Ch 46: Assessment and Management of Patients with Diabetes

"Your body is using protein and fat for energy instead of glucose."

A 16-year-old client newly diagnosed with type 1 diabetes has a very low body weight despite eating regular meals. The client is upset because friends frequently state, "You look anorexic." Which statement by the nurse would be the best response to help this client understand the cause of weight loss due to this condition? "Don't worry about what your friends think; the carbohydrates you eat are being quickly digested, increasing your metabolism." "I will refer you to a dietician who can help you with your weight." "Your body is using protein and fat for energy instead of glucose." "You may be having undiagnosed infections, causing you to lose extra weight."

Increased hunger

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? Dizziness Increased hunger Fatigue Numbness

Blood glucose level 1,100 mg/dl

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

ketoacidosis

A client with a history of type 1 diabetes is demonstrating fast, deep, labored breathing and has fruity odored breath. What could be the cause of the client's current serious condition? ketoacidosis hyperosmolar hyperglycemic nonketotic syndrome All options are correct. hepatic disorder

Metformin

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

Serum glucose level of 52 mg/dl

A client with diabetes mellitus has a prescription for 5 units of U-100 regular insulin and 25 units of U-100 isophane insulin suspension (NPH) to be taken before breakfast. At about 4:30 p.m., the client experiences headache, sweating, tremor, pallor, and nervousness. What is the most probable cause of these signs and symptoms? Serum calcium level of 8.9 mg/dl Serum calcium level of 10.2 mg/dl Serum glucose level of 450 mg/dl Serum glucose level of 52 mg/dl

Hypoglycemia

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

Deficient knowledge (treatment regimen).

A client with long-standing type 1 diabetes is admitted to the hospital with unstable angina pectoris. After the client's condition stabilizes, the nurse evaluates the diabetes management regimen. The nurse learns that the client sees the physician every 4 weeks, injects insulin after breakfast and dinner, and measures blood glucose before breakfast and at bedtime. Consequently, the nurse should formulate a nursing diagnosis of: Impaired adjustment. Defensive coping. Deficient knowledge (treatment regimen). Health-seeking behaviors (diabetes control).

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

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

8:30 AM.

A health care provider prescribes short-acting insulin for a patient, instructing the patient to take the insulin 20 to 30 minutes before a meal. The nurse explains to the patient that Humulin-R taken at 6:30 AM will reach peak effectiveness by: 2:30 PM. 10:30 AM. 12:30 PM. 8:30 AM.

"Destruction of special cells in the pancreas causes a decrease in insulin production. Glucose levels rise because insulin normally breaks it down."

A newly admitted client with a diagnosis of type 1 diabetes asks the nurse what caused their diabetes. When the nurse is explaining to the client the etiology of type 1 diabetes, what process should the nurse describe? "The tissues in your body are resistant to the action of insulin, making the glucose levels in your blood increase." "The amount of glucose that your body makes overwhelms your pancreas and decreases your production of insulin." "Damage to your pancreas causes an increase in the amount of glucose that it releases, and there is not enough insulin to control it." "Destruction of special cells in the pancreas causes a decrease in insulin production. Glucose levels rise because insulin normally breaks it down."

Below-normal serum potassium level

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? Below-normal serum potassium level Serum ketone bodies Elevated serum acetone level Serum alkalosis

Insulin is absorbed more rapidly at abdominal injection sites than at other sites.

A nurse explains to a client that she will administer his first insulin dose in his abdomen. How does absorption at the abdominal site compare with absorption at other sites? Insulin is absorbed more slowly at abdominal injection sites than at other sites. Insulin is absorbed rapidly regardless of the injection site. Insulin is absorbed unpredictably at all injection sites. Insulin is absorbed more rapidly at abdominal injection sites than at other sites.

Dietitian

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? Home health nurse Dietitian Psychiatrist Social worker

Increased thirst, hunger, and urination

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

Presence of autoantibodies against islet cells

A nurse is teaching a diabetic support group about the causes of type 1 diabetes. The teaching is determined to be effective when the group is able to attribute which factor as a cause of type 1 diabetes? Rare ketosis Altered glucose metabolism Obesity Presence of autoantibodies against islet cells

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

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? Ensuring that the patient understands that some favorite foods may not be allowed on the meal plan and substitutes will need to be found Making sure that the patient is aware that quantity of foods will be limited Determining whether the patient is on insulin or taking oral antidiabetic medication Reviewing the patient's diet history to identify eating habits and lifestyle and cultural eating patterns

Younger than 30 years of age Ketosis-prone Little or no endogenous insulin

A patient is diagnosed with type 1 diabetes. What clinical characteristics does the nurse expect to see in this patient? Select all that apply. Older than 65 years of age Younger than 30 years of age Ketosis-prone Obesity at diagnoses Little or no endogenous insulin

Inhibit the production of glucose by the liver.

A patient is prescribed Glucophage, an oral antidiabetic agent classified as a biguanide. The nurse knows that a primary action of this drug is its ability to: Increase the absorption of carbohydrates in the intestines. Inhibit the production of glucose by the liver. Stimulate the beta cells of the pancreas to secrete insulin. Decrease the body's sensitivity to insulin.

138 mg/dL, 2 hours postprandial.

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: 90 mg/dL before meals. 80 mg/dL, 1 hour postprandial. 138 mg/dL, 2 hours postprandial. 120 mg/dL, 1 hour postprandial.

Glycosylated hemoglobin level

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? Glucose via an oral glucose tolerance test Fasting blood glucose level Glucose via a urine dipstick test Glycosylated hemoglobin level

3 months

Glycosylated hemoglobin reflects blood glucose concentrations over which period of time? 1 month 3 months 6 months 9 months

10 to 15 minutes

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

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

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

NPH

The nurse is preparing to administer intermediate-acting insulin to a patient with diabetes. Which insulin will the nurse administer? Iletin II Lispro (Humalog) Glargine (Lantus) NPH

When mixing insulin, the regular insulin is drawn up into the syringe first.

The nurse is teaching a client about self-administration of insulin and about mixing regular and neutral protamine Hagedorn (NPH) insulin. Which information is important to include in the teaching plan? There is no need to inject air into the bottle of insulin before withdrawing the insulin. When mixing insulin, the regular insulin is drawn up into the syringe first. When mixing insulin, the NPH insulin is drawn up into the syringe first. If two different types of insulin are ordered, they need to be given in separate injections.

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

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: The pancreatic hormone glucagon will stimulate the liver to release stored glucose. The process of gluconeogenesis will be inhibited. Insulin will be released to facilitate the transport of sugar. Glycogenesis will be decreased by the liver.

4 to 6 hours

What is the duration of regular insulin? 4 to 6 hours 24 hours 12 to 16 hours 3 to 5 hours

"Test your blood glucose every 4 hours."

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

insulin resistance

Which is a characteristic of type 2 diabetes? little or no insulin ketosis-prone when insulin absent insulin resistance presence of islet antibodies

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

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

The client has eaten and has not taken or received insulin.

Which of the following factors would a nurse identify as a most likely cause of diabetic ketoacidosis (DKA) in a client with diabetes? The client continues medication therapy despite adequate food intake. The client has been exercising more than usual. The client has not consumed sufficient calories. The client has eaten and has not taken or received insulin.

Diet soda

Which of the following would be considered a "free" item from the exchange list? Diet soda 1 tsp olive oil Medium apple Green salad

It cannot be mixed with any other type of insulin.

Which statement is correct regarding glargine insulin? Its peak action occurs in 2 to 3 hours. It is absorbed rapidly. It cannot be mixed with any other type of insulin. It is given twice daily.

A glucose challenge test should be performed between 24 and 28 weeks.

Which statement is true regarding gestational diabetes? Onset usually occurs in the first trimester. There is a low risk for perinatal complications. It occurs in most pregnancies. A glucose challenge test should be performed between 24 and 28 weeks.

Lispro

Which type of insulin acts most quickly? Regular Lispro Glargine NPH