A client was recently admitted with a diagnosis of diabetes mellitus. The nurse notices that the client has polyphagia, polydipsia, and oliguria. He also complains of headache and malaise, with a fingerstick glucose of 1000. Assessment reveals poor skin turgor and other signs of dehydration. Labs reveal hypokalemia, negative ketones, and elevated BUN. Which diagnosis could be made?

Hyperosmolar hyperglycemic nonketotic syndrome (HHNS).

Diabetic ketoacidosis.

Diabetic neuropathy.

Diabetic nephropathy.

Answer and Explanation

The Correct Answer is A

Choice A rationale: Hyperosmolar hyperglycemic nonketotic syndrome (HHNS) is characterized by extremely high blood glucose levels (often over 600 mg/dL), severe dehydration, and altered mental status. The presence of negative ketones differentiates it from diabetic ketoacidosis. The body's remaining insulin production is enough to prevent ketosis but not enough to control severe hyperglycemia.
Choice B rationale: Diabetic ketoacidosis (DKA) is a severe complication characterized by hyperglycemia, dehydration, and the presence of ketones in the blood and urine. The client's lab results in this scenario specifically state "negative ketones," which rules out DKA as the primary diagnosis. Fruity breath would also be present in DKA.
Choice C rationale: Diabetic neuropathy is a long-term complication of diabetes that affects the nerves, leading to symptoms like numbness, tingling, or pain. It is a chronic condition and does not manifest with the acute metabolic crisis of extremely high blood glucose (1000 mg/dL), dehydration, and malaise described in the scenario.
Choice D rationale: Diabetic nephropathy is a chronic complication affecting the kidneys, characterized by progressive kidney damage and eventual kidney failure. While elevated BUN can be a sign, the acute presentation with extremely high glucose and dehydration is more indicative of a life-threatening metabolic emergency like HHNS rather than chronic organ damage.

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Correct Answer is A

Explanation

Choice A rationale: For a young adult with newly diagnosed type 1 diabetes mellitus, annual eye examinations by an ophthalmologist are recommended starting five years after the diagnosis. The risk of diabetic retinopathy, a microvascular complication, increases over time with chronic hyperglycemia. Therefore, maintaining a regular schedule for eye exams is crucial for early detection and management of vision changes.
Choice B rationale: This statement is incorrect as it suggests waiting for a vision problem to develop or until a later age. Regular, proactive screening is essential for managing diabetes. Diabetic retinopathy often progresses without noticeable symptoms in its early stages, so waiting for a change in vision can lead to delayed treatment and more significant damage.
Choice C rationale: This statement is inaccurate because while vision can be affected, it does not necessarily change quickly in the early stages. The recommendation for annual or even more frequent exams is based on the duration of diabetes and the presence of any complications, not an assumption of rapid change. For a newly diagnosed client, the standard is annual exams after a few years.
Choice D rationale: This statement is dangerously incorrect. Chronic hyperglycemia is a major risk factor for several eye diseases, including diabetic retinopathy, cataracts, and glaucoma. All clients with diabetes, regardless of age or how well-controlled their blood sugar is, are at risk for these complications and require regular, scheduled eye examinations to monitor for early signs of damage.

Correct Answer is ["3.2"]

Explanation

Step 1:

80 mg ÷ 125 mg × 5 mL = 3.2 mL.

The nurse will administer 3.2 mL

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Naxlex Comprehensive Predictor Exams

After teaching a young adult client who is newly diagnosed with type 1 diabetes mellitus, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the need for eye examinations?

Correct Answer is A

Explanation

The physician orders Dilantin oral suspension 80 mg po three times a day for seizures. The medication is supplied in 125 mg/5 mL. How many milliliters will the nurse administer?

Correct Answer is ["3.2"]

Explanation

A patient who has type 2 diabetes is scheduled for an oral endoscopy and has been NPO (nothing by mouth) since midnight. What is the best action by the nurse regarding the administration of her oral antidiabetic drugs?

The patient has 1000 mL ordered over 10 hours. Using an IV pump, how many milliliters per hour should the IV fluids be infused?

A nurse teaches a client with diabetes mellitus about sick day management. Which statement should the nurse include in this client's teaching?

After teaching a client who is recovering from a complete thyroidectomy, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional instruction?

Which of the following are complications of insulin therapy? (Select all that apply).

A 19-year-old woman has been diagnosed with hypothyroidism and has started thyroid replacement therapy with levothyroxine (Synthroid). After 6 months, she calls the nurse to say that she feels better and wants to stop the medication. Which response by the nurse is correct?

While assessing a client with Graves disease, the nurse notes that the client's temperature has risen 1 degree Fahrenheit. Which action should the nurse take first?