Saunders NCLEX (DM) Qs
The nurse is caring for a client with a diagnosis of diabetic ketoacidosis (DKA). Which assessment
findings are consistent with this diagnosis? Select all that apply.
1. Polyuria
2. Polydipsia
3. Polyphagia
4. Dry mouth
5. Flushed, dry skin
6. Moist mucous membranes
Rationale:
Clinical manifestations of DKA include polyuria (frequent urination); polydipsia (excessive thirst); polyphagia
(excessive hunger); dry mouth; and flushed, dry skin. The client with DKA experiences dehydration.
The emergency department nurse is reviewing the laboratory test results for a client suspected of
having diabetic ketoacidosis (DKA). Which laboratory result should the nurse expect to note in this
disorder?
1 Serum pH of 9.0
.
2 Absent ketones in the urine
.
3 Serum bicarbonate of 22 mEq/L (22 mmol/L)
.
4 Blood glucose level of 500 mg/dL (28.5 mmol/L)
.
Rationale:
In the client with DKA, the nurse should expect to note blood glucose levels between
350 and 1500 mg/dL (20 and 85.7 mmol/L), ketonuria, serum pH less than 7.35, and
serum bicarbonate less than 15 mEq/L (15 mmol/L).
A client with type 2 diabetes mellitus is complaining of polydipsia, polyuria,
weight loss, and weakness. Laboratory results indicate a blood glucose level of
800 mg/dL (45.7 mmol/L) and nonketosis. The nurse reviews the health care
provider's documentation and expects to note which diagnosis?
1. Hypoglycemia
2. Pheochromocytoma
, 3. Diabetic ketoacidosis (DKA)
4. Hyperosmolar hyperglycemic syndrome (HHS)
A client is admitted to the hospital with a diagnosis of pheochromocytoma. The nurse would check
which item to detect the primary manifestation of this disorder?
1. Weight
2. Urine ketones
3. Blood pressure
4. Skin temperature
A client newly diagnosed with diabetes mellitus is started on a 2-dose insulin protocol combination of
short- and intermediate-acting insulin injected twice daily. What portion of the total dose is given
before breakfast, and what portion is given before the evening meal?
1. Half before breakfast and half before the evening meal
2. Two thirds before breakfast and one third before the evening meal
3. One third before breakfast and two thirds before the evening meal
4. Three fourths before breakfast and one fourth before the evening meal
The nurse is providing instructions regarding insulin administration for a client newly diagnosed with diabetes
mellitus. The health care provider has prescribed a mixture of NPH insulin and regular insulin. The nurse
should instruct the client that which is the first step in this procedure?
1. Draw up the correct dosage of NPH insulin into the syringe.
2. Draw up the correct dosage of regular insulin into the syringe.
3. Inject air equal to the amount of NPH insulin prescribed into the vial of NPH
insulin.
4. Inject air equal to the amount of regular insulin prescribed into the vial of regular
insulin.
Rationale:
The initial step in preparing an injection of insulin that is a mixture of NPH and regular insulin is to inject air
into the NPH insulin bottle equal to the amount of insulin prescribed. The client would then be instructed to
inject an amount of air equal to the amount of prescribed insulin into the regular insulin bottle. The regular
insulin would then be withdrawn, followed by the NPH insulin. Contamination of regular insulin with NPH
insulin will convert part of the regular insulin into a longer acting form.
, The home care nurse is visiting a client newly diagnosed with diabetes mellitus. The client tells the
nurse that he is planning to eat dinner at a local restaurant this week. The client asks the nurse if eating
at a restaurant will affect diabetic control and if this is allowed. Which nursing response is most
appropriate?
1. "You are not allowed to eat in restaurants."
2. "You should order a half-portion meal and have fresh fruit for dessert."
3. "If you plan to eat in a restaurant, you need to skip the lunchtime meal."
4. "You should increase your daily dose of insulin by half on the day that you plan to
eat in the restaurant."
A client is brought to the emergency department in an unresponsive state, and a diagnosis of
hyperosmolar hyperglycemic syndrome is made. The nurse would immediately prepare to initiate
which anticipated health care provider's prescription?
1. Endotracheal intubation
2. 100 units of NPH insulin
3. Intravenous infusion of normal saline
4. Intravenous infusion of sodium bicarbonate
Rationale:
The primary goal of treatment in hyperosmolar hyperglycemic syndrome (HHS) is to rehydrate the client to
restore fluid volume and to correct electrolyte deficiency.
Intravenous (IV) fluid replacement is similar to that administered in diabetic ketoacidosis (DKA) and begins
with IV infusion of normal saline. Regular insulin, not NPH insulin, would be administered.
The use of sodium bicarbonate to correct acidosis is avoided because it can precipitate a further drop in
serum potassium levels.
Intubation and mechanical ventilation are not required to treat HHS.
A client is admitted with suspected diabetic ketoacidosis (DKA). Which clinical
manifestations best support a diagnosis of DKA?
1. Blood glucose 500 mg/dL (27.8 mmol/L); arterial blood gases: pH 7.30, PaCo 2 50,
HCO3– 26.
2. Blood glucose 400 mg/dL (22.2 mmol/L); arterial blood gases: pH 7.38, PaCo 2 40,
HCO3– 22.
3. Blood glucose 450 mg/dL (25.0 mmol/L); arterial blood gases: pH 7.48, PaCo 2 39,
The nurse is caring for a client with a diagnosis of diabetic ketoacidosis (DKA). Which assessment
findings are consistent with this diagnosis? Select all that apply.
1. Polyuria
2. Polydipsia
3. Polyphagia
4. Dry mouth
5. Flushed, dry skin
6. Moist mucous membranes
Rationale:
Clinical manifestations of DKA include polyuria (frequent urination); polydipsia (excessive thirst); polyphagia
(excessive hunger); dry mouth; and flushed, dry skin. The client with DKA experiences dehydration.
The emergency department nurse is reviewing the laboratory test results for a client suspected of
having diabetic ketoacidosis (DKA). Which laboratory result should the nurse expect to note in this
disorder?
1 Serum pH of 9.0
.
2 Absent ketones in the urine
.
3 Serum bicarbonate of 22 mEq/L (22 mmol/L)
.
4 Blood glucose level of 500 mg/dL (28.5 mmol/L)
.
Rationale:
In the client with DKA, the nurse should expect to note blood glucose levels between
350 and 1500 mg/dL (20 and 85.7 mmol/L), ketonuria, serum pH less than 7.35, and
serum bicarbonate less than 15 mEq/L (15 mmol/L).
A client with type 2 diabetes mellitus is complaining of polydipsia, polyuria,
weight loss, and weakness. Laboratory results indicate a blood glucose level of
800 mg/dL (45.7 mmol/L) and nonketosis. The nurse reviews the health care
provider's documentation and expects to note which diagnosis?
1. Hypoglycemia
2. Pheochromocytoma
, 3. Diabetic ketoacidosis (DKA)
4. Hyperosmolar hyperglycemic syndrome (HHS)
A client is admitted to the hospital with a diagnosis of pheochromocytoma. The nurse would check
which item to detect the primary manifestation of this disorder?
1. Weight
2. Urine ketones
3. Blood pressure
4. Skin temperature
A client newly diagnosed with diabetes mellitus is started on a 2-dose insulin protocol combination of
short- and intermediate-acting insulin injected twice daily. What portion of the total dose is given
before breakfast, and what portion is given before the evening meal?
1. Half before breakfast and half before the evening meal
2. Two thirds before breakfast and one third before the evening meal
3. One third before breakfast and two thirds before the evening meal
4. Three fourths before breakfast and one fourth before the evening meal
The nurse is providing instructions regarding insulin administration for a client newly diagnosed with diabetes
mellitus. The health care provider has prescribed a mixture of NPH insulin and regular insulin. The nurse
should instruct the client that which is the first step in this procedure?
1. Draw up the correct dosage of NPH insulin into the syringe.
2. Draw up the correct dosage of regular insulin into the syringe.
3. Inject air equal to the amount of NPH insulin prescribed into the vial of NPH
insulin.
4. Inject air equal to the amount of regular insulin prescribed into the vial of regular
insulin.
Rationale:
The initial step in preparing an injection of insulin that is a mixture of NPH and regular insulin is to inject air
into the NPH insulin bottle equal to the amount of insulin prescribed. The client would then be instructed to
inject an amount of air equal to the amount of prescribed insulin into the regular insulin bottle. The regular
insulin would then be withdrawn, followed by the NPH insulin. Contamination of regular insulin with NPH
insulin will convert part of the regular insulin into a longer acting form.
, The home care nurse is visiting a client newly diagnosed with diabetes mellitus. The client tells the
nurse that he is planning to eat dinner at a local restaurant this week. The client asks the nurse if eating
at a restaurant will affect diabetic control and if this is allowed. Which nursing response is most
appropriate?
1. "You are not allowed to eat in restaurants."
2. "You should order a half-portion meal and have fresh fruit for dessert."
3. "If you plan to eat in a restaurant, you need to skip the lunchtime meal."
4. "You should increase your daily dose of insulin by half on the day that you plan to
eat in the restaurant."
A client is brought to the emergency department in an unresponsive state, and a diagnosis of
hyperosmolar hyperglycemic syndrome is made. The nurse would immediately prepare to initiate
which anticipated health care provider's prescription?
1. Endotracheal intubation
2. 100 units of NPH insulin
3. Intravenous infusion of normal saline
4. Intravenous infusion of sodium bicarbonate
Rationale:
The primary goal of treatment in hyperosmolar hyperglycemic syndrome (HHS) is to rehydrate the client to
restore fluid volume and to correct electrolyte deficiency.
Intravenous (IV) fluid replacement is similar to that administered in diabetic ketoacidosis (DKA) and begins
with IV infusion of normal saline. Regular insulin, not NPH insulin, would be administered.
The use of sodium bicarbonate to correct acidosis is avoided because it can precipitate a further drop in
serum potassium levels.
Intubation and mechanical ventilation are not required to treat HHS.
A client is admitted with suspected diabetic ketoacidosis (DKA). Which clinical
manifestations best support a diagnosis of DKA?
1. Blood glucose 500 mg/dL (27.8 mmol/L); arterial blood gases: pH 7.30, PaCo 2 50,
HCO3– 26.
2. Blood glucose 400 mg/dL (22.2 mmol/L); arterial blood gases: pH 7.38, PaCo 2 40,
HCO3– 22.
3. Blood glucose 450 mg/dL (25.0 mmol/L); arterial blood gases: pH 7.48, PaCo 2 39,
