Chapter 59-Care of Clients with Diabetes Mellitus MED SURG QUESTIONS

A 29-year-old client with type 1 diabetes is admitted to the ED with nausea and abdominal pain. His respiratory rate is 34/min with deep breaths and a fruity smell to his breath. He is responsive, but difficult to arouse. 1. What does the nurse suspect is happening with this client? 2. What serum glucose level would the nurse expect to see with this client? A family member asks why the client is breathing so rapidly and deeply. 3. How will the nurse respond? 4. In the ED, the client is diagnosed with diabetic ketoacidosis (DKA). What is the nurse's first priority for managing this condition? A. Airway Assessment B. Administration of insulin C. Fluid and electrolyte correction D. Administration of IV potassium Twenty minutes later, the client is admitted to the ICU for DKA management. The client is receiving IV regular insulin with frequent finger sticks to check glucose level. His potassium level is 2.5, and IV potassium supplements have been ordered. 5. What assessment must the nurse make before giving the IV potassium? A. RR of less than 24/min B. Production of at least 30 mL/hr of urine C. Oriented to time, place and person D. Finger stick glucose of less than 200 Two days later the client is recovered and is preparing for discharge. His partner asks what they can do to prevent this from happening again in the future. 6. What teaching will the nurse provide? (Select all that apply.) A. Monitor glucose whenever the client is ill. B. Decrease fluid intake when nausea and vomiting occur. C. Watch for and report any illness lasting more than 1 to 2 days. D. Check blood glucose levels every 4 to 6 hours if anorexia, nausea, or vomiting is experienced. E. Check urine ketones when blood glucose is greater than 300 mg/dL.

1. DKA 2. High BG, over 300 3. To compensate for all the acid in the body (Kussmaul's breathing) 4. A. Airway assessment 5. B. Production of less than 30 mL/hr of urine 6. A., C., D., and E.

Which statement by a client indicates to the nurse correct understanding of what to do when the sensations of hunger and shakiness occur? A. "I will eat three graham crackers." B. "I will drink a glass of water." C. "I will sit down and rest." D. "I will give myself a dose of glucagon."

A. "I will eat three graham crackers."

A client expresses fear and anxiety over the life changes associated with diabetes, stating, "I am scared that I can't do it all and will get so sick that I will be a burden on my family." What is the nurse's best response? A. "Let's tackle it piece by piece. What is most scary to you?" B. "It is overwhelming, isn't it?" C. "Let's see how much you can learn today, so you are less nervous." D. "Many people live with diabetes and do it just fine."

A. "Let's tackle it piece by piece. What is most scary to you?"

What action will the nurse advise to prevent harm for a client with diabetes who has a 3-cm callus on the ball of the right foot? A. "Make an appointment with your podiatrist as soon as possible." B. "Make an appointment with a pedicurist and have them cut or file off the callus." C. "Soak your feet nightly in warm water and peel of a little of the callus every day." D. "Apply an over-the-counter callus-dissolving pad and follow the package directions."

A. "Make an appointment with your podiatrist as soon as possible."

Which statement made by a client who is learning about self-injection of insulin indicates to the nurse that clarification is needed about injection site selection and rotation? A. "The abdominal site is best because it is closest to the pancreas." B. "I can reach my thigh best, so I will use different areas of the same thigh." C. "If I change my injection site from the thigh to an arm, the inulin absorption may be different." D. "By rotating sites within one area, my chance of having skin changes is less."

A. "The abdominal site is best because it is closest to the pancreas."

How will the nurse reply when a client with type 2 diabetes tells the nurse that he would like to have a 12-ounce glass of beer with supper but believes that is now impossible? A. "You can have a beer with a meal if you test yourself for hypoglycemia an hour later." B. "You can have a beer with a meal if you test yourself for hyperglycemia an hour later." C. "There are nonalcoholic beers available that you can substitute for a regular beer." D. "If you gave up dessert, you can still have one beer."

A. "You can have a beer with a meal if you test yourself for hypoglycemia an hour later."

The nurse has just received report on a group of clients. Which client is the nurse's first priority? A. A 26 year old with type 1 diabetes whose insulin pump is beeping "occlusion." B. A 30 year old with type 1 diabetes who is reporting thirst. C. A 40 year old with type 2 diabetes who has a blood glucose of 150 mg/dL (8.3 mmol/L). D. A 50 year old with type 2 diabetes with a blood pressure of 150/90 mm Hg.

A. A 26 year old with type 1 diabetes whose insulin pump is beeping "occlusion."

Which client does the nurse caution to avoid self-monitoring of blood glucose (SMBG) at alternate sites? A. A 55-year-old client who has hypoglycemic unawareness B. An 80-year-old client with type 2 diabetes mellitus C. A 45-year-old client with type 1 diabetes mellitus D. A 75-year-old client whose blood glucose levels show little variation

A. A 55-year-old client who has hypoglycemic unawareness

A nurse is teaching a group of clients about metabolic syndrome. Which assessment finding does the nurse anticipate? A. Male waist circumference of 44 inches B. Fasting blood glucose 90 mg/dL C. Triglyceride value of 140 mg/dL D. Blood pressure 128/84

A. Male waist circumference of 44 inches

Which new-onset symptoms will the nurse instruct a client with diabetes who is prescribed to take the sodium-glucose cotransport inhibitor, empagliflozin, to report to the diabetes health care provider to prevent harm? Select all that apply. A. Muscle weakness and dizziness on standing B. Redness and tenderness at the injection site C. Rapid weight gain and shortness of breath D. Redness and tenderness of the perineum E. Sensations of hunger, tremors, sweating, and confusion F. Pain and burning on urination

A. Muscle weakness and dizziness on standing D. Redness and tenderness of the perineum E. Sensations of hunger, tremors, sweating, and confusion F. Pain and burning on urination

Which precaution is most important for the nurse to teach a client who has cardiovascular autonomic neuropathy (CAN) from diabetes to prevent harm? A. "Check your hands and feet weekly for chronic excessive sweating." B. "Change positions slowly when moving from sitting to standing." C. "Avoid drinking caffeine or caffeinated beverages." D. "Be sure to take your blood pressure drug daily."

B. "Change positions slowly when moving from sitting to standing."

Which specific action is a priority for the nurse to teach a client with diabetes who has peripheral neuropathy to prevent harm? A. "Wear a medical alert bracelet." B. "Never go barefoot." C. "Never reuse insulin syringes." D. "Drink at least 3 L of fluids daily."

B. "Never go barefoot."

When caring for a client having a hypoglycemic episode, which symptom requires immediate nursing intervention? A. Hunger B. Confusion C. Headache D. Tachycardia

B. Confusion

What is the nurse's best action when finding that a client who has had diabetes for 15 years has decreased sensory perception in both feet? A. Testing the sensory perception of the client's hands B. Examining both feet for indications of injury C. Explaining to the client that peripheral neuropathy is now present D. Documenting the finding as the only action

B. Examining both feet for indications of injury

What is the nurse's best response when a client with diabetes who is being treated for hypoglycemic asks why people without diabetes don't become severely hypoglycemic even after fasting for 8 hours? A. In a person without diabetes, fasting for 8 hours converts proteins into glycose (gluconeogenesis) so that hypergycemia develops rather than hypoglycemia. B. In a person without diabetes, the secretion of glucagon prevents hypoglycemia by promoting glucose release from liver storage sites (glycogenolysis). C. Normal metabolism is so slow when a person without diabetes fasts that blood glucose does not enter cells to be used for energy. As a result, hypoglycemia does not occur. D. Lipolysis (fat breakdown) in fat stores occurs faster in the nondiabetic person, which converts fatty acids into glucose to maintain blood glucose levels.

B. In a person without diabetes, the secretion of glucagon prevents hypoglycemia by promoting glucose release from liver storage sites (glycogenolysis).

How will the nurse evaluate the level of glycemic control for a client with diabetes whose laboratory values include a fasting blood glucose level of 82 mg/dL (mmol/L) and an A1c of 5.9%? A. The values indicate that the client has poorly managed his or her disease. B. The values indicate that the client has managed his or her disease well. C. The client's glucose control for the past 24 hours has been good but the overall control is poor. D. The client's glucose control for the past 24 hours has been poor but the overall control is good.

B. The values indicate that the client has managed his or her disease well.

A client newly diagnosed with type 1 diabetes says she is not ready to learn everything about diabetes control right now. Which information has the greatest priority for the nurse to teach this client and her family for now to prevent harm? (Select all that apply.) A. Causes of type 1 diabetes B. What to do when ill? C. Symptoms and treatment of hypoglycemia D. Insulin administration E. Dietary control of blood glucose F. Importance of regular exercise

B. What to do when ill? C. Symptoms and treatment of hypoglycemia D. Insulin administration

What is the nurse's best response to a client newly diagnosed with type 1 diabetes who asks why insulin is only given by injection and not as an oral drug? A. "Injected insulin works faster than oral drugs to lower blood glucose levels." B. "Oral insulin is so weak that it would require very high dosages to be effective." C. "Insulin is a small protein that is destroyed in by stomach acids and intestinal enzymes." D. "Insulin is a "high alert drug" and could more easily be abused if it were available as an oral agent."

C. "Insulin is a small protein that is destroyed in by stomach acids and intestinal enzymes."

What is the nurse's best response to a client with type 2 diabetes controlled with metformin who asks why now that he is recovering from surgery, is he prescribed to receive insulin therapy for a few days? A. "Your insurance doesn't permit metformin to be used during hospitalization." B. "Your presurgical testing indicates that you now have type 1 diabetes and require daily insulin." C. "You just need insulin temporarily because the stress of surgery causes increased blood glucose levels for a day or two." D. "You must take insulin from now on because the surgery has aggravated the intensity of your diabetes."

C. "You just need insulin temporarily because the stress of surgery causes increased blood glucose levels for a day or two."

When (at which time) will the nurse plan to monitor for hypoglycemia in a client with type 1 diabetes received regular insulin at 7:00 a.m.? A. 7:30 a.m. B. 7:30 p.m. C. 11:00 a.m. D. 2:00 p.m.

C. 11:00 a.m. regular insulin is a short-acting type of insulin, onset is 1/2-1 hr. Peak time is 2-4 hr which is when hypoglycemia can occur

The nurse has just received report on a group of clients. Which client is the nurse's first priority? A. A 50 year old taking repaglinide who has nausea and back pain. B. A 55 year old taking pioglitazone who has bilateral ankle swelling. C. A 45 year old taking metformin who has abdominal cramps. D. A 40 year old taking glyburide who is dizzy and sweaty.

C. A 45 year old taking metformin who has abdominal cramps.

Which client assessment finding indicates to the nurse the possible presence of diabetic autonomic neuropathy? A. Loss of sensation in both feet B. Hyperglycemia C. Intermittent constipation D. Increased thirst

C. Intermittent constipation

Which action is appropriate for the nurse to delegate to the assistive personnel (AP) when caring for clients with diabetes? A. Monitoring a client who reports palpitations and anxiety B. Verifying the infusion rate on a continuous infusion insulin pump C. Performing a blood glucose check on a client who requires insulin D. Assessing a client who reports tremors and irritability

C. Performing a blood glucose check on a client who requires insulin

Which assessment is a priority for the nurse to make when a client with diabetic ketoacidosis (DKA) who is being monitored while receiving an insulin infusion begins to show an irregular heart beat with inverted T-waves? A. Rate of IV infusion B. Urine output C. Potassium level D. Breath sounds

C. Potassium level

Which action will the nurse recommend to a client with type 1 diabetes on insulin therapy who has been having a morning fasting blood glucose (FBG) level of 160 mg/dL (8.9 mmol/L) and is diagnosed with "dawn phenomenon" to achieve better control? A. Eat a bedtime snack containing equal amounts of protein and carbohydrates." B. Avoid eating any carbohydrate with your evening meal." C. Take your evening insulin dose right before going to bed instead of at supper time." D. "Inject the insulin into your arm rather than into the abdomen around the navel."

C. Take your evening insulin dose right before going to bed instead of at supper time."

When does the nurse teach a client with type 1 diabetes to avoid exercise? A. During colder months B. If serum glucose is less than 150 C. When ketones are present in the urine D. At times when emotional stress is high

C. When ketones are present in the urine

What is the nurse's best response to a client newly diagnosed with diabetes who asks why he is always so thirsty? A. "Without insulin, glucose is excreted rather than used in the cells. The loss of glucose directly triggers thirst, especially for sugared drinks." B. "The extra glucose in the blood increases the blood sodium level, which increases your sense of thirst." C. "Without insulin, glucose combines with blood cholesterol, which damages the kidneys, making you feel thirsty even when no water has been lost." D. "The extra glucose in the blood makes the blood thicker, which then triggers thirst so that the water you drink will dilute the blood glucose level."

D. "The extra glucose in the blood makes the blood thicker, which then triggers thirst so that the water you drink will dilute the blood glucose level."

Which action has the highest priority for the nurse to take when a client with type 1 diabetes arrives in the emergency department breathing deeply and stating, "I can't catch my breath." and has vital signs of: T 98.4° F (36.9° C), P 112 beats/min, R 38 breaths/min, BP 91/54 mm Hg, and O2 saturation 99% on room air? A. Administering oxygen B. Connecting a cardiac monitor C. Assessing arterial blood gas (ABG) values D. Assessing blood glucose level

D. Assessing blood glucose level

Which factor is most important for the nurse to assess before providing instruction to a client newly diagnosed with diabetes about the disease and its management? A. Current energy level and rest patterns B. Sexual orientation C. Current lifestyle for diet and exercise D. Education and literacy levels

D. Education and literacy levels

Which assessment finding in a client with diabetes mellitus indicates to the nurse that the disease is damaging the kidneys? A. White blood cells (WBCs) in the urine during a random urinalysis B. Ketone bodies in the urine during acidosis C. Glucose in the urine during hyperglycemia D. Protein in the urine during a random urinalysis

D. Protein in the urine during a random urinalysis