2016), p. 1330.

4. B.

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.

Test-Taking Strategy: Use therapeutic communication techniques to answer the question. Remember that the client’s feelings are the priority. Keeping this in mind will direct you easily to the correct option.

Review: Therapeutic communication techniques
Level of Cognitive Ability: Applying
Client Needs: Psychosocial Integrity
Integrated Process: Caring
Content Area: Adult Health—Endocrine
Priority Concepts: Anxiety; Caregiving
References: Lewis et al. (2014), pp. 1185–1186; Perry, Potter, Ostendorf (2014).

5. D.

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 health care provider 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 health care provider’s advice and are usually adjusted on the basis of blood glucose levels, not urinary glucose readings.

Test-Taking Strategy: Use general medication guidelines to answer the question. Note that options A, B, and C are comparable or alike and all relate to adjustment of insulin doses.

Review: Sick day rules for diabetic management
Level of Cognitive Ability: Evaluating
Client Needs: Physiological Integrity
Integrated Process: Nursing Process—Evaluation
Content Area: Adult Health—Endocrine
Priority Concepts: Client Education; Glucose Regulation
Reference: Ignatavicius, Workman (2016), p. 1335.

6. C.

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.

Test-Taking Strategy: Note the strategic word, next. Focus on the subject, management of DKA. Eliminate option B first, knowing that short-duration (rapid-acting) insulin is used in the management of DKA. Eliminate option A next, knowing that this is the treatment for hypoglycemia. Note the words the serum glucose level is now decreased to 240 mg/dL (13.7 mmol/L). This should indicate that the IV solution containing dextrose is the next step in the management of care.

Review: Diabetic ketoacidosis (DKA)
Level of Cognitive Ability: Synthesizing
Client Needs: Physiological Integrity
Integrated Process: Nursing Process—Planning
Content Area: Adult Health—Endocrine
Priority Concepts: Clinical Judgment; Glucose Regulation
Reference: Ignatavicius, Workman (2016), pp. 1332–1335.

7. A.

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 B can be eliminated because this finding is characteristic of hypoglycemia. Options C and D are not associated with diabetes mellitus.

Test-Taking Strategy: Focus on the subject, chronic complications of diabetes mellitus. Recall that poor glycemic control contributes to development of the chronic complications of diabetes mellitus. Remember the 3 Ps associated with hyperglycemia—polyuria, polydipsia, and polyphagia.

Review: Signs of chronic complications of diabetes mellitus
Level of Cognitive Ability: Analyzing
Client Needs: Physiological Integrity
Integrated Process: Nursing Process—Analysis
Content Area: Adult Health—Endocrine
Priority Concepts: Clinical Judgment; Glucose Regulation
Reference: Ignatavicius, Workman (2016), pp. 1302, 1333.

8. B.

Rationale: An increased blood glucose level will cause the kidneys to excrete the glucose in the urine. This glucose is accompanied by fluids and electrolytes, causing an osmotic diuresis leading to dehydration. This fluid loss must be replaced when it becomes severe. Options A, C, and D are not related specifically to the information in the question.

Test-Taking Strategy: Note the strategic word, priority, and focus on the information in the question. Use Maslow’s Hierarchy of Needs theory. The correct option indicates a problem that may need to be addressed after providing for the priority physiological needs.

Review: Hyperglycemia
Level of Cognitive Ability: Analyzing
Client Needs: Physiological Integrity
Integrated Process: Nursing Process—Planning
Content Area: Adult Health—Endocrine
Priority Concepts: Clinical Judgment; Glucose Regulation
Reference: Ignatavicius, Workman (2016), pp. 1333–1334.

9. A.

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.

Test-Taking Strategy: Note the strategic words, need for further teaching. These words indicate a negative event query and the need to select the incorrect statement. Remembering that the client needs to take insulin will direct you easily to the correct option.

Review: Sick day guidelines
Level of Cognitive Ability: Evaluating
Client Needs: Physiological Integrity
Integrated Process: Teaching and Learning
Content Area: Adult Health—Endocrine
Priority Concepts: Client Education; Glucose Regulation
Reference: Ignatavicius, Workman (2016), p. 1335.

10. C.

Rationale: In the client with type 2 diabetes mellitus, an elevated temperature may indicate infection. Infection is a leading cause of hyperosmolar hyperglycemic syndrome in the client with type 2 diabetes mellitus. The other findings are within normal limits.

Test-Taking Strategy: Note the strategic word, priority. Use knowledge of the normal values of vital signs to direct you to the correct option. The client’s temperature is the only abnormal value. Remember that an elevated temperature can indicate an infectious process that can lead to complications in the client with diabetes mellitus.

Review: Normal and abnormal findings for the client with diabetes mellitus
Level of Cognitive Ability: Analyzing
Client Needs: Physiological Integrity
Integrated Process: Nursing Process—Assessment
Content Area: Adult Health—Endocrine
Priority Concepts: Glucose Regulation; Infection
Reference: Lewis et al. (2014), pp. 1184–1185.

11. A.

Rationale: When preparing a mixture of short-acting insulin, such as regular insulin, with another insulin preparation, the short-acting insulin is drawn into the syringe first. This sequence will avoid contaminating the vial of short-acting insulin with insulin of another type. Options B, C, and D identify correct actions for preparing NPH and short acting insulin.

Test-Taking Strategy: Note the strategic words, need for further teaching. These words indicate a negative event query and ask you to select an option that is an incorrect action. Remember RN—draw up the Regular (short-acting) insulin before the NPH insulin.

Review: Preparation of NPH and short-acting insulin
Level of Cognitive Ability: Evaluating
Client Needs: Physiological Integrity
Integrated Process: Teaching and Learning
Content Area: Pharmacology—Endocrine Medications
Priority Concepts: Client Education; Glucose Regulation
Reference: Burchum, Rosenthal (2016), pp. 689–680.

12.B.

Rationale: Insulin in unopened vials should be stored under refrigeration until needed. Vials should not be frozen. When stored unopened under refrigeration, insulin can be used up to the expiration date on the vial. Options 1, 3, and 4 are incorrect.

Test-Taking Strategy: Note the subject, how to store unopened vials of insulin. Options C and D are comparable or alike regarding where to store the insulin and should be eliminated. Remembering that insulin should not be frozen will assist in eliminating option A.

Review: Storage of insulin
Level of Cognitive Ability: Applying
Client Needs: Physiological Integrity
Integrated Process: Teaching and Learning
Content Area: Pharmacology—Endocrine Medications
Priority Concepts: Client Education; Safety
Reference: Burchum, Rosenthal (2016), p. 681.

13. B, C, E.

Rationale: When alcohol is combined with glimepiride, a disulfiram-like reaction may occur. This syndrome includes flushing, palpitations, and nausea. Alcohol can also potentiate the hypoglycemic effects of the medication. Clients need to be instructed to avoid alcohol consumption while taking this medication. Low-calorie desserts should also be avoided. Even though the calorie content may be low, carbohydrate content is most likely high and can affect the blood glucose. The items in options B, C, and E are acceptable to consume.

Test-Taking Strategy: Note the strategic word, most. Remembering that alcohol can affect the action of many medications will assist in eliminating option 1. Next, recalling that carbohydrates need to be controlled in a diabetic diet will assist in eliminating option D.

Review: Glimepiride
Level of Cognitive Ability: Applying
Client Needs: Physiological Integrity
Integrated Process: Teaching and Learning
Content Area: Pharmacology—Endocrine Medications
Priority Concepts: Client Education; Glucose Regulation
Reference: Burchum, Rosenthal (2016), p. 688.

14. A.

Rationale: Prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics, and potassium supplements. Option B, a beta blocker, and option C, a monoamine oxidase inhibitor, have their own intrinsic hypoglycemic activity. Option D decreases urinary excretion of sulfonylurea agents, causing increased levels of the oral agents, which can lead to hypoglycemia.

Test-Taking Strategy: Focus on the subject, an increase in the blood glucose level. Recalling that prednisone is a corticosteroid and that corticosteroids decrease the effects of oral hypoglycemics will direct you to the correct option.

Review: Glyburide and prednisone
Level of Cognitive Ability: Analyzing
Client Needs: Physiological Integrity
Integrated Process: Nursing Process—Assessment
Content Area: Pharmacology—Endocrine Medications
Priority Concepts: Clinical Judgment; Glucose Regulation
Reference: Lilley et al. (2014), pp. 516, 540–541.

15. A.

Rationale: The nurse needs to be aware of the effective and ineffective coping mechanisms that can occur in a client when loss is anticipated. The expression of anger is known to be a normal response to impending loss, and the anger may be directed toward the self, God or other spiritual being, or caregivers. Notifying the hospital lawyer is inappropriate. Guilt may or may not be a component of the client’s feelings, and the data in the question do not indicate that guilt is present.

Test-Taking Strategy: Note the subject, psychosocial care of a client needing amputation. Also note the strategic word, best. Note that the correct option and option address coping and defense mechanisms. This provides you with the clue that one of these options may be the correct response. In addition, knowledge of the stages of grief associated with loss will direct you to the correct option.

Review: Stages of grief and expected client responses
Level of Cognitive Ability: Analyzing
Client Needs: Psychosocial Integrity
Integrated Process: Nursing Process—Assessment
Content Area: Mental Health
Priority Concepts: Anxiety; Coping
Reference: Ignatavicius, Workman (2016), pp. 1071–1072.

16. C.

Rationale: An insulin vial in current use can be kept at room temperature for 1 month without significant loss of activity. Direct sunlight and heat must be avoided. Therefore, options A, B, and D are incorrect.

Test-Taking Strategy: Note the subject, client understanding of discharge instructions related to storage of insulin. Noting the closed-ended words only in option 1 and all in option B will assist you in eliminating these options. Recalling that direct sunlight and heat need to be avoided will assist you in eliminating option D.

Review: Storage of insulin
Level of Cognitive Ability: Evaluating
Client Needs: Physiological Integrity
Integrated Process: Nursing Process—Evaluation
Content Area: Pharmacology—Endocrine Medications
Priority Concepts: Client Education; Glucose Regulation
Reference: Burchum, Rosenthal (2016), p. 681.

17. D.

Rationale: The most common side effect of metformin is gastrointestinal disturbances, including decreased appetite, nausea, and diarrhea. These generally subside over time. This medication does not cause weight gain; clients lose an average of 7 to 8 lb (3.2 to 3.6 kg) because the medication causes nausea and decreased appetite. Although hypoglycemia can occur, it is not the most common side effect. Flushing and palpitations are not specifically associated with this medication.

Test-Taking Strategy: Note the strategic word, most. To answer correctly, it is necessary to recall that the most common side effect of metformin is gastrointestinal disturbances.

Review: Side effects of metformin
Level of Cognitive Ability: Applying
Client Needs: Physiological Integrity
Integrated Process: Teaching and Learning
Content Area: Pharmacology—Endocrine Medications
Priority Concepts: Client Education; Glucose Regulation
Reference: Burchum, Rosenthal (2016), p. 700.

18. A.

Rationale: The client with diabetes is prone to serious foot injuries secondary to peripheral neuropathy and decreased circulation. The client should be taught to avoid going barefoot to prevent injury. Shoes that do not fit properly should not be worn because they will cause blisters that can become nonhealing, serious wounds for the diabetic client. Toenails should be cut straight across. A heating pad should not be used because of the risk of burns due to insensitivity to temperature.

Test-taking Strategy: Recall the concepts of diabetic foot care, taking note of how to ensure that the risk for injuries and damage to the foot is reduced or eliminated.

Review: Risk for injury
Level of Cognitive Ability: Applying
Client Needs: Physiological Integrity
Integrated Process: Synthesis; Teaching and Learning
Content Area: Adult Health- Endocrine
Priority Concepts: Diabetic foot care; prevention of injuries
Reference: Burchum, Rosenthal (2016), p. 700.

19. B.

Rationale: Proper and careful first-aid treatment is important when a client with diabetes has a skin cut or laceration. The skin should be kept supple and as free of organisms as possible. Washing and bandaging the cut will accomplish this. Washing wounds with alcohol is too caustic and drying to the skin. Having the children help is an unrealistic suggestion and does not educate the client about proper care of wounds. Tight control of blood glucose levels through adherence to the medication regimen is vitally important; however, it does not mean that careful attention to cuts can be ignored.

Test-taking Strategy: Infection control measures, especially in patients who are diabetic should be noted. Their poor healing ability is one of the most important factors to consider in providing immediate care.

Review: Risk for injury
Level of Cognitive Ability: Applying
Client Needs: Reduction of Risk Potential
Integrated Process: Application; Synthesis
Content Area: Adult Health- Endocrine
Priority Concepts: Infection Control
Reference: Burchum, Rosenthal (2016).

20. D.

Rationale: Diabetes mellitus is a multifactorial, systemic disease associated with problems in the metabolism of all food types. The client’s diet should contain appropriate amounts of all three nutrients, plus adequate minerals and vitamins.

Test-taking Strategy: Review concepts of nutrition, especially macronutrients and their role to optimal body functioning. Ratio of macronutrients

Review: Nutritional needs of diabetic patients
Level of Cognitive Ability: Analyzing
Client Needs: Physiological Integrity
Integrated Process: Nursing Process—Analysis
Content Area: Adult Health—Endocrine
Priority Concepts: Clinical Judgment; Glucose Regulation
Reference: Ignatavicius, Workman (2016).

21. D.

Rationale: A client with diabetes who takes any first- or second-generation sulfonylurea should be advised to avoid alcohol intake. Sulfonylureas in combination with alcohol can cause serious disulfiram (Antabuse)–like reactions, including flushing, angina, palpitations, and vertigo. Serious reactions, such as seizures and possibly death, may also occur. Hypokalemia, hyperkalemia, and hypocalcemia do not result from taking sulfonylureas in combination with alcohol.

Test-taking Strategy: Recall information about sulfonylurea and its compatibility with other drugs and substances.

Review: Drug interactions: sulfonylurea
Level of Cognitive Ability: Applying
Client Needs: Physiological Integrity
Integrated Process: Teaching and Learning
Content Area: Pharmacology—Endocrine Medications
Priority Concepts: Client Education; Glucose Regulation
Reference: Burchum, Rosenthal (2016).

22. B.

Rationale: The client with diabetes mellitus is especially prone to hypertension due to atherosclerotic changes, which leads to problems of the microvascular and macrovascular systems. This can result in complications in the heart, brain, and kidneys. Heart disease and stroke are twice as common among people with diabetes mellitus than among people without the disease. Painful, inflamed joints accompany rheumatoid arthritis. A stooped appearance accompanies osteoporosis with narrowing of the vertebral column. A low hemoglobin concentration accompanies anemia, especially iron deficiency anemia and anemia of chronic disease.

Test-taking Strategy: Review complications of diabetes mellitus, especially on the cardiovascular system and its effect on the integrity of vessels.

Client Needs: Reduction of Risk Potential
Integrated Process: Application; Synthesis
Content Area: Adult Health- Endocrine
Priority Concepts: Infection Control
Reference: Burchum, Rosenthal (2016), p. 700.

23. D.

Rationale: The client with diabetes mellitus who is taking NPH insulin (Humulin N) in the evening is most likely to become hypoglycemic shortly after midnight because this insulin peaks in 6 to 8 hours. The client should eat a bedtime snack to help prevent hypoglycemia while sleeping.

Test-taking Strategy: Remember about the onset, peak and duration of action of different types of insulin.

Review: Actions of insulin
Level of Cognitive Ability: Evaluating
Client Needs: Physiological Integrity
Integrated Process: Teaching and Learning
Content Area: Pharmacology—Endocrine Medications
Priority Concepts: Client Education; Glucose Regulation
Reference: Burchum, Rosenthal (2016), pp. 689–680.

24. A.

Rationale: Colds and influenza present special challenges to the client with diabetes mellitus because the body’s need for insulin increases during illness. Therefore, the client must take the prescribed insulin dose, increase the frequency of blood glucose testing, and maintain an adequate fluid intake to counteract the dehydrating effect of hyperglycemia. Clear fluids, juices, and Gatorade are encouraged. Not taking insulin when sick, or taking half the normal dose, may cause the client to develop ketoacidosis.

Test-taking Strategy: Recall the different metabolic demands of the body for nutrients and insulin depending on the stress it faces. Focus on patient’s optimal functioning even with these needs present.

Review: Sick day guidelines
Level of Cognitive Ability: Evaluating
Client Needs: Physiological Integrity
Integrated Process: Teaching and Learning
Content Area: Adult Health—Endocrine
Priority Concepts: Client Education; Glucose Regulation
Reference: Ignatavicius, Workman (2016), p. 1335.

25. A.

Rationale: Imbalanced nutrition: Less than body requirements is a priority nursing diagnosis for the client with diabetes mellitus who is experiencing vomiting with influenza. The diabetic client should eat small, frequent meals of 50 g of carbohydrate or food equal to 200 calories every 3 to 4 hours. If the client cannot eat the carbohydrates or take fluids, the health care provider should be called or the client should go to the emergency department. The diabetic client is in danger of complications with dehydration, electrolyte imbalance, and ketoacidosis. Increasing the client’s coping skills is important to lifestyle behaviors, but it is not a priority during this acute illness of influenza. Pain relief may be a need for this client, but it is not the priority at this time; neither is intolerance for activity.

Test-taking Strategy: Note for the potential loss of nutrients, fluid and electrolytes in a patient who is vomiting and apply these concepts to the diabetic patient.

Review: Sick day guidelines
Level of Cognitive Ability: Evaluating
Client Needs: Physiological Integrity
Integrated Process: Teaching and Learning
Content Area: Adult Health—Endocrine
Priority Concepts: Client Education; Glucose Regulation
Reference: Ignatavicius, Workman (2016), p. 1335.

26. D.

Rationale: The best response is to allow the client to verbalize her fears about giving herself a shot each day. Tactics that increase fear are not effective in changing behavior. If possible, the client needs to be responsible for her own care, including giving self-injections. It is unlikely that the client’s insurance company will pay for home-care visits if the client is capable of self-administration.

Test-taking Strategy: Note the concept, which is focusing on the feelings of the patient. Brush up on therapeutic communication.

Review: Feelings patients may have about diagnosis and treatment
Level of Cognitive Ability: Analyzing
Client Needs: Psychosocial Integrity
Integrated Process: Nursing Process—Assessment
Content Area: Mental Health
Priority Concepts: Anxiety; Coping
Reference: Ignatavicius, Workman (2016).

27. 32 units

Rationale: Clients commonly need to mix insulin, requiring careful mixing and calculation. The total dosage is 10 units plus 22 units, for a total of 32 units.

Review: Dosage and Calculation
Level of Cognitive Ability: Evaluating
Client Needs: Physiological Integrity
Integrated Process: Teaching and Learning
Content Area: Pharmacology—Endocrine Medications
Priority Concepts: Client Education; Insulin Admninistration
Reference: Burchum, Rosenthal (2016).

28. C.

Rationale: Renal failure frequently results from the vascular changes associated with diabetes mellitus. ACE inhibitors increase renal blood flow and are effective in decreasing diabetic nephropathy. Chronic obstructive pulmonary disease is not a complication of diabetes, nor is it prevented by ACE inhibitors. Pancreatic cancer is neither prevented by ACE inhibitors nor considered a complication of diabetes. Cerebrovascular accident is not directly prevented by ACE inhibitors, although management of hypertension will decrease vascular disease.

Test-taking Strategy: Review complications of diabetes mellitus, especially on the urinary system and its effect on other organs and systems of the body.

Client Needs: Reduction of Risk Potential
Integrated Process: Application; Synthesis
Content Area: Adult Health- Endocrine
Priority Concepts: Infection Control
Reference: Burchum, Rosenthal (2016).

29. A.

Rationale: The four most commonly reported signs and symptoms of hypoglycemia are nervousness, weakness, perspiration, and confusion. Other signs and symptoms include hunger, incoherent speech, tachycardia, and blurred vision. Anorexia and Kussmaul’s respirations are clinical manifestations of hyperglycemia or ketoacidosis. Bradycardia is not associated with hypoglycemia; tachycardia is.

Review: Signs of hypoglycemia
Level of Cognitive Ability: Evaluating
Client Needs: Physiological Integrity
Integrated Process: Nursing Process—Evaluation
Content Area: Adult Health—Endocrine
Priority Concepts: Client Education; Glucose Regulation

30. B.

Rationale: Steroids can cause hyperglycemia because of their effects on carbohydrate metabolism, making diabetic control more difficult. Aspirin is not known to affect glucose metabolism. Sulfonylureas are oral hypoglycemic agents used in the treatment of diabetes mellitus. ACE inhibitors are not known to affect glucose metabolism.

Client Needs: Reduction of Risk Potential
Integrated Process: Application; Synthesis
Content Area: Adult Health- Endocrine
Priority Concepts: Infection Control
Reference: Burchum, Rosenthal (2016).

References

  1. Lisko, S. (2017). NCLEX-RN questions & answers made incredibly easy! (Seventh edition.).
    Philadelphia: Wolters Kluwer.
  2. Nettina, S. (2019). Lippincott Manual of Nursing Practice (11th ed.). Lippincott, Williams &
    Wilkins.
  3. Silvestri, L. A., & Silvestri, A. E. (2020). Saunders comprehensive review for the NCLEX-RN
    examination (Eighth edition.). St. Louis, Missouri: Elsevier.

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