Archer NCLEX Endocrine, DM, and Insulin - Live webinar. Archer Review, a comprehensive reviewer for NCLEX-RN and NCLEX-PN exams, is focused on making quality and comprehensive test prep affordable to every nurse worldwide. Combine these crash courses along with Archer's highly popular NCLEX Qbanks with 2500 Qs that have consistently achieved a 97% pass rate. This 3-hour Endocrinology, Diabetes, and insulin management crash course is one such webinar to shed light on one of the difficult and frequently tested topics on NCLEX. This is one of the several Archer content review crash courses to strengthen your concepts and face NCLEX more confidently. The idea of this webinar is to: 1. Go over all frequently tested NCLEX concepts in Endocrine disorders - Addison's, Cushing's, Thyroid, SIADH, Hyperparathyroidism, hypoglycemia, Diabetes, and Insulin management. 2. Endocrine diseases labs interpretation, Diabetes types/ concepts, insulin-related issues, diabetic diets, Client education, reduction of risk potential, and nursing interventions. 3. Provide you with challenge quizzes throughout the course after every class of disorders. You may actively participate by entering your answers or asking questions during Q and A sessions. Get your doubts clarified and understand concepts! COST: just $10

1. Endocrine
Archer NCLEX Review Crash
Course

2. Welcome!
● Please stay muted so that there is no background noise.
● If you have a question please enter it in the chat, or use the ‘raise hand’
feature, so that I can un-mute you and you can ask your question.
● We will be taking a 5-10 minute breaks as needed throughout the course.

3. Hormone -
Glucocorticoids, mineralocorticoids, and
sex hormones….
STEROIDS
Not enough steroids →
Addison’s disease
Too many steroids → Cushing's
disease

4. Steroids
● Produced by the adrenal cortex
● Glucocorticoids
○ Affect mood
○ Cause immunosuppression
○ Breakdown fats & proteins
○ Inhibit insulin
● Mineralocorticoids - aldosterone
○ Retention of sodium and water
○ Excretion of potassium
● Sex hormones - testosterone, estrogen, progesterone

5. Addison’s Disease

6. What is Addison’s Disease
● Adrenocortical insufficiency - not enough steroids
● Decreased glucocorticoids
○ Fatigue
○ Weight loss
○ Hypoglycemia
○ Confusion
● Decreased mineralocorticoids
○ Loss of sodium and water → hyponatremic, fluid volume deficit
○ Retention of potassium → hyperkalemic
○ Hypotension
● Decreased sex hormones

7. Assessment

8. Treatment
● Think SHOCK!
○ IV fluid administration
○ Increased sodium intake
● I&O
● Daily weight
● Replace steroids
○ Prednisolone
○ Fludrocordisone

9. NCLEX Question
A nurse knows that in the event of an Addisonian crisis, it is most appropriate
to administer which of the following medications intravenously?
a. Insulin
b. Normal saline solution
c. dextrose 5% in water
d. dextrose 5% in half-normal saline solution

10. Answer: B
One problem of a client in the Addisonian crisis is hyponatremia. The nurse
should, therefore, anticipate administering the standard saline solution.
Glucose, vasopressors, and hydrocortisone are also used to treat the
Addisonian crisis. It would be inappropriate to administer insulin, dextrose 5%
in water, or dextrose 5% in half-normal saline solution for this client. The
correct answer is option B, while options A, C, and D are incorrect.

11. Cushing’s Disease

12. What is Cushing’s Disease?
● Excess of steroids
● Body has too much glucocorticoids, mineralocorticoids and sex hormones
○ Glucocorticoids
■ Immunosuppression
■ Hyperglycemia
■ Mood alteration
■ Fat redistribution (excess glucocorticoids cause lipolysis of extremities and
lipogenesis in the trunk)
○ Mineralocorticoids
■ Fluid retention
■ Sodium retention
■ Potassium excretion
○ Sex hormones
■ Oily skin/acne

13. Assessment
● Think extremities
● Moon faced
● Truncal obesity
● Buffalo hump
● Hyperglycemia
● Immunosuppressed
● CHF
● Weight gain
● Fluid volume excess

14. Treatment
● Adrenalectomy
○ Remove the glands secreting the excess hormones
○ Can remove one or both
● Avoid infection
○ Patient is immunosuppressed
○ Hand washing
○ Limiting visitors

15. NCLEX Question
Your client is a patient with low potassium levels and accelerated
hypertension. The physician has listed the cause as "hyperaldosteronism."
Which of the following endocrine disorders cause an increased amount of
aldosterone? Select all that apply.
A. Cushing’s disease
B. Addison’s disease
C. Crohn's disease
D. Pheochromocytoma

16. Answer: A
Cushing's disease (Choice A) is caused by an increased secretion of adrenocorticotropic hormone (ACTH) from the pituitary
gland. Increased ACTH causes increased stimulation and hyperplasia of the adrenal cortex. This leads to increased levels of both
glucocorticoids(cortisol) and mineralocorticoids(aldosterone). The physician may order ACTH and Cortisol levels to establish the
diagnosis of Cushing's disease. Clinical symptoms include abdominal obesity, moon facies, neck hump, abdominal striae,
increased blood glucose, secondary diabetes, hypertension, and Hypokalemia. Other manifestations include Osteoporosis and
increased risk of fractures. Clients are prone to increased risk of infections because excess steroids (cortisol) cause
immunosuppression.
Choice B is incorrect. Addison's disease is autoimmune destruction of the adrenal cortex. The resulting adrenal insufficiency
would cause low levels of cortisol and aldosterone. There is a reflex increase in ACTH due to feedback from the Adrenal gland.
Clinical manifestations of Addison's disease include fatigue, diarrhea, hyperpigmentation, and hypotension (opposite of
hyperaldosteronism). Hypoaldosteronism can be associated with hyperkalemia (elevated potassium levels), hyponatremia (low
sodium levels), and mild metabolic acidosis.
Choice C is incorrect. Crohn's disease is a GI disorder involving inflammation of the digestive tract. It does not cause increased
aldosterone.
Choice D is incorrect. Pheochromocytoma is a tumor of Adrenal Medulla. Since medulla produces catecholamines, cancer
involving this area is associated with high levels of Adrenaline and Nor-adrenaline. Adrenal medulla does not produce
aldosterone. Therefore, secondary refractory hypertension in Pheochromocytoma is mediated by Catecholamine excess, not by
aldosterone excess.

17. Hormone -
Antidiuretic hormone
(ADH)
Not enough ADH → DI
Too much ADH → SIADH

18. Antidiuretic Hormone
● Secreted from the pituitary gland
● Pituitary gland is in the brain, between your eyeballs
● Be on the lookout for these issues if a patient had:
○ Craniotomy
○ Head injury
○ Sinus surgery
● Causes anti - diuresis - holding on to WATER
○ Only water is retained, so sodium!
○ Increased ADH → increased water
● Antidiuretic hormone = ADH = Vasopressin

19. Diabetes Insipidus
(DI)

20. What is Diabetes Insipidus?
● There is not enough ADH in the body
● Without ADH to tell the body to hold onto water, the kidneys produce
HUGE amounts of urine.
● This leads to fluid volume deficit
● Hypotension
● Shock

21. Assessment

22. Lab Values
● Urine = dilute
○ Decreased USG
○ Decreased urine osmolarity
● Blood = concentrated
○ Increased Serum Na
○ Increased serum osmolarity
○ Serum Hct > 40%

23. Treatment
● Monitor Neuro status
● Replace fluids
○ Monitory hourly UOP
○ Replace volume + MIVF
● Vasopressin
● DDAVP

24. NCLEX Question
Diabetes Insipidus is a potential complication of which of the following
procedures?
A. Surgical removal of the pituitary gland
B. Reduction of mass on the thyroid gland
C. Hysterectomy
D. Dilation and curettage

25. Answer: A
A is correct. Any surgery that is near the pituitary gland will present with the disk for
diabetes insipidus. This is because the posterior pituitary is the gland that regulates
antidiuretic hormone, and a decreased amount of ADH results in DI.
B is incorrect. A reduction of mass on the thyroid gland would not result in increased
risk for diabetes insipidus.
C is incorrect. A hysterectomy would not result in an increased risk for diabetes
insipidus.
D is incorrect. A dilation and curettage would not result in an increased risk for diabetes
insipidus.
NCSBN Client Need:
Topic: Physiological Integrity
Subtopic: Reduction of Risk Potential
Subject: Adult Health
Lesson: Endocrine
Reference: DeWit, S. C., & Williams, P. A. (2013). Fundamental concepts and skills for nursing. Elsevier Health Sciences.

26. Syndrome of Inappropriate Antidiuretic
Hormone Secretion
(SIADH)

27. What is SIADH?
● The body is making too much ADH
● With too much antidiuresis, the kidneys stop excreting water and HOLD
ON to it!
● Decreased UOP
● Hypervolemia
● Fluid volume excess

29. Assessment
● Fluid volume excess
○ JVD
○ Edema
○ Wet lung sounds
○ Hypertension
○ Weight gain
● Anorexia
● Nausea
● Vomiting
● Low serum sodium
○ Irritability
○ Confusion
○ Hallucinations
○ Seizures (Na < 125)

30. Lab Values
● Urine = concentrated
○ Increased USG
○ Increased urine sodium
○ Increased urine osmolarity
● Blood = dilute
○ Decreased Serum Na
○ Decreased serum osmolarity
○ Dilutional anemia

31. Treatment
● Monitor serum sodium
○ Sodium replacement
● Seizure precautions
● Fluid restriction
● Hypertonic saline
● Demeclocycline
○ Works to reduce the responsiveness of the collecting tubule cells to ADH

32. NCLEX Question
A client suddenly develops syndrome of inappropriate antidiuretic hormone
(SIADH) after undergoing cranial surgery. Which manifestations should the
nurse expect to see from the patient? Select all that apply.
a. Edema and weight gain
b. Decreased urine production
c. Hypotension
d. A low urine specific gravity

33. Answers: A and B
SIADH is an abnormal release of the antidiuretic hormone, which causes the
client to retain water abnormally. This leads to manifestations such as edema,
weight gain, and low urine output. Excessive urine production, low blood
pressure, and a little urine specific gravity are manifestations of Diabetes
insipidus.

34. BreakBack at….

35. Hormone -
Thyroid hormone
(T3 & T4)
Not enough thyroid hormone →
hypothyroidism
Too much thyroid hormone →
hyperthyroidism (Grave’s
Disease)

36. Thyroid hormone
● Produced by the thyroid gland
● There are two types: T3 and T4
● Thyroid hormones = energy

37. Hyperthyroidism

38. What is hyperthyroidism?
● Also known as Graves Disease
● The body has too much thyroid hormone
● Decreased levels of TSH
● Anterior pituitary see’s low TSH and signals to the Thyroid gland to secrete
more T3 and T4
● T3 and T4 continue to be secreted despite being high
● The negative feedback loop is broken
High T4 / Low TSH

40. Treatment
● Antithyroid - methimazole
○ Stops the thyroid from making T3 and T4
● Iodine compounds
○ Used to decrease the size and vascularity of the thyroid gland
● Radioactive Iodine therapy
○ Destroys thyroid cells
○ Can cause hypothyroidism
● Thyroidectomy
○ Removal of all or some of the thyroid gland

41. Hypothyroidism

42. What is hypothyroidism?
● The body does not have enough thyroid hormone
● Increased levels of TSH trying to signal the thyroid to make more T3 and
T4
● Thyroid gland cannot secrete enough T3 and T4 despite high TSH
● T3 and T4 continue to be low
● The negative feedback loop is broken
Low T4 / High TSH

44. Treatment
● Levothyroxine - thyroid hormone
○ Take on an empty stomach
○ Take at the same time every day
○ Will take this forever

45. NCLEX Question
Which of the following is most consistent with a patient who has
hypothyroidism?
A. Thin, anxious-appearing female with exophthalmos with rapid pulse and
complaints of diarrhea
B. Slightly obese, perspiring female who complains of feeling cold all the
time and frequent diarrhea
C. Thin, perspiring male with a hoarse voice, facial edema, and a thick
tongue with complaints of diarrhea
D. Slightly obese female with periorbital edema who complains of cold
intolerance, brittle hair, and dry skin

46. Answer: D
The correct answer is D. The patient with hypothyroidism would demonstrate clinical signs
and symptoms of a low metabolic rate resulting from the depletion of circulating thyroid
hormone.
A is incorrect. Exophthalmos may occur when hyperthyroidism is present.
B is incorrect. The patient is not likely to perspire, as lower than normal body temperature is
usually present.
C is incorrect. Constipation is a likely complaint among those with hypothyroidism.
NCSBN Client Need
Topic: Physiological Integrity
Subtopic: Physiological Adaptation
Resource: Fundamentals of Nursing 8th Edition (Wolters/Klewer)

47. Hormone -
Parathyroid Hormone
(PTH)
Not enough PTH →
Hypoparathyroidism
Too much PTH →
Hyperparathyroidism

48. Parathyroid Hormone
● Secreted by the parathyroid glands
● Causes calcium to be pulled out of the
bones and into the blood.
● Causes an increase in serum calcium.

49. Hypoparathyroidism

50. What is hypoparathyroidism?
● The parathyroid glands do not secrete enough PTH
● There are low serum calcium levels
● Low serum calcium levels cause high serum phosphorus levels

51. Assessment

52. Treatment
● Fix the electrolyte imbalances
○ Calcium replacement
○ Phosphorus binders

53. NCLEX Question
Which of the following statements are true regarding hypoparathyroidism?
Select all that apply.
A. Patients with hypoparathyroidism have decreased serum calcium levels.
B. Patients with hypoparathyroidism have increased serum phosphate
levels.
C. Hypoparathyroid patients are typically irritable and extremely agitated.
D. There is no cure for hyperparathyroidism.

54. Answer: A, B, and C
A is correct. The parathyroid secretes parathyroid hormone. Parathyroid hormone causes calcium
from the bones to be released into the serum, increasing serum calcium levels. So, when there is not
enough parathyroid hormone, patients are hypocalcemic.
B is correct. Calcium and phosphorus have an inverse relationship. Due to decreased levels of PTH
decreasing serum calcium, the phosphorus will then be increased. So, these patients are
hyperphosphatemic.
C is correct. Hypoparathyroidism leads to decreased serum calcium, which in turn leads to patients
being more agitated and irritable.
D is incorrect. The treatment for hypoparathyroidism is replacement of parathyroid hormone
NCSBN Client Need:
Topic: Physiological Integrity
Subtopic: Basic care, comfort
Reference: DeWit, S. C., Stromberg, H., &amp; Dallred, C. (2016). Medical-surgical nursing: Concepts &amp; practice. Elsevier Health Sciences.
Subject: Adult health
Lesson: Endocrine

55. Hyperparathyroidism

56. What is hyperparathyroidism?
● The parathyroid glands secrete too much PTH
● There are high serum calcium levels
● High serum calcium levels cause low serum phosphorus levels

57. Assessment

58. Treatment
● Partial parathyroidectomy
○ There are 6 parathyroid glands
○ Taking out 2 can decrease PTH secretion
○ Can cause rebound hypocalcemia if decreases too much

59. NCLEX Question
A patient was admitted to the ER due to low serum calcium levels. Upon
further examination, he demonstrates carpopedal spasms and reports
numbness in his lips and hands. An ECG was taken and revealed a prolonged
QT interval. Upon assessment of the client, the nurse should suspect which
condition?
a. Hyperthyroidism
b. Hypothyroidism
c. Hyperparathyroidism
d. Hypoparathyroidism

60. Answer: D
A is incorrect. Patients with Hyperthyroidism display a generalized metabolic excitement in almost all their body
systems. They can reveal heat intolerance, warm skin, insomnia, irritability, palpitations, tachycardia, diarrhea,
fatigue, and weight loss.
B is incorrect. Hypothyroidism results in a general metabolic depression of almost all body systems. The patient may
manifest low heart rate, low blood pressure, decreased urine output, constipation, shallow, slow respirations, muscle
weakness, diminished deep tendon reflexes, cold intolerance, and sometimes a decrease in body temperature.
C is incorrect. Symptoms of Hyperparathyroidism include a serum Calcium level of 10.9 mg/dL or higher. The patient
may also display neurological symptoms such as lethargy, fatigue, personality changes, paresthesia, severe stupor,
and even coma. GI symptoms would include dyspepsia, nausea, and constipation.
D is correct. Symptoms of Hypoparathyroidism mirror that of hypocalcemia. It manifests as numbness and tingling of
the lips and hands, tetany, carpopedal spasms (Trousseau's sign), Chvostek’s sign, muscle, and abdominal cramps.
ECG analysis may reveal a prolonged QT interval and T-wave abnormalities. Because of low serum calcium, serum
phosphorus levels may also be increased.

61. Hormone -
Insulin
Not enough Insulin → DM, DKA,
HHNS
Too much Insulin →
Hypoglycemia

62. Insulin
● Produced in the pancreas
○ 𝛃-islets of Langerhan
● Acts as the ‘key’ to transport
glucose from the bloodstream to
the cells
● Allows the cells to use glucose as
fuel
● Normal BG: 70-110

65. Diabetes Mellitus Type I

66. What is Diabetes Mellitus Type I?
● DMTI
● Autoimmune disease - or idiopathic
● Body has destroyed the beta cells of
the pancreas that produce insulin
● There is little or no insulin in the
body
● Very high levels of glucose in the
bloodstream
● No glucose can get to the cells for
fuel

67. Assessment
The Classic ‘3 P’s’
Polydipsia
Polyuria
Polyphagia

68. Lab Values
● Hyperglycemia
○ Fasting BG >126 times 2
● Elevated HgA1c
○ Above 6.5%
○ Goal for diabetics is <7%
○ Normal for a non-diabetic is < 5.5%

69. Treatment
INSULIN
● Basal bolus system
● Long-acting agent given once per day
● Short-acting agent given with meals to cover the cars eaten
● Regular insulin
○ Short acting
● NPH
○ Intermediate acting
● Glargine
○ Long acting

70. Insulin Peak and Onset Times
Type Generic
Name
Onset Peak Duration
Rapid-Acting Insulin
aspart
15 min 30-90 min 3-5 hrs
Insulin
lispro
15 min 30-90 min 3-5 hrs
Short-Acting Regular 30-60 min 2-4 hrs 6-8 hrs
Intermediate-
acting
NPH 1-2 hrs 6-14 hrs 16-24 hrs
Long-acting Glargine 1-2 hrs none 24 hrs

71. Insulin Storage
● Keep away from heat and direct sunlight
● Never freeze insulin
● Store in the refrigerator until ready for use
● When actively using, keep at room temperature
● At room temperature:
○ NPH: good for one month
○ Glargine: good for 28 days
○ Rapid and short acting: good for 28 days

72. Mixing Insulin
1. Draw up air equal to the total amount of insulin needed
2. Inject the correct amount of air into the NPH vial
3. Inject the remaining air into the regular insulin
4. Draw up the correct amount of regular insulin
5. Draw up the correct amount of NPH insulin
Clear, then cloudy (regular 1st, NPH 2nd!)
NEVER mix long-acting insulin

73. Insulin Administration
● Can only give Regular via IV
● All others given SubQ
● Rotate sites
● Syringes measured in units
● Never use expired or cloudy insulin
○ NPH is the only cloudy insulin

74. Subcutaneous injection sites

75. Injections

76. Diet
● Avoid simple sugars
● High protein
● Non-starchy veggies
● Whole grains
● Eat when insulin is at its peak
● Regular exercise routine
● Exercise after eating
● Monitor for hypoglycemia

77. Hypoglycemia
Diaphoretic
Cold sweats
Tachycardic
Restless
Hungry
Irritable
Trouble concentrating
Confusion
Shaking
Cool and clammy, need some CANDY
Hyperglycemia
Hot
Dry mouth
Thirsty
Weak
Headache
Frequent urination
Blurry vision
Nausea
Confusion
Dry and hot, needs an INSULIN SHOT

78. NCLEX Question
You are teaching a new group of nurses about insulin administration for the
client with type I diabetes mellitus. Which of the following points should you
include? Select all that apply.
A. It is important to wait for the client’s food tray to be delivered before
administering their glargine.
B. When drawing up different types of insulin in a syringe together. first
draw up regular insulin and then NPH.
C. You should teach patients to eat 1-2 hours after taking their regular
insulin.
D. Monitoring the HbA1c is very important. and patients with diabetes
should have a goal of less than 7%.

79. Answer: B and D
A is incorrect. Glargine, or Lantus, is a long-acting insulin. It has a length of action of 24 hours and does not have a peak.
Because of this, it is given just once a day and acts as the basal insulin for the client. Glargine can be provided in the morning or
evening, as long as the client takes it at the same time every day. Because there is no peak, glargine does not need to be timed
with meals, so you would not teach the new nurses to wait for the client's food before administration.
B is correct. This is an appropriate teaching point. Regular insulin is the standard insulin given IV. It is active for about 6 to 8
hours, and peaks in 2-4 hours. Regular insulin is clear. NPH insulin is considered intermediate-acting insulin. It is active for about
16-24 hours and peaks in 6-14 hours. NPH insulin is cloudy. It is safe to administer regular insulin and NPH insulin together in
the same syringe, but they must be drawn up correctly. You should teach the nurses first to draw up regular insulin, and then
draw up the NPH insulin.
C is incorrect. You should teach patients to eat 2-4 hours after taking their regular insulin. The peak of regular insulin is 2-4
hours, and we should teach patients to eat when insulin is at its peak level. This is because, when insulin is at its peak, blood
sugar is at its lowest. This is the most appropriate timing for regular insulin administration and meals.
D is correct. Monitoring of the HbA1c is incredibly vital in diabetic patients, and you should educate your patient about the need
to check this level at their doctor's appointments. Glycosylated Hemoglobin (HbA1c) shows the percentage of red blood cells
that have become saturated with hemoglobin. The higher this number is, the higher the patient's blood sugar has been over the
past 3-4 months. Anything higher than 6.5% indicates that the patient has diabetes. For patients with diagnosed diabetes, their
goal should be an HbA1c of less than 7%, and they should have it checked every 3-4 months.

80. BreakBack at….

81. Diabetic Ketoacidosis
(DKA)

82. What is Diabetic Ketoacidosis?
● There is no insulin to carry glucose to the cells
● Glucose builds up in the blood (High BG)
● Blood becomes hypertonic, causing fluid to shift into the vascular space.
● Kidneys work to filter this excess fluid and glucose - polyuria
● Cells are not receiving any fluid or glucose - they are starving - polydipsia &
polyphagia
● Because cells don’t have any glucose for energy, break down proteins and fat
● This produces ketones - which are an acid
● Causes a metabolic acidosis
○ Kidneys increase production of bicarb to compensate
○ Kussmaul respirations - to blow off CO2 to compensate
○ High serum potassium

83. Assessment

84. Lab results
● BG > 400
● pH < 7.35
● Bicarb < 22
● Positive urine ketones

85. Treatment
● Labs
○ Hourly BG and serum potassium
○ ABGs - evaluate the metabolic acidosis and look for resolution
● Fluids
○ Monitor output and prevent shock
○ NS used to start
○ When BG lowers to 250-300, D5W added to solution to prevent hypoglycemia
■ Blood sugar should be lowered slowly
■ Rapid drop will cause a shift of fluid into the cells and cerebral edema
● Insulin
○ Decrease the blood sugar
○ Drive potassium back into the cell

86. NCLEX Question
Your patient’s chart indicates she has a history of diabetic ketoacidosis. Which
of the following would you expect to see with this patient if her condition is
acute? Select All That Apply.
A. Vomiting
B. Extreme thirst
C. Weight gain
D. Acetone breath smell

87. Answer: A, B, and D
Diabetic ketoacidosis is a severe complication of diabetes that occurs when
the body produces high levels of ketones. Signs and symptoms often develop
quickly, sometimes within 24 hours. For some, these signs and symptoms may
be the first indication of having diabetes. Common symptoms include
excessive thirst, frequent urination, nausea and vomiting, abdominal pain,
weakness and fatigue, shortness of breath, fruit-scented breath,m, and
confusion.
The correct answers are A, B, and D.
C is incorrect. Weight loss would be expected, not weight gain.

88. Diabetes Mellitus Type II

89. What is Diabetes Mellitus Type II?
● There is either not enough insulin,
insulin resistance, or bad insulin
● Commonly found with patients who
are overweight.
● Their body can’t make enough
insulin to keep up with the glucose.
● The increased glucose in the blood
suppresses the immune system,
causes increased bacteria in the
blood, and decreases circulation.
● This is what causes long term
damage:
○ Poor wound healing
○ Frequent infections
○ Vision problems
○ Kidney problems

90. Assessment

92. Treatment
DIET
● Low carb - complex carbs
● Proteins & veggies
EXERCISE
● Eat before exercising
● Exercise when blood sugar is
at its highest
● Establish a routine
ORAL AGENTS
● Work to decrease the amount
of circulating glucose
● Improves how the body
produces insulin and uses
insulin
● Metformin
INSULIN

93. NCLEX Question
A patient newly diagnosed with type 2 diabetes mellitus is prescribed
metformin. The patient asks the nurse why he has prescribed the medication.
The nurses most appropriate response would be:
A. You no longer produce any insulin; you need that to lower your blood
sugar
B. Your body now only produces very little amount of insulin. You need that
to help lower your blood sugar
C. The physician noticed that you cannot administer your own insulin, so he
prescribed tablet for you.
D. This drug helps to increase your blood sugar levels

94. Answer: B
A is incorrect. Type I diabetics are unable to produce insulin, not type 2
diabetics.
B is correct. Metformin is an oral hyperglycemic agent. People with type 2
diabetes produce tiny amounts of insulin; that is why oral hyperglycemic
agents are prescribed to help lower their blood sugar. They work to decrease
the amount of circulating glucose and improve. how the body produces
insulin and uses insulin
C is incorrect. The client does not require insulin for his treatment.
D is incorrect. Metformin does not increase the patient’s blood sugar levels; it
lowers them.

95. Hyperosmolar Hyperglycemic Nonketotic
Syndrome (HHNS)

96. What is HHNS?
● Complication of type II diabetes
● Blood glucose elevated above 600
○ Usually around 1100
● NO breakdown of fats (therefore no ketosis or acidosis)
● Gradual onset

97. Assessment
● Altered LOC
● Dry mucous membranes
● Increased BUN/Cr
● Dehydration
Similar to DKA, but without the ketosis/acidosis

98. Treatment
● Determine the cause
● Replace fluids
● Insulin therapy
● Monitor electrolytes
● Treat electrolyte imbalances

99. NCLEX Question
You are working in the emergency department when a 52 year old male with a
history of Type II diabetes presents with an altered level of consciousness, and
dry mucous membranes. Which of the following lab values does the nurse
expect? Select all that apply.
A. BUN - 42
B. BG - 1184
C. pH - 7.1
D. Cr - 0.3

100. Answer:
A is correct. A BUN of 42 is elevated and would indicate dehydration as this
nurse expects.
B is correct. A BG of 1184 is extremely elevate as the nurse would expect in
HHNS. These patients typically present with blood sugars greater than 1100.
C is incorrect. A pH of 7.1 indicates acidosis, which is not present in HHNS. In
HHNH, the patient is making just enough insulin to prevent the body from
producing ketones, therefore there will be a normal pH.
D is incorrect. A Cr of 0.3 is normal. In HHNS the patient is extremely
dehydrated and the nurse would therefore expect the serum creatinine to be
elevated.

101. Hypoglycemia

102. What is Hypoglycemia?
● When there is not enough glucose in the bloodstream
● BG <70
● Causes
○ Not enough food
○ Too much insulin
○ Too much exercise
○ Sepsis

103. Assessment
● Cold
● Clammy
● Confused
● Shakey
● Nervous
● Nausea
● Headache
● Hungry

104. Treatment
1. Have a snack - about 15 grams of carbs
a. 4-6 oz of soda/juice/milk
b. 8-10 pieces of candy
2. Wait 15 minutes, and check BG again
3. If still <70, eat another 15 grams of carbs
4. After the BG rises, eat a snack with complex carb/protein to help keep the BG up
a. Crackers with peanut butter
What if the patient is unconscious?!
If IV access → push D50W
If no IV → IM Glucagon (catabolic hormone, raises concentration of glucose in the bloodstream)

105. NCLEX Question
While working on the pediatric floor, you are assigned to a 10-year old
diagnosed with Type I diabetes mellitus. Upon checking their AC glucose, it is
45. Place the following actions in the order that the nurse should perform
them:
A. Give the child a snack of crackers and peanut butter
B. Re-check the blood glucose level
C. Document the incident
D. Give the child one cup of orange juice

106. Answer: D, B, A, C
The priority action the nurse needs to perform after seeing that a patient is hypoglycemic is to
give the child one cup of orange juice. Juice has a high glucose content that is quickly available
to the body. Another option would be frosting in the patient's cheek.
After 15 minutes, the nurse should then recheck the blood glucose level to see if the sugar
has come up. If it has, then the nurse can proceed to the next step. If the sugar is still low, the
nurse should continue administering a source of glucose and re-checking the blood sugar
after 15 minutes until it is in the normal range.
The next priority nursing action is giving the child a snack of crackers and peanut butter. It is
essential to provide them with a meal containing some complex carbohydrates and protein,
as this will help maintain their blood glucose within normal limits instead of it dropping again.
Lastly, the nurse needs to document the incident, actions taken, and the patient’s response.

107. Wrap up
questions

108. NCLEX Question
Which of the following hormones are secreted by the thyroid gland? Select all
that apply.
A. Calcitonin
B. TSH
C. T3
D. Insulin

109. Answer: A and C
A is correct. The thyroid gland secretes calcitonin. Calcitonin is essential for the regulation of calcium in the body.
When released by the thyroid gland, it increases the amount of calcium that is deposited in the bones, therefore
decreasing the amount in the blood.
B is incorrect. The pituitary gland secretes Thyroid-stimulating hormone. This can be confusing since the word thyroid
is in the name, but the thyroid gland itself does not secrete TSH. Instead, this hormone is secreted by the pituitary
and then acts upon the thyroid gland. The more TSH is acting upon the thyroid gland, the less T3 and T4 that will be
released. This is why TSH levels are high in hypothyroidism. The less TSH is acting upon the thyroid gland, the more
T3 and T4 that will be secreted. This is why TSH is low in Graves Disease.
C is correct. Triiodothyronine, or T3, is secreted by the thyroid gland. T3 and T4 are the primary hormones secreted
by the thyroid gland. They act upon metabolism and speed up everything in the body. Their levels are low in
hypothyroidism and high in hyperthyroidism.
D is incorrect. Insulin is secreted by the pancreas. This is a complex hormone that helps regulate glucose levels in the
cells and bloodstream. Insulin transports glucose into the cells so that they may have the energy for metabolism. We
typically think of diabetes as the endocrine disorder that is associated with insulin.
NCSBN Client Need:
Topic: Physiological Integrity
Subtopic: Basic care, comfort:
Reference: DeWit, S. C., Stromberg, H., &amp; Dallred, C. (2016). Medical-surgical nursing: Concepts &amp; practice. Elsevier Health Sciences.
Subject: Adult health

110. NCLEX Question
The nurse is teaching a client that has been prescribed NPH insulin for his
diabetes. Which statement by the client indicates understanding regarding
NPH insulin storage?
A. “NPH can be stored at room temperature for one month.”
B. “NPH can be stored at room temperature for three months.”
C. “NPH can’t be stored at room temperature.”
D. “NPH insulin can be stored under direct sunlight.”

111. Answer: A
A is correct. An insulin vial can be kept at room temperature for one month
without significant loss of potency.
B is incorrect. An insulin vial can be kept at room temperature only for one
month without significant loss of potency.
C is incorrect. NPH vials can be stored at room temperature and can last for
one month.
D is incorrect. The client should be instructed to store insulin to avoid sunlight.
Direct sunlight decreases the potency of insulin.

112. NCLEX Question
The client with a diagnosis of Diabetes Mellitus is being discharged with insulin
aspart. The nurse is instructing him about the effects of insulin aspart,
particularly its peak effects. Which statement by the nurse indicates client
understanding?
A. “I need to eat breakfast within 10 minutes of taking my insulin.”
B. “I must have some candy or any form of sugar with me at all times”
C. “I need to eat some snacks early in the afternoon.”
D. “I need to eat something sweet before bedtime.“

113. Answer: A
A is correct. Insulin aspart has a very quick onset and peak action. Its onset is 15
minutes from administration and peaks at 30-90 minutes after administration. The
client should understand that he needs to eat within 10-15 minutes of drug
administration to prevent hypoglycemia.
B is incorrect. This is true in all patients that receive any medication that lowers blood
sugar levels. This however, does not apply particularly to insulin aspart.
C is incorrect. This would be true of the patient taking NPH insulin, not insulin aspart.
NPH insulin peaks at 8-12 hours after administration (around 2-3 pm in the afternoon if
taken in the morning before breakfast). However, insulin aspart is a rapid-acting insulin
whose peak is at 30-90 minutes after administration, so eating snacks in the afternoon
does not indicate understanding of the peak time of insulin aspart.
D is incorrect. There is no need to eat something sweet at bedtime.

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