DIABETES

The nurse instructs the client with diabetes on self-care during days of illness. Which client statement indicates that teaching has been effective? Select all that apply. "I will increase my intake of fluids." "I will skip my diabetes medication for the day." "I will test my blood sugar level every 3 to 4 hours." "I will call the doctor if I have vomiting or diarrhea." "I will eat soft foods if I cannot tolerate regular food."

"I will increase my intake of fluids." "I will test my blood sugar level every 3 to 4 hours." "I will call the doctor if I have vomiting or diarrhea." "I will eat soft foods if I cannot tolerate regular food." During periods of illness, the client with diabetes should be instructed to increase the intake of fluids to prevent dehydration. The blood glucose level should be checked every 3 to 4 hours. The health care provider should be contacted if vomiting or diarrhea occurs as extreme fluid loss may cause dehydration. Soft foods should be substituted for regularly ingested foods if the regular meal plan cannot be followed.

A nurse knows to assess a patient with type 1 diabetes for postprandial hyperglycemia. The nurse knows that glycosuria is present when the serum glucose level exceeds: 120 mg/dL 140 mg/dL 160 mg/dL 180 mg/dL

180 mg/dL Explanation: Glycosuria occurs when the renal threshold for sugar exceeds 180 mg/dL. Glycosuria leads to an excessive loss of water and electrolytes (osmotic diuresis).

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

4 to 6 hours Explanation: The duration of regular insulin is 4 to 6 hours; 3 to 5 hours is the duration for rapid-acting insulin such as Novolog. The duration of NPH insulin is 12 to 16 hours. The duration of Lantus insulin is 24 hours.

Which of the following is an age-related change that may affect diabetes? Select all that apply. Decreased renal function Taste changes Decreased vision Increased bowel motility Increased proprioception

Decreased renal function Taste changes Decreased vision Age-related changes include decreased renal function, taste changes, decreased vision, decreased bowel motility, and decreased proprioception.

x Which of the following insulins are used for basal dosage? Glargine (Lantus) NPH (Humulin N) Lispro (Humalog) Aspart (Novolog)

Glargine (Lantus) Explanation: Lantus is used for basal dosage. NPH is an intermediate acting insulin, usually taken after food. Humalog and Novolog are rapid-acting insulins.

A nurse is inspecting the feet of a client with diabetes and finds a tack sticking in the sole of one foot. The client denies feeling anything unusual in the foot. Which is the best rationale for this finding? In diabetes, the autonomic nerves are affected. Motor neuropathy causes muscles to weaken and atrophy. High blood sugar decreases blood circulation to nerves. Nephropathy is a common complication of diabetes mellitus.

High blood sugar decreases blood circulation to nerves. Explanation: Diabetic neuropathy results from poor glucose control and decreased blood circulation to nerve tissues. The lack of sensitivity increases the potential for soft tissue injury without awareness. Autonomic neuropathy is a complication of diabetes mellitus but not significant with peripheral injuries. Motor neuropathy does occur with poor glucose control but not specific to this injury. Nephropathy is a common complication that directly affects the kidneys.

x A client newly diagnosed with type 1 diabetes asks the nurse why injection site rotation is important. What is the nurse's best response? Avoid infection. Promote absorption. Minimize discomfort. Prevent muscle destruction.

Promote absorption. Explanation: Subcutaneous injection sites require rotation to avoid breakdown and/or buildup of subcutaneous fat, either of which can interfere with insulin absorption in the tissue. Infection and discomfort are risks involved with injection site but not the primary reason for rotation of sites. Insulin is not injected into the muscle.

A nurse is educating a client about the benefits of fruit versus fruit juice in the diabetic diet. The client states, "What difference does it make if you drink the juice or eat the fruit? It is all the same." What are the best responses by the nurse? Select all that apply. "Eating the fruit instead of drinking juice decreases the glycemic index by slowing absorption." "Eating the fruit is more satisfying than drinking the juice. You will get full faster." "Eating the fruit will give you more vitamins and minerals than the juice will." "Eating the fruit will lead to hyperglycemia and the fruit juice will not lead to hyperglycemia." "The fruit has less sugar than the juice."

"Eating the fruit instead of drinking juice decreases the glycemic index by slowing absorption." "The fruit has less sugar than the juice." Explanation: Eating whole fruit instead of drinking juice decreases the glycemic index, because fiber in the fruit slows absorption. A serving of juice has more sugar than a serving of fruit. Whether a fruit is more satisfying and has more vitamins and minerals than the fruit's juice are dependent on the types of fruit and juices. Eating fruit does not lead to hyperglycemia.

x A nurse prepares teaching for a client with newly-diagnosed diabetes. Which statements about the role of insulin will the nurse include in the teaching? Select all that apply. "Insulin permits entry of glucose into the cells of the body." "Insulin promotes synthesis of proteins in various body tissues." "Insulin promotes the storage of fat in adipose tissue." "Insulin interferes with glucagon from the pancreas." "Insulin interferes with the release of growth hormone from the pituitary."

"Insulin permits entry of glucose into the cells of the body." "Insulin promotes synthesis of proteins in various body tissues." "Insulin promotes the storage of fat in adipose tissue." Insulin is a hormone secreted by the endocrine part of the pancreas. In addition to lowering blood glucose by permitting entry of glucose into the cells, insulin also promotes protein synthesis and the storage of fat in adipose tissue. Somatostatin exerts a hypoglycemic effect by interfering with glucagon from the pancreas and the release of growth hormone from the pituitary.

x A client has just been diagnosed with type 1 diabetes. When teaching the client and family how diet and exercise affect insulin requirements, the nurse should include which guideline? "You'll need more insulin when you exercise or increase your food intake." "You'll need less insulin when you exercise or reduce your food intake." "You'll need less insulin when you increase your food intake." "You'll need more insulin when you exercise or decrease your food intake."

"You'll need less insulin when you exercise or reduce your food intake." Explanation: The nurse should advise the client that exercise, reduced food intake, hypothyroidism, and certain medications decrease insulin requirements. Growth, pregnancy, greater food intake, stress, surgery, infection, illness, increased insulin antibodies, and certain medications increase insulin requirements.

x When the dawn phenomenon occurs, the patient has relatively normal blood glucose until approximate what time of day? 3 AM 5 AM 7 AM 9 AM

3 AM Explanation: During the dawn phenomenon, the patient has a relatively normal blood glucose level until about 3 AM, when the level begins to rise.

x 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: 8:30 AM. 10:30 AM. 12:30 PM. 2:30 PM.

8:30 AM. Explanation: Short-acting insulin reaches its peak effectiveness 2 to 3 hours after administration. See Table 30-3 in the text.

x A client newly diagnosed with type 1 diabetes has an unusual increase in blood glucose from bedtime to morning. The physician suspects the client is experiencing insulin waning. Based on this diagnosis, the nurse expects which change to the client's medication regimen? Administering a dose of intermediate-acting insulin before the evening meal Changing the time of evening injection of intermediate-acting insulin from dinnertime to bedtime Decreasing evening bedtime dose of intermediate-acting insulin and administering a bedtime snack Increasing morning dose of long-acting insulin

Administering a dose of intermediate-acting insulin before the evening meal Explanation: Insulin waning is a progressive rise in blood glucose form bedtime to morning. Treatment includes increasing the evening (before dinner or bedtime) dose of intermediate-acting or long-acting insulin or instituting a dose of insulin before the evening meal if that is not already part of the treatment regimen.

A nurse is teaching a client about insulin infusion pump use. What intervention should the nurse include to prevent infection at the injection site? Change the needle every 3 days. Wear sterile gloves when inserting the needle. Take the ordered antibiotics before initiating treatment. Use clean technique when changing the needle.

Change the needle every 3 days. Explanation: The nurse should teach the client to change the needle every 3 days to prevent infection. The client doesn't need to wear gloves when inserting the needle. Antibiotic therapy isn't necessary before initiating treatment. Sterile technique, not clean technique, is needed when changing the needle.

x When the nurse is caring for a patient with type 1 diabetes, what clinical manifestation would be a priority to closely monitor? Hypoglycemia Hyponatremia Ketonuria Polyphagia

Hypoglycemia Explanation: The therapeutic goal for diabetes management is to achieve normal blood glucose levels (euglycemia) without hypoglycemia while maintaining a high quality of life.

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? Increase frequency of glucose self-monitoring. Decrease food intake until nausea passes. Do not take insulin if not eating. Take half the usual dose of insulin until symptoms resolve.

Increase frequency of glucose self-monitoring. Explanation: Minor illnesses such as influenza can present a special challenge to a diabetic client. The body's need for insulin increases during illness. Therefore, the client should take the prescribed insulin dose, increase the frequency of glucose monitoring, and maintain adequate fluid intake to counteract the dehydrating effects of hyperglycemia. Clear liquids and juices are encouraged. Taking less than normal dose of insulin may lead to ketoacidosis.

x For a client with hyperglycemia, which assessment finding best supports a nursing diagnosis of Deficient fluid volume? Cool, clammy skin Jugular vein distention Increased urine osmolarity Decreased serum sodium level

Increased urine osmolarity Explanation: In hyperglycemia, urine osmolarity (the measurement of dissolved particles in the urine) increases as glucose particles move into the urine. The client experiences glucosuria and polyuria, losing body fluids and experiencing deficient fluid volume. Cool, clammy skin; jugular vein distention; and a decreased serum sodium level are signs of fluid volume excess, the opposite imbalance.

Exercise lowers blood glucose levels. Which of the following are the physiologic reasons that explain this statement. Select all that apply. Increases lean muscle mass Increases resting metabolic rate as muscle size increases Decreases the levels of high-density lipoproteins Decreases total cholesterol Increases glucose uptake by body muscles

Increases lean muscle mass Increases resting metabolic rate as muscle size increases Decreases total cholesterol Increases glucose uptake by body muscles

A nurse educator been invited to local seniors center to discuss health-maintaining strategies for older adults. The nurse addresses the subject of diabetes mellitus, its symptoms, and consequences. What should the educator teach the participants about type 1 diabetes? The participants are unlikely to develop a new onset of type 1 diabetes. New cases of diabetes are highly uncommon in older adults. New cases of diabetes will be split roughly evenly between type 1 and type 2. Type 1 diabetes always develops before the age of 20.

The participants are unlikely to develop a new onset of type 1 diabetes. Explanation: Type 1 diabetes usually (but not always) develops in people younger than 20. In older adults, an onset of type 2 is far more common. A significant number of older adults develops type 2 diabetes.

x A client receives a daily injection of glargine insulin at 7:00 a.m. When should the nurse monitor this client for a hypoglycemic reaction? Between 8:00 and 10:00 a.m. Between 4:00 and 6:00 p.m. Between 7:00 and 9:00 p.m. This insulin has no peak action and does not cause a hypoglycemic reaction.

This insulin has no peak action and does not cause a hypoglycemic reaction. Explanation: "Peakless" basal or very long-acting insulins are approved by the U.S. Food and Drug Administration for use as a basal insulin; that is, the insulin is absorbed very slowly over 24 hours and can be given once a day. It has is no peak action.

The nurse understands that a client with diabetes mellitus is at greater risk for developing which of the following complications? Low blood pressure Urinary tract infections Lifelong obesity Elevated triglycerides

Urinary tract infections Explanation: Elevated levels of blood glucose and glycosuria supports bacterial growth and places the diabetic at greater risk for urinary tract, skin, and vaginal infections. Obesity, elevated triglycerides, and high blood pressure are considered symptoms of metabolic syndrome, which can result in type 2 diabetes mellitus.

x A nurse is preparing the daily care plan for a client with newly diagnosed diabetes mellitus. The priority nursing concern for this client should be: monitoring blood glucose every 4 hours and as needed. checking for the presence of ketones with each void. providing client education at every opportunity. administering insulin routinely and as needed via a sliding scale.

providing client education at every opportunity. Explanation: The nurse should use routine care responsibilities as teaching opportunities with the intention of preparing the client to understand and eventually manage his disease. Monitoring blood glucose, checking for the presence of ketones, and administering insulin are important when caring for a client with diabetes, but they aren't the priority of care.

A client with type 1 diabetes has been on a regimen of multiple daily injection therapy. He's being converted to continuous subcutaneous insulin therapy via an insulin pump. While teaching the client about continuous subcutaneous insulin therapy, the nurse should tell him that the regimen includes the use of: intermediate- and long-acting insulins. short- and long-acting insulins. rapid-acting insulin only. short- and intermediate-acting insulins.

rapid-acting insulin only. Explanation: A continuous subcutaneous insulin regimen uses a basal rate and boluses of rapid-acting insulin. Multiple daily injection therapy uses a combination of rapid-acting and intermediate- or long-acting insulins.