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The nurse administers a combination of regular insulin and NPH insulin subcutaneously to a client at 0800. At which time should the nurse initially assess the client for hypoglycemia based on the peaks of the medications?
- A. 830
- B. 1000
- C. 1200
- D. 1400
Correct Answer: B
Rationale: Regular insulin peaks at 2-4 hours (1000-1200), and NPH peaks at 4-12 hours. Initial hypoglycemia risk is highest around 1000 due to regular insulin's peak effect.
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The nurse is assessing a client with a myxedema coma. Which of the following would be an expected finding?
- A. Glucose 59 mg/dL (3.28 mmol/L) [70-110 mg/d, 4.0-6.0 mmol/L]
- B. Sodium 155 mEq/L (mmol/L) [135-145 mEq/L, mmol/L]
- C. Serum pH 7.49 [7.35-7.45]
Correct Answer: A
Rationale: Myxedema coma, a severe hypothyroid state, can cause hypoglycemia due to reduced metabolism. Hypernatremia and alkalosis are not typical; hyponatremia and acidosis are more common.
The nurse is evaluating the treatment plan for a client with type II diabetes mellitus. Select the findings in the nurses' note that indicate that the client is not meeting the treatment goals
- A. The client presents for a routine follow-up after being diagnosed with diabetes mellitus type II.
- B. The most recent hemoglobin A1C was 7.6%.
- C. A weight gain of three kilograms was noted.
- D. The client reports a painless ulcer on the right anterior ankle.
- E. The client stated he stopped walking barefoot.
- F. The client requested a referral for a diabetic cooking class.
Correct Answer: B, C, D
Rationale: HbA1C of 7.6% exceeds the target (<7%), indicating poor control. Weight gain and a painless ulcer suggest complications like poor circulation or neuropathy. Stopping barefoot walking and requesting classes are positive steps.
The nurse has instructed a client scheduled for an injection of dulaglutide for diabetes mellitus (type two). Which of the following statements by the client would require follow-up?
- A. I should tell my doctor if I experience abdominal pain and vomiting.
- B. I should take this medication within one hour of eating a meal.
- C. If this medication works, I should notice a reduction in my hemoglobin A1C (HbA1c).
- D. I will receive this medication once a week.
Correct Answer: B
Rationale: Dulaglutide, a GLP-1 agonist, is taken weekly regardless of meals, not within one hour of eating. Abdominal pain/vomiting should be reported, HbA1c reduction is expected, and weekly dosing is correct.
The nurse is reviewing endocrine disorders with a group of students. It would be correct for the nurse to identify which manifestation is associated with hyperthyroidism?
- A. Injected (red) conjunctiva
- B. Insomnia
- C. Increased systolic blood pressure
- D. Diaphoresis
- E. Confusion
Correct Answer: B, C, D
Rationale: Hyperthyroidism increases metabolism, causing insomnia, elevated systolic BP, and sweating (diaphoresis). Red conjunctiva and confusion are not typical features of this condition.
The nurse is caring for a client suspected of having an endocrine disorder. Based on the client's laboratory data, the nurse is at the highest risk for which condition? See the exhibit.
- A. syndrome of inappropriate antidiuretic hormone (SIADH)
- B. diabetes insipidus (DI)
- C. cushing's syndrome/disease
- D. adrenal insufficiency
Correct Answer: C
Rationale: Without specific lab data, Cushing's is a common suspect in endocrine disorders with weight gain, hyperglycemia, and hypertension. SIADH, DI, and adrenal insufficiency require specific lab patterns (e.g., sodium, urine output).