Diabetes, DKA, HHNS NCLEX REVIEW

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1. An 18-year-old female client, 52422tall, weigh-

2. Type 2 diabetes is a disor-
ing 113 kg, comes to the clinic for a non der usually occurring around
healing wound on her lower leg, which she the age of 40, but it is now
has had for two (2) weeks. Which disease being detected in children
process should the nurse suspect the client and young adults as a re-
has developed? sult of obesity and seden-
tary lifestyles. Non healing
1. Type 1 diabetes.' wounds are a hallmark sign
2. Type 2 diabetes. of type 2 diabetes.This client
3. Gestational diabetes. weighs 248.6 pounds and is
4. Acanthosis nigricans. short.

2. The client diagnosed with type 1 diabetes 3. This result parallels a

has a glycosylated hemoglobin (A1c) of serum blood glucose level
8.1%. Which interpretation should the nurse of approximately 180 to200
make based on this result? mg/dL. An A1c is a blood test
reflecting average blood glu-
1. This result is below normal levels. cose levels over a period of
2. This result is within acceptable levels. three (3) months; clients with
3. This result is above recommended levels. elevated blood glucose lev-
4. This result is dangerously high. els are at risk for developing
long-term complications.

3. The nurse administered 28 units of Humulin 1. Humulin N peaks in 6

N, an intermediate-acting insulin, to a clientto 8 hours, making the
diagnosed with type 1 diabetes at 1600. client at risk for hypoglycemia
Which intervention should the nurse imple- around midnight, which is
ment? why the client should receive
a bedtime snack.This snack
1. Ensure the client eats the bedtime snack. will prevent nighttime hypo-
2. Determine how much food the client ate glycemia.
at lunch.
3. Perform a glucometer reading at 0700.
4. Offer the client protein after administer-
ing insulin.

4. The client diagnosed with type 1 dia- Three (3) units.

betes is receiving Humalog, a rapid-acting The client's result is 189,
insulin,by sliding scale. The order reads which is between151 and
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 Diabetes, DKA, HHNS NCLEX REVIEW
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blood glucose level: <150, zero (0) units; 200, so the nurse should ad-
151 to 200,three (3) units; 201 to 250, six minister3 units of Humalog in-
(6) units; >251, contact health-care provider. sulin subcutaneously
The UAP reports to the nurse the client's
glucometer reading is 189. How much in-
sulin should the nurse administer to the
client?

5. The nurse is discussing the importance of 4. All clients who exercise

exercising with a client diagnosed with type should perform warmup and
2 diabetes whose diabetes is well controlled cool-down exercises to help
with diet and exercise. Which information prevent muscle strain and in-
should the nurse include in the teaching jury.
about diabetes?

1. Eat a simple carbohydrate snack before

exercising.
2. Carry peanut butter crackers when exer-
cising.
3. Encourage the client to walk 20 minutes
three (3) times a week.
4. Perform warm up and cool-down exercis-
es.

6. The nurse is assessing the feet of a client 3.A necrotic big toe indi-
with long-term type 2 diabetes. Which as- cates "dead" tis-sue. The
sessment data warrant immediate interven- client does not feel pain, does
tion by the nurse? not realize the injury, and
does not seek treatment. In-
1. The client has crumbling toenails. creased blood glucose levels
2. The client has athlete's foot. decrease the oxygen supply
3. The client has a necrotic big toe. needed to heal the wound
4. The client has thickened toenails. and increase the risk for de-
veloping an infection

7. The home health nurse is completing the 1. Age-related visual changes

admission assessment for a 76-year-old and diabetic retinopathy
client diagnosed with type 2 diabetes con- could cause the client to have
trolled with 70/30 insulin. Which interven- difficulty in reading and draw-

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 Diabetes, DKA, HHNS NCLEX REVIEW
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tion should be included in the plan of care? ing up insulin dosage accu-
rately.
1. Assess the client's ability to read small
print.
2. Monitor the client's serum PT level.
3. Teach the client how to perform a hemo-
globin A1c test daily.
4. Instruct the client to check the feet week-
ly.

8. The client with type 2 diabetes controlled 2.Biguanide medication must

with biguanide oral diabetic medication is be held for a test with contrast
scheduled for a (CT) scan with contrast of medium because it increas-
the abdomen to evaluate pancreatic func- es the risk of lactic acido-
tion. Which intervention should the nurse sis,which leads to renal prob-
implement? lems.

1. Provide a high-fat diet 24 hours prior to

test.
2. Hold the biguanide medication for 48
hours prior to test.
3. Obtain an informed consent form for the
test
.4. Administer pancreatic enzymes prior to
the test.

9. The diabetic educator is teaching a class on 1, 2, 5

diabetes type 1 and is discussing sick-day
rules. Which interventions should the di- 1.The most important issue to
abetes educator include in the discus- teachclients is to take insulin
sion?Select all that apply. even if they areunable to eat.
Glucose levels are in-creased
1. Take diabetic medication even if unable to with illness and stress.
eat the client's normal diabetic diet.
2. If unable to eat, drink liquids equal to the 2.The client should drink liq-
client's normal caloric intake. uids such asregular cola or
3. It is not necessary to notify the orange juice, or eat reg-
health-care provider if ketones are in the ular gelatin, which provide
urine. enoughglucose to prevent hy-

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 Diabetes, DKA, HHNS NCLEX REVIEW
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4. Test blood glucose levels and test urine poglycemia whenreceiving in-
ketones once a day and keep a record. sulin.
5. Call the health-care provider if glucose
levels are higher than 180 mg/dL. 5.The HCP should be noti-
fied if the bloodglucose level
is this high. Regular insulin-
may need to be prescribed to
keep theblood glucose level
within acceptablerange

10. The client received 10 units of Humulin R, a 3. Regular insulin peaks in

fast-acting insulin, at 0700. At 1030 the UAP 2 to 4 hours.Therefore, the
tells the nurse the client has a headache and nurse should think about the
is really acting "funny." Which intervention possibility the client is hav-
should the nurse implement first? ing a hypoglycemic reaction
and should assess the client.
1. Instruct the UAP to obtain the blood glu- The nurse should not dele-
cose level. gate nursing tasks to a UAP if
2. Have the client drink eight (8) ounces of the client is unstable.
orange juice.
3. Go to the client's room and assess the
client for hypoglycemia.
4. Prepare to administer one (1) ampule 50%
dextrose intravenously.

11. The nurse at a free standing health care 2.Client advocacy focuses
clinic is caring for a 56-year-old male clientsupport on theclient's auton-
who is homeless and is a type 2 diabetic omy. Even if the nursedis-
controlled with insulin. Which action is an agrees with his living on the
example of client advocacy? street,it is the client's right. Ar-
ranging for someone to give
1. Ask the client if he has somewhere he can him his insulin provides for his
go and live. needs and allows hischoices
2. Arrange for someone to give him insulin
at a local homeless shelter.
3. Notify Adult Protective Services about
the client's situation.
4. Ask the HCP to take the client off insulin
because he is homeless.

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12. The nurse is developing a care plan for the 1.The short-term goal must
client diagnosed with type 1 diabetes.The address the response part of
nurse identifies the problem "high risk for the nursing diagnosis,which
hyperglycemia related to non compliance is "high risk for hyper-
with the medication regimen." Which state- glycemia,"and this blood glu-
ment is an appropriate short-term goal for cose level is within acceptable
the client? ranges for a client who is non
compliant.
1. The client will have a blood glucose level
between 90 and 140 mg/dL.
2. The client will demonstrate appropriate
insulin injection technique.
3. The nurse will monitor the client's blood
glucose levels four (4) times a day.
4. The client will maintain normal kidney
function with 30-mL/hr urine output.

13. The client diagnosed with type 2 diabetes is 3.Dry mucous membranes
admitted to the intensive care unit with hy- are a result of the hyper-
perosmolar hyperglycemic nonketonic syn- glycemia and occur with both
drome (HHNS) coma. Which assessment HHNS and DKA.
data should the nurse expect the client to
exhibit?
1. Kussmaul's respirations.
2. Diarrhea and epigastric pain.
3. Dry mucous membranes.
4. Ketone breath odor.

14. The elderly client is admitted to the inten- 1.The initial fluid replacement
sive care department diagnosed with se- is 0.9%normal saline (an iso-
vere HHNS. Which collaborative interven- tonic solution) intravenously,
tion should the nurse include in the plan of followed by 0.45% saline.The
care? rate depends on the client's
1. Infuse 0.9% normal saline intravenously. fluid volume status and phys-
2. Administer intermediate-acting insulin. ical health, especially of the
3. Perform blood glucometer checks daily. heart.
4. Monitor arterial blood gas results.

15.

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Which electrolyte replacement should the 2.The client in DKA los-
nurse anticipate being ordered by the- es potassium fromincreased
health-care provider in the client diagnosed urinary output, acidosis,
with DKA who has just been admitted tothe cata-bolic state, and vom-
ICU? iting. Replacementis essen-
tial for preventing cardiac
1. Glucose. dys-rhythmias secondary to
2. Potassium. hypokalemia
3. Calcium.
4. Sodium

16. The client diagnosed with HHNS was ad- 4. When the glucose lev-
mitted yesterday with a blood glucose level el is decreased to around
of 780 mg/dL. The client's blood glucose 300 mg/dL, the regular in-
level is now 300 mg/dL. Which intervention sulin infusion therapy is de-
should the nurse implement? creased. Subcutaneous in-
sulin will be administered per
1. Increase the regular insulin IV drip. sliding scale.
2. Check the client's urine for ketones.
3. Provide the client with a therapeutic dia-
betic meal.
4. Notify the HCP to obtain an order to de-
crease insulin.

17. The client diagnosed with type 1 diabetes is
found lying unconscious on the floor of the
bathroom. Which intervention should the
nurse implement first?
1. Administer 50% dextrose IVP.
2. Notify the health-care provider.
3. Move the client to the ICU.
4. Check the serum glucose level.
1. The nurse should assume
the client is hypoglycemic
and administer IVP dextrose,
which will rouse the client im-
mediately. If the collapse is
the result of hyperglycemia,
this additional dextrose will
not further injure the client.

18. Which assessment data indicate the client 2.The client's level of con-
diagnosed with diabetic ketoacidosis is re- sciousness can be altered be-
sponding to the medical treatment? cause of dehydration and aci-
dosis. If the client's sensorium
1. The client has tented skin turgor and dry is intact, the client is getting

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mucous membranes. better and responding to the
2. The client is alert and oriented to date, medical treatment.
time, and place.
3. The client's ABG results are pH 7.29,
PaCO2 44, HCO315.
4. The client's serum potassium level is 3.3
mEq/L.

19. The UAP on the medical floor tells the nurse 2. The client will not be com-
the client diagnosed with DKA wants some- pliant with the diet if he or she
thing else to eat for lunch. Which interven- is still hungry.Therefore, the
tion should the nurse implement? nurse should request the di-
etitian talk to the client to try to
1. Instruct the UAP to get the client addition- adjust the meals so the client
al food. will adhere to the diet.
2. Notify the dietitian about the client's re-
quest.
3. Request the HCP increase the client's
caloric intake.
4. Tell the UAP the client cannot have any-
thing else.

20. The emergency department nurse is caring 3. The most common precip-
for a client diagnosed with HHNS who has itating factoris infection. The
a blood glucose of 680 mg/dL. Which ques- manifestations may beslow
tion should the nurse ask the client to deter- to appear, with onset rang-
mine the cause of this acute complication? ingfrom 24 hours to 2 weeks

1. "When is the last time you took your in-

sulin?"
2. "When did you have your last meal?"
3. "Have you had some type of infection
lately?"
4. "How long have you had diabetes?"

21. The nurse is discussing ways to prevent 3.Illness increases blood glu-
diabetic keto acidosis with the client diag- cose levels;therefore, the
nosed with type 1 diabetes. Which instruc- client must take insulinand
tion is most important to discuss with the consume high-carbohydrate

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 Diabetes, DKA, HHNS NCLEX REVIEW
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client? foodssuch as regular Jell-O,
regular popsi-cles, and or-
1. Refer the client to the American Diabetes ange juice
Association.
2. Do not take any over-the-counter medica-
tions.
3. Take the prescribed insulin even when
unable to eat because of illness.
4. Explain the need to get the annual flu and
pneumonia vaccines.

22. The charge nurse is making client assign- 3. Multifocal PVCs, which are
ments in the intensive care unit. Which secondary to hypokalemia
client should be assigned to the most expe- and can occur in clients
rienced nurse? with DKA, are a potential-
ly life-threatening emergency.
1. The client with type 2 diabetes who has a This client needs an experi-
blood glucose level of 348 mg/dL. enced nurse.
2. The client diagnosed with type 1 diabetes
who is experiencing hypoglycemia.
3. The client with DKA who has multifocal
premature ventricular contractions.
4. The client with HHNS who has a plasma
osmolarity of 290 mOsm/L.

23. Which arterial blood gas results should the 4.This ABG indicates meta-
nurse expect in the client diagnosed with bolic acidosis,which is ex-
diabetic ketoacidosis? pected in a client diagnosed-
with diabetic ketoacidosis.
1. pH 7.34, PaO299, PaCO2 48, HCO324.
2. pH 7.38, PaO295, PaCO240, HCO322.
3. pH 7.46, PaO285, PaCO230, HCO326.
4. pH 7.30, PaO290, PaCO230, HCO318.

24. The client is admitted to the ICU diagnosed 1, 2, 3, 4, 5

with DKA. Which interventions shouldthe
nurse implement? Select all that apply.

1. Maintain adequate ventilation.

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 Diabetes, DKA, HHNS NCLEX REVIEW
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2. Assess fluid volume status.
3. Administer intravenous potassium.
4. Check for urinary ketones.
5. Monitor intake and output.

25. A client is brought to the emergency de- 3

partment in an unresponsive state, and a
diagnosis of hyperglycemic hyperosmolar The primary goal of treatment
state (HHS) is made. The nurse would imme- in hyperglycemic hyperosmo-
diately prepare to initiate which anticipated
lar state (HHS) is to rehy-
health care provider's prescription drate the client to restore fluid
volume and to correct elec-
1.Endotracheal intubation trolyte deficiency. Intravenous
2.100 units of NPH insulin fluid replacement is similar to
3.Intravenous infusion of normal saline that administered in diabetic
4.Intravenous infusion of sodium bicarbon- ketoacidosis (DKA) and be-
ate gins with IV infusion of nor-
mal saline. Regular insulin,
not NPH insulin, would be ad-
ministered. The use of sodium
bicarbonate to correct acido-
sis is avoided because it can
precipitate a further drop in
serum potassium levels. Intu-
bation and mechanical venti-
lation are not required to treat
HHS.

26. A client with a diagnosis of diabetic ketoaci- 356

dosis (DKA) is being treated in the emer-
gency department. Which findings would In DKA, the arterial pH is
the nurse expect to note as confirming this lower than 7.35, plasma bi-
diagnosis? Select all that apply. carbonate is lower than 15
mEq/L, the blood glucose lev-
1 Increase in pH el is higher than 250 mg/dL,
2.Comatose state and ketones are present in
3.Deep, rapid breathing the blood and urine. The
4.Decreased urine output client would be experienc-
ing polyuria, and Kussmaul's

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5.Elevated blood glucose level respirations (deep and rapid
6.Low plasma bicarbonate level breathing pattern) would be
present. A comatose state
may occur if DKA is not treat-
ed, but coma would not con-
firm the diagnosis.

27. The nurse teaches a client with diabetes 236

mellitus about differentiating between hy-
poglycemia and ketoacidosis. The client Shakiness, palpitations, and
demonstrates an understanding of the lightheadedness are signs of
teaching by stating that a form of glucose hypoglycemia and would indi-
should be taken if which symptoms devel- cate the need for food or glu-
op? Select all that apply cose. Polyuria, blurred vision,
and a fruity breath odor are
1.Polyuria signs of hyperglycemia.
2.Shakiness
3.Palpitations
4.Blurred vision
5.Lightheadedness
6.Fruity breath odor

28. A client is admitted to a hospital with a 3

diagnosis of diabetic ketoacidosis (DKA).
The initial blood glucose level was 950 During management of DKA,
mg/dL. A continuous intravenous infusion when the blood glucose level
of short-acting insulin is initiated, along falls to 250 to 300 mg/dL, the
with intravenous rehydration with normal infusion rate is reduced and
saline. The serum glucose level is now 240 a dextrose solution is added
mg/dL. The nurse would next prepare to ad- to maintain a blood glucose
minister which item? level of about 250 mg/dL, or
until the client recovers from
1.Ampule of 50% dextrose ketosis. Fifty percent dextrose
2.NPH insulin subcutaneously is used to treat hypoglycemia.
3.Intravenous fluids containing dextrose NPH insulin is not used to
4.Phenytoin (Dilantin) for the prevention of treat DKA. Phenytoin (Dilan-
seizures tin) is not a usual treatment
measure for DKA.

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