Assessment and Management of Patients with Diabetes PrepU

The nurse is administering lispro insulin. Based on the onset of action, how long before breakfast should the nurse administer the injection? A. 10 to 15 minutes B. 30 to 40 minutes C. 1 to 2 hours D. 3 hours

A. 10 to 15 minutes

A nurse is caring for a diabetic patient with a diagnosis of nephropathy. What would the nurse expect the urinalysis report to indicate? A. Albumin B. White blood cells C. Bacteria D. Red blood cells

A. Albumin

A nurse expects to note an elevated serum glucose level in a client with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which other laboratory finding should the nurse anticipate? A. Below-normal serum potassium level B. Serum alkalosis C. Serum ketone bodies D. Elevated serum acetone level

A. Below-normal serum potassium level

A client with diabetes mellitus is receiving an oral antidiabetic agent. The nurse observes for which condition when caring for this client? A. Hypoglycemia B. Blurred vision C. Polydipsia D. Polyuria

A. Hypoglycemia

A 60-year-old client comes to the ED reporting weakness, vision problems, increased thirst, increased urination, and frequent infections that do not seem to heal easily. The physician suspects that the client has diabetes. Which classic symptom should the nurse watch for to confirm the diagnosis of diabetes? A. Increased hunger B. Dizziness C. Fatigue D. Numbness

A. Increased hunger

Which term refers to the progressive increase in blood glucose from bedtime to morning? A. Insulin waning B. Somogyi effect C. Diabetic ketoacidosis (DKA) D. Dawn phenomenon

A. Insulin waning

Which is a by-product of fat breakdown in the absence of insulin and accumulates in the blood and urine? A. Ketones B. Cholesterol C. Creatinine D. Hemoglobin

A. Ketones

A nurse is caring for a client with an abnormally low blood glucose concentration. What glucose level should the nurse observe when assessing laboratory results? A. Less than 70 mg/dL (3.7 mmol/L) B. Between 70 and 75 mg/dL (3.9 to 4.16 mmol/L) C. Between 75 and 90 mg/dL (4.16 to 5.00 mmol/L) D. 95 mg/dL (5.27 mmol/L)

A. Less than 70 mg/dL (3.7 mmol/L)

Which clinical characteristic is associated with type 1 diabetes (previously referred to as insulin-dependent diabetes mellitus)? A. Presence of islet cell antibodies B. Rare ketosis C. Requirement for oral hypoglycemic agents D. Obesity

A. Presence of islet cell antibodies

After being sick for 3 days, a client with a history of diabetes mellitus is admitted to the hospital with diabetic ketoacidosis (DKA). The nurse should evaluate which diagnostic test results to prevent dysrhythmias? A. Serum potassium level B. Serum sodium level C. Serum chloride level D. Serum calcium level

A. Serum potassium level

A client with status asthmaticus requires endotracheal intubation and mechanical ventilation. Twenty-four hours after intubation, the client is started on the insulin infusion protocol. The nurse must monitor the client's blood glucose levels hourly and watch for which early signs and symptoms associated with hypoglycemia? A. Sweating, tremors, and tachycardia B. Dry skin, bradycardia, and somnolence C. Polyuria, polydipsia, and polyphagia D. Bradycardia, thirst, and anxiety

A. Sweating, tremors, and tachycardia

Which may be a potential cause of hypoglycemia in the client diagnosed with diabetes mellitus? A. The client has not eaten but continues to take insulin or oral antidiabetic medications. B. The client has not been exercising. C. The client has not complied with the prescribed treatment regimen. D. The client has eaten but has not taken or received insulin.

A. The client has not eaten but continues to take insulin or oral antidiabetic medications.

During a class on exercise for clients with diabetes mellitus, a client asks the nurse educator how often to exercise. To meet the goals of planned exercise, the nurse educator should advise the client to exercise: A. at least three times per week. B. at least five times per week. C. every day. D. at least once per week.

A. at least three times per week.

A client with type 1 diabetes asks the nurse about taking an oral antidiabetic agent. The nurse explains that these medications are effective only if the client: A. has type 2 diabetes. B. is pregnant and has type 2 diabetes. C. has type 1 diabetes. D. prefers to take insulin orally.

A. has type 2 diabetes.

Which factor is the focus of nutrition intervention for clients with type 2 diabetes? A. weight loss B. blood glucose level C. carbohydrate intake D. protein metabolism``

A. weight loss

Which would be included in the teaching plan for a client diagnosed with diabetes mellitus? A. The only diet change needed in the treatment of diabetes is to stop eating sugar. B. An elevated blood glucose concentration contributes to complications of diabetes, such as diminished vision. C. Sugar is found only in dessert foods. D. Once insulin injections are started in the treatment of type 2 diabetes, they can never be discontinued.

B. An elevated blood glucose concentration contributes to complications of diabetes, such as diminished vision.

A client is admitted with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which laboratory finding should the nurse expect in this client? A. Arterial pH 7.25 B. Blood glucose level 1,100 mg/dl C. Blood urea nitrogen (BUN) 15 mg/dl D. Plasma bicarbonate 12 mEq/L

B. Blood glucose level 1,100 mg/dl

Which information should be included in the teaching plan for a client receiving glargine, a "peakless" basal insulin? A. Draw up the drug first, then add regular insulin. B. Do not mix with other insulins. C. It is rapidly absorbed and has a fast onset of action. D. Administer the total daily dosage in two doses.

B. Do not mix with other insulins.

A client with diabetes mellitus is receiving an oral antidiabetic agent. The nurse observes for which condition when caring for this client? A. Polydipsia B. Hypoglycemia C. Blurred vision D. Polyuria

B. Hypoglycemia

The nurse is educating the client with diabetes on setting up a sick plan to manage blood glucose control during times of minor illness such as influenza. Which is the most important teaching item to include? A. Decrease food intake until nausea passes. B. Increase frequency of glucose self-monitoring. C. Take half the usual dose of insulin until symptoms resolve. D. Do not take insulin if not eating.

B. Increase frequency of glucose self-monitoring.

A nurse is assessing a client who is receiving total parenteral nutrition (TPN). Which finding suggests that the client has developed hyperglycemia? A. Decreased appetite B. Increased urine output C. Diaphoresis D. Cheyne-Stokes respirations

B. Increased urine output

The nurse is administering an insulin drip to a patient in ketoacidosis. What insulin does the nurse know is the only one that can be used intravenously? A. NPH B. Regular C. Lispro D. Lantus

B. Regular

The pancreas continues to release a small amount of basal insulin overnight, while a person is sleeping. The nurse knows that if the body needs more sugar: A. Insulin will be released to facilitate the transport of sugar. B. The pancreatic hormone glucagon will stimulate the liver to release stored glucose. C. The process of gluconeogenesis will be inhibited. D. Glycogenesis will be decreased by the liver.

B. The pancreatic hormone glucagon will stimulate the liver to release stored glucose.

Which intervention is essential when performing dressing changes on a client with a diabetic foot ulcer? A. Debriding the wound three times per day B. Using sterile technique during the dressing change C. Applying a heating pad D. Cleaning the wound with a povidone-iodine solution

B. Using sterile technique during the dressing change

A client has been recently diagnosed with type 2 diabetes, and reports continued weight loss despite increased hunger and food consumption. This condition is called: A. anorexia. B. polyphagia. C. polyuria. D. polydipsia.

B. polyphagia.

A patient has been newly diagnosed with type 2 diabetes, and the nurse is assisting with the development of a meal plan. What step should be taken into consideration prior to making the meal plan? A. Making sure that the patient is aware that quantity of foods will be limited B. Ensuring that the patient understands that some favorite foods may not be allowed on the meal plan and substitutes will need to be found C. Reviewing the patient's diet history to identify eating habits and lifestyle and cultural eating patterns D. Determining whether the patient is on insulin or taking oral antidiabetic medication

C. Reviewing the patient's diet history to identify eating habits and lifestyle and cultural eating patterns

A client tells the nurse that she has been working hard for the past 3 months to control her type 2 diabetes with diet and exercise. To determine the effectiveness of the client's efforts, the nurse should check: A. fasting blood glucose level. B. urine glucose level. C. glycosylated hemoglobin level. D. serum fructosamine level.

C. glycosylated hemoglobin level.

A nurse is caring for a client with type 1 diabetes who exhibits confusion, light-headedness, and aberrant behavior. The client is conscious. The nurse should first administer: A. I.M. or subcutaneous glucagon. B. I.V. bolus of dextrose 50%. C. 10 units of fast-acting insulin. D. 15 to 20 g of a fast-acting carbohydrate such as orange juice.

D. 15 to 20 g of a fast-acting carbohydrate such as orange juice.

What is the duration of regular insulin? A. 12 to 16 hours B. 24 hours C. 3 to 5 hours D. 4 to 6 hours

D. 4 to 6 hours

When administering insulin to a client with type 1 diabetes, which of the following would be most important for the nurse to keep in mind? A. Area for insulin injection B. Duration of the insulin C. Technique for injecting D. Accuracy of the dosage

D. Accuracy of the dosage

A client's blood glucose level is 45 mg/dl. The nurse should be alert for which signs and symptoms? A. Polyuria, polydipsia, polyphagia, and weight loss B. Polyuria, polydipsia, hypotension, and hypernatremia C. Kussmaul respirations, dry skin, hypotension, and bradycardia D. Coma, anxiety, confusion, headache, and cool, moist skin

D. Coma, anxiety, confusion, headache, and cool, moist skin

A client with a serum glucose level of 618 mg/dl is admitted to the facility. He's awake and oriented, has hot dry skin, and has the following vital signs: temperature of 100.6° F (38.1° C), heart rate of 116 beats/minute, and blood pressure of 108/70 mm Hg. Based on these assessment findings, which nursing diagnosis takes highest priority? A. Ineffective thermoregulation related to dehydration B. Imbalanced nutrition: Less than body requirements related to insulin deficiency C. Decreased cardiac output related to elevated heart rate D. Deficient fluid volume related to osmotic diuresis

D. Deficient fluid volume related to osmotic diuresis

During a follow-up visit 3 months after a new diagnosis of type 2 diabetes, a client reports exercising and following a reduced-calorie diet. Assessment reveals that the client has only lost 1 pound and did not bring the glucose-monitoring record. Which value should the nurse measure? A. Glucose via an oral glucose tolerance test B. Fasting blood glucose level C. Glucose via a urine dipstick test D. Glycosylated hemoglobin level

D. Glycosylated hemoglobin level

A nurse is preparing to discharge a client with coronary artery disease and hypertension who is at risk for type 2 diabetes. Which information is important to include in the discharge teaching? A. How to recognize signs of diabetic ketoacidosis B. How to monitor ketones daily C. How to self-inject insulin D. How to control blood glucose through lifestyle modification with diet and exercise

D. How to control blood glucose through lifestyle modification with diet and exercise

A nurse is providing education to a client who is newly diagnosed with diabetes mellitus. What are classic symptoms associated with diabetes? A. Increased weight loss, dehydration, and fatigue B. Increased weight gain, appetite, and thirst C. Loss of appetite, increased urination, and dehydration D. Increased thirst, hunger, and urination

D. Increased thirst, hunger, and urination

The nurse is preparing a presentation for a group of adults at a local community center about diabetes. Which of the following would the nurse include as associated with type 2 diabetes? A. Little to no relation to pre-diabetes B. Less common than type 1 diabetes C. Onset most common during adolescence D. Insulin production insufficient

D. Insulin production insufficient

A young adult client with type 1 diabetes does not want to have to self-administer insulin injections several times a day. Which medication approach would the nurse recommend that best controls the condition and meets the client's needs? A. 1 injection per day B. Injection before each meal C. 2 injections premixed D. Insulin pump

D. Insulin pump

A client with diabetes is receiving an oral antidiabetic agent that acts to help the tissues use available insulin more efficiently. Which of the following agents would the nurse expect to administer? A. Glipizide B. Repaglinide C. Glyburide D. Metformin

D. Metformin

Lispro (Humalog) is an example of which type of insulin? A. Long-acting B. Short-acting C. Intermediate-acting D. Rapid-acting

D. Rapid-acting

A client with type 2 diabetes asks the nurse why he can't have a pancreatic transplant. Which of the following would the nurse include as a possible reason? A. Increased risk for urologic complications B. Need for exocrine enzymatic drainage C. Need for lifelong immunosuppressive therapy D. Underlying problem of insulin resistance

D. Underlying problem of insulin resistance

Which type of insulin acts most quickly? A. Glargine B. Lispro C. NPH D. Regular

B. Lispro

A patient who is diagnosed with type 1 diabetes would be expected to: A. Need exogenous insulin. B. Receive daily doses of a hypoglycemic agent. C. Be restricted to an American Diabetic Association diet. D. Have no damage to the islet cells of the pancreas.

A. Need exogenous insulin.

Insulin is secreted by which of the following types of cells? A. Melanocytes B. Beta cells C. Basal cells D. Neural cells

B. Beta cells

After teaching a client with type 1 diabetes who is scheduled to undergo an islet cell transplant, which client statement indicates successful teaching? A. "I might need insulin later on but probably not as much or as often." B. "This transplant will provide me with a cure for my diabetes." C. "I will receive a whole organ with extra cells to produce insulin." D. "They'll need to create a connection from the pancreas to allow enzymes to drain."

A. "I might need insulin later on but probably not as much or as often."

A nurse is teaching a client recovering from diabetic ketoacidosis (DKA) about management of "sick days." The client asks the nurse why it is important to monitor the urine for ketones. Which statement is the nurse's best response? A. "Ketones accumulate in the blood and urine when fat breaks down in the absence of insulin. B. Ketones signal an insulin deficiency that will cause the body to start breaking down stored fat for energy." C. "Ketones are formed when insufficient insulin leads to cellular starvation. As cells rupture, they release these acids into the blood." D. "Excess glucose in the blood is metabolized by the liver and turned into ketones, which are an acid." "When the body does not have enough insulin, hyperglycemia occurs. Excess glucose is broken down by the liver, causing acidic by-products to be released."

A. "Ketones accumulate in the blood and urine when fat breaks down in the absence of insulin.

An agitated, confused client arrives in the emergency department. The client's history includes type 1 diabetes, hypertension, and angina pectoris. Assessment reveals pallor, diaphoresis, headache, and intense hunger. A stat blood glucose sample measures 42 mg/dl, and the client is treated for an acute hypoglycemic reaction. After recovery, the nurse teaches the client to treat hypoglycemia by ingesting: A. 10 to 15 g of a simple carbohydrate. B. 2 to 5 g of a simple carbohydrate. C. 18 to 20 g of a simple carbohydrate. D. 25 to 30 g of a simple carbohydrate.

A. 10 to 15 g of a simple carbohydrate.

Which instruction about insulin administration should a nurse give to a client? A. "Discard the intermediate-acting insulin if it appears cloudy." B. "Always follow the same order when drawing the different insulins into the syringe." C. "Shake the vials before withdrawing the insulin." D. "Store unopened vials of insulin in the freezer at temperatures well below freezing."

B. "Always follow the same order when drawing the different insulins into the syringe."

A client is taking glyburide (DiaBeta), 1.25 mg P.O. daily, to treat type 2 diabetes. Which statement indicates the need for further client teaching about managing this disease? A. "I always wear my medical identification bracelet." B. "I skip lunch when I don't feel hungry." C. "I always carry hard candy to eat in case my blood sugar level drops." D. "I avoid exposure to the sun as much as possible."

B. "I skip lunch when I don't feel hungry."

A client with diabetes mellitus has a blood glucose level of 40 mg/dL. Which rapidly absorbed carbohydrate would be most effective? A. 1/2 tbsp honey or syrup B. three to five LifeSavers candies C. 1/2 cup fruit juice or regular soft drink D. 4 oz of skim milk

C. 1/2 cup fruit juice or regular soft drink

A patient who is 6 months' pregnant was evaluated for gestational diabetes mellitus. The doctor considered prescribing insulin based on the serum glucose result of: A. 80 mg/dL, 1 hour postprandial. B. 120 mg/dL, 1 hour postprandial. C. 138 mg/dL, 2 hours postprandial. D. 90 mg/dL before meals.

C. 138 mg/dL, 2 hours postprandial.

A client with diabetes comes to the clinic for a follow-up visit. The nurse reviews the client's glycosylated hemoglobin test results. Which result would indicate to the nurse that the client's blood glucose level has been well-controlled? A. 7.5 % B. 8.5% C. 6.5% D. 8.0%

C. 6.5%

A nurse educates a group of clients with diabetes mellitus on the prevention of diabetic nephropathy. Which of the following suggestions would be most important? A. Take the antidiabetic drugs regularly. B. Eat a high-fiber diet. C. Control blood glucose levels. D. Drink plenty of fluids.

C. Control blood glucose levels.

A nurse is preparing a client with type 1 diabetes for discharge. The client can care for himself; however, he's had a problem with unstable blood glucose levels in the past. Based on the client's history, he should be referred to which health care worker? A. Home health nurse B. Social worker C. Dietitian D. Psychiatrist

C. Dietitian

A client is admitted with diabetic ketoacidosis (DKA). Which order from the physician should the nurse implement first? A. Administer sodium bicarbonate 50 mEq IV push. B. Start an infusion of regular insulin at 50 U/hr. C. Infuse 0.9% normal saline solution 1 L/hr for 2 hours. D. Administer regular insulin 30 U IV push.

C. Infuse 0.9% normal saline solution 1 L/hr for 2 hours.

NPH is an example of which type of insulin? A. Rapid-acting B. Short-acting C. Intermediate-acting D. Long-acting

C. Intermediate-acting

The nurse is explaining glycosylated hemoglobin testing to a diabetic client. Which of the following provides the best reason for this order? A. Is less costly than performing daily blood sugar test B. Best indicator for the nutritional state of the client C. Reflects the amount of glucose stored in hemoglobin over past several months. D. Provides best information on the body's ability to maintain normal blood functioning

C. Reflects the amount of glucose stored in hemoglobin over past several months.

A client is admitted to the unit with diabetic ketoacidosis (DKA). Which insulin would the nurse expect to administer intravenously? A. Glargine B. Lente C. Regular D. NPH

C. Regular

Which instruction should a nurse give to a client with diabetes mellitus when teaching about "sick day rules"? A. "Follow your regular meal plan, even if you're nauseous." B. "Don't take your insulin or oral antidiabetic agent if you don't eat." C. "It's okay for your blood glucose to go above 300 mg/dl while you're sick." D. "Test your blood glucose every 4 hours."

D. "Test your blood glucose every 4 hours."

Once digested, what percentage of carbohydrates is converted to glucose? A. 70 B. 80 C. 90 D. 100

D. 100