DIABETES

A patient is admitted with diabetes mellitus, has a glucose level of 380 mg/dl, and a moderate level of ketones in the urine. As the nurse assesses for signs of ketoacidosis, which of the following respiratory patterns would the nurse expect to find? A-Central apnea B-Hypoventilation C-Kussmaul respirations D- Cheyne-Stokes respirations"

C

A home health nurse is at the home of a client with diabetes and arthritis. The client has difficulty drawing up insulin. It would be most appropriate for the nurse to refer the client to: A) A social worker from the local hospital B) An occupational therapist from the community center C) A physical therapist from the rehabilitation agency D) Another client with diabetes mellitus and takes insulin"

B

A patient with type 2 diabetes has sensory neuropathy of the feet and legs and peripheral vascular disease evidenced by decreased peripheral pulses and dependent rubor. The nurse teaches the patient that a. the feet should be soaked in warm water on a daily basis. b. flat-soled leather shoes are the best choice to protect the feet from injury. c. heating pads should always be set at a very low temperature. d. over-the-counter (OTC) callus remover may be used to remove callus and prevent pressure.

B

During a diabetes screening program, a patient tells the nurse, "My mother died of complications of type 2 diabetes. Can I inherit diabetes?" The nurse explains that: a.) as long as the patient maintains normal weight and exercises, type 2 diabetes can be prevented. b.) the patient is at a higher than normal risk for type 2 diabetes and should have periodic blood glucose level testing. c.) there is a greater risk for children developing type 2 diabetes when the father has type 2 diabetes. d.) although there is a tendency for children of people with type 2 diabetes to develop diabetes, the risk is higher for those with type 1 diabetes."

B

Rhe goal for pre-prandial blood glucose for those with Type 1 diabetes mellitus is: a. <80 mg/dl b. < 130 mg/dl c. <180 mg/dl d. <6%

B

The guidelines for Carbohydrate Counting as medical nutrition therapy for diabetes mellitus includes all of the following EXCEPT: a. Flexibility in types and amounts of foods consumed b. Unlimited intake of total fat, saturated fat and cholesterol c. Including adequate servings of fruits, vegetables and the dairy group d. Applicable to with either Type 1 or Type 2 diabetes mellitus

B

The nurse is caring for a client who has normal glucose levels at bedtime, hypoglycemia at 2am and hyperglycemia in the morning. What is this client likely experiencing? "A. Dawn phenomenon B. Somogyi effect C. An insulin spike D. Excessive corticosteroids"

B

Risk factors for type 2 diabetes include all of the following except: a. Advanced age b. Obesity c. Smoking d. Physical inactivity"

C

The nurse is working with an overweight client who has a high-stress job and smokes. This client has just received a diagnosis of Type II Diabetes and has just been started on an oral hypoglycemic agent. Which of the following goals for the client which if met, would be most likely to lead to an improvement in insulin efficiency to the point the client would no longer require oral hypoglycemic agents? a. Comply with medication regimen 100% for 6 months b. Quit the use of any tobacco products by the end of three months c. Lose a pound a week until weight is in normal range for height and exercise 30 minutes daily d. Practice relaxation techniques for at least five minutes five times a day for at least five months

C

Which of the following diabetes drugs acts by decreasing the amount of glucose produced by the liver? a. Sulfonylureas b. Meglitinides c. Biguanides d. Alpha-glucosidase inhibitors

C

A 37-year-old forklift operator presents with shakiness, sweating, anxiety, and palpitations and tells the nurse he has type 1 diabetes mellitus. Which of the follow actions should the nurse do first? A. Inject 1 mg of glucagon subcutaneously. B. Administer 50 mL of 50% glucose I.V. C. Give 4 to 6 oz (118 to 177 mL) of orange juice. D. Give the client four to six glucose tablets.

C

A diabetic patient has a serum glucose level of 824 mg/dL (45.7 mmol/L) and is unresponsive. Following assessment of the patient, the nurse suspects diabetic ketoacidosis rather than hyperosmolar hyperglycemic syndrome based on the finding of a. polyuria b. severe dehydration c. rapid, deep respirations d. decreased serum potassium"

C

A diabetic patient is admitted with ketoacidosis and the health care provider writes all of the following orders. Which order should the nurse implement first? a. Start an infusion of regular insulin at 50 U/hr. b. Give sodium bicarbonate 50 mEq IV push. c. Infuse 1 liter of normal saline per hour. d. Administer regular IV insulin 30 U.

C

A diagnosis of hyperglycemic hyperosmolar nonketotic coma (HHNC) is made for a patient with type 2 diabetes who is brought to the emergency department in an unresponsive state. The nurse will anticipate the need to a. administer glargine (Lantus) insulin. b. initiate oxygen by nasal cannula. c. insert a large-bore IV catheter. d. give 50% dextrose as a bolus.

C

A patient received 6 units of REGULAR INSULIN 3 hours ago. The nurse would be MOST concerned if which of the following was observed? a. kussmaul respirations and diaphoresis b. anorexia and lethargy c. diaphoresis and trembling d. headache and polyuria

C

"Which of the following factors are risks for the development of diabetes mellitus? (Select all that apply.) "a) Age over 45 years b) Overweight with a waist/hip ratio >1 c) Having a consistent HDL level above 40 mg/dl d) Maintaining a sedentary lifestyle

ABD

A nurse shoud recognize which symptom as a cardinal sign of diabetes mellitus? a. Nausea b. Seizure c. Hyperactivity d. Frequent urination

D

A patient recovering from DKA asks the nurse how acidosis occurs. The best response by the nurse is that a. insufficient insulin leads to cellular starvation, and as cells rupture they release organic acids into the blood. b. when an insulin deficit causes hyperglycemia, then proteins are deaminated by the liver, causing acidic by-products. c. excess glucose in the blood is metabolized by the liver into acetone, which is acidic. d. an insulin deficit promotes metabolism of fat stores, which produces large amounts of acidic ketones.

D

A patient screened for diabetes at a clinic has a fasting plasma glucose level of 120 mg/dl (6.7 mmol/L). The nurse will plan to teach the patient about a. use of low doses of regular insulin. b. self-monitoring of blood glucose. c. oral hypoglycemic medications. d. maintenance of a healthy weight.

D

During a teaching session, the nurse tells the client that 50% to 60% of daily calories should come from carbohydrates. What should the nurse say about the types of carbohydrates that can be eaten? a. Simple carbohydrates are absorbed more rapidly than complex carbohydrates. b. Simple sugars cause a rapid spike in glucose levels and should be avoided c. Simple sugars should never be consumed by someone with diabetes. d. Try to limit simple sugars to between 10% and 20% of daily calories.

D

Prediabetes is associated with all of the following except: a. Increased risk of developing type 2 diabetes b. Impaired glucose tolerance c. Increased risk of heart disease and stroke d. Increased risk of developing type 1 diabetes

D

The benefits of using an insulin pump include all of the following except: a. By continuously providing insulin they eliminate the need for injections of insulin b. They simplify management of blood sugar and often improve A1C c. They enable exercise without compensatory carbohydrate consumption d. They help with weight loss

D

The nurse teaches the diabetic patient who rides a bicycle to work every day to administer morning insulin into the a. thigh. b. buttock. c. arm. d. abdomen.

D

You are doing some teaching with a client who is starting on a sulfonylurea antidiabetic agent. The client mentions that he usually has a couple of beers each night and takes an aspirin each day to prevent heart attack and/or strokes. Which of the following responses would be best on the part of the nurse? a. As long as you only drink two beers and take one aspirin, this should not be a problem b. The aspirin is alright but you need to give up drinking any alcoholic beverages c. Aspirin and alcohol will cause the stomach to bleed more when on a sulfonylurea drug d. Taking alcohol and/or aspirin with a sulfonylurea drug can cause development of hypoglycemia

D

"What insulin type can be given by IV? Select all that apply: "A. Glipizide (Glucotrol) B. Lispro (Humalog) C. NPH insulin D. Glargine (Lantus) E. Regular insulin

E

"What will the nurse teach the client with diabetes regarding exercise in his or her treatment program? 1. During exercise the body will use carbohydrates for energy production, which in turn will decrease the need for insulin. 2. With an increase in activity, the body will use more carbohydrates; therefore more insulin will be required. 3. The increase in activity results in an increase in the use of insulin; therefore the client should decrease his or her carbohydrate intake. 4. Exercise will improve pancreatic circulation and stimulate the islets of Langerhans to increase the production of intrinsic insulin.

1

"Which of the following is accurate pertaining to physical exercise and type 1 diabetes mellitus? "1. Physical exercise can slow the progression of diabetes mellitus. 2. Strenuous exercise is beneficial when the blood glucose is high. 3. Patients who take insulin and engage in strenuous physical exercise might experience hyperglycemia. 4. Adjusting insulin regimen allows for safe participation in all forms of exercise."

1

A nurse is caring for a cient with type 1 diabetes mellitus. which client complaint would alert the nurse to the presence of a possible hypoglycemic reaction? 1. Tremors 2. Anorexia 3. Hot, dry skin 4. Muscle cramps

1

The nurse administered 28 units of Humulin N, an intermediate-acting insulin, to a client diagnosed with Type 1 diabetes at 1600. Which action should the nurse implement? 1. Ensure the client eats the bedtime snack. 2. Determine how much food the client ate at lunch. 3. Perform a glucometer reading at 0700. 4. Offer the client protein after administering insulin.

1

A nurse is preparing a teaching plan for a client with diabetes Mellitus regarding proper foot care. Which instruction is included in the plan? 1. Soak feet in hot water 2. apply a moisturizing lotion to dry feet but not between the toes 3. Always have a podiatrist cut your toenails, never cut them yourself 4. avoid using mild soap on the feet

2

Which electrolyte replacement should the nurse anticipate being ordered by the health-care provider in the client diagnosed with DKA who has just been admitted to the ICD? 1.Glucose. 2.Potassium. 3.Calcium. 4.Sodium

2

A nurse performs a physical assessment on a client with type 2 diabetes mellitus. Findings include a fasting blood glucose of 120 mg/dL, temp of 101 F, pulse of 88 bpm, respirations of 22, and blood pressure of 100/72. Which finding would be of most concern to the nurse? 1. Pulse 2. Respiration 3. Temperature 4. Blood pressure"

3

The nurse is caring for a client with long-term Type 2 diabetes and is assessing the feet. Which assessment data would warrant immediate intervention by the nurse? 1)The client has crumbling toenails 2)The client has athlete's feet 3)The client has a necrotic big toe 4)The client has thickened toenails."

3

A client with diabetes mellitus demonstratees acute anxiety when first admitted for the treatment of hyperglycemia. The most appropriate intervention to decrease the client's anxiety would be to: 1. administer a sedative 2. make sure the client knows all the correct medical terms to understand what is happening 3. ignore the signs and symptoms of anxiety so that they will soon disappear 4. convey empathy, trust, and respect toward the client

4

Of which of the following symptoms might an older woman with diabetes mellitus complain? 1) anorexia 2)pain intolerance 3) weight loss 4) perineal itching

4

After the home health nurse has taught a patient and family about how to use glargine and regular insulin safely, which action by the patient indicates that the teaching has been successful? a. The patient disposes of the open insulin vials after 4 weeks. b. The patient draws up the regular insulin in the syringe and then draws up the glargine. c. The patient stores extra vials of both types of insulin in the freezer until needed. d. The patient's family prefills the syringes weekly and stores them in the refrigerator.

A

Cardiac monitoring is initiated for a patient in diabetic ketoacidosis (DKA). The nurse recognizes that this measure is important to identify a. electrocardiographic (ECG) changes and dysrhythmias related to hypokalemia. b. fluid overload resulting from aggressive fluid replacement. c. the presence of hypovolemic shock related to osmotic diuresis. d. cardiovascular collapse resulting from the effects of hyperglycemia.

A

When a client learned that the symptoms of diabetes were caused by high levels of blood glucose the client decided to stop eating carbohydrates. In this instance, the nurse would be concerned that the client would develop what complication? a. acidosis b. atherosclerosis c. glycosuria d. retinopathy

A

which are symptoms of hypoglycemia? A. irritability B. drowsiness c. Abdominal pain D. nausea and vomiting

A

The nurse is educating a pregnant client who has gestational diabetes. Which of the following statements should the nurse make to the client? Select all that apply. a. Cakes, candies, cookies, and regular soft drinks should be avoided. b. Gestational diabetes increases the risk that the mother will develop diabetes later in life. c. Gestational diabetes usually resolves after the baby is born. d. Insulin injections may be necessary. e. The baby will likely be born with diabetes f. The mother should strive to gain no more weight during the pregnancy.

ABCD

Analyze the following diagnostic findings for your patient with type 2 diabetes. Which result will need further assessment? A) BP 126/80 B) A1C 9% C)FBG 130mg/dL D) LDL cholesterol 100mg/dL

B

A client is admitted to the hospital with signs and symptoms of diabetes mellitus. Which findings is the nurse most likely to observe in this client? Select all that apply: 1. Excessive thirst 2. Weight gain 3. Constipation 4. Excessive hunger 5. Urine retention 6. Frequent, high-volume urination

146

"The client diagnosed with Type 1 diabetes has a glycosylated hemoglobin (A1c) of 8.1%. Which interpretation should the nurse make based on this result? 1.This result is below normal levels. 2.This result is within acceptable levels. 3.This result is above recommended levels 4.This result is dangerously high.

3

The client diagnosed with type 1 diabetes is receiving Humalog, a rapid-acting insulin, by sliding scale. The unlicensed assistive personnel (UAP) reports to the nurse the client's glucometer reading is 189. How much insulin should the nurse administer to the client?

3 units

"The nurse is discussing the importance of exercising to a client diagnosed with Type 2diabetes whose diabetes is well controlled with diet and exercise. Which informationshould the nurse include in the teaching about diabetes? 1.Eat a simple carbohydrate snack before exercising. 2.Carry peanut butter crackers when exercising. 3.Encourage the client to walk 20 minutes three (3) times a week. 4.Perform warmup and cooldown exercises

4

A client with DKA is being treated in the ED. What would the nurse suspect? 1. Comatose state 2. Decreased Urine Output 3. Increased respirations and an increase in pH. 4. Elevated blood glucose level and low plasma bicarbonate level.

4

"The nurse is caring for a patient whose blood glucose level is 55mg/dL. What is the likely nursing response? "A. Administer a glucagon injection B. Give a small meal C. Administer 10-15 g of a carbohydrate D. Give a small snack of high protein food"

C

In educating a client with diabetes, what response would reveal need for further education? A. I should avoid tights B. I should take good care of my toe nails C. I should not go more than 3 days without washing my feet D. I should avoid going barefoot and should wear clean socks

C

The nurse assisting in the admission of a client with diabetic ketoacidosis will anticipate the physician ordering which of the following types of intravenous solution if the client cannot take fluids orally? a. 0.45% normal saline solution b. Lactated Ringer's solution c. 0.9 normal saline solution d. 5% dextrose in water (D5W)

A

Which one of the following methods/techniques will the nurse use when giving insulin to a thin person? [Hint] A. Pinch the skin up and use a 90 degree angle B. Use a 45 degree angle with the skin pinched up C. Massage the area of injection after injecting the insulin D. Warm the skin with a warmed towel or washcloth prior to the injection

A

An 18-year-old female client, 5'4'' tall, weighing 113 kg, comes to the clinic for a non-healing wound on her lower leg, which she has had for two weeks. Which disease process should the nurse suspect the client is developing? A. Type 1 diabetes B. Type 2 diabetes C. Gestational diabetes D. Acanthosis nigricans"

B

Patients with type 1 diabetes mellitus may require which of the following changes to their daily routine during times of infection? a. no change b. less insulin c. more insulin d. oral diabetic agents

C

Which statement by the patient with type 2 diabetes is accurate. a. ""I am supposed to have a meal or snack if I drink alcohol"" b. ""I am not allowed to eat any sweets because of my diabetes."" c. I do not need to watch what I eat because my diabetes is not the bad kind."" d. The amount of fat in my diet is not important; it is just the carbohydrates that raise my blood sugar."""

A

A nurse is preparing a plan of care for a client with diabetes mellitus who has hyerglycemia. The priority nursing diagnosis would be: 1. Deficient knowledge 2. Deficient fluid volume 3. Compromised family coping 4. Imbalanced nutrition less than body requirements

2

Intramuscular glucagon is administered to an unresponsive patient for treatment of hypoglycemia. Which action should the nurse take after the patient regains consciousness? a. Give the patient a snack of cheese and crackers. b. Have the patient drink a glass of orange juice or nonfat milk. c. Administer a continuous infusion of 5% dextrose for 24 hours. d. Assess the patient for symptoms of hyperglycemia.

A

"The nurse is teaching a class on atherosclerosis. Which statement describes the scien-tific rationale as to why diabetes is a risk factor for developing atherosclerosis? 1.Glucose combines with carbon monoxide, instead of with oxygen, and this leads tooxygen deprivation of tissues. 2.Diabetes stimulates the sympathetic nervous system, resulting in peripheralconstriction that increases the development of atherosclerosis. 3.Diabetes speeds the atherosclerotic process by thickening the basement membraneof both large and small vessels. 4.The increased glucose combines with the hemoglobin, which causes deposits of plaque in the lining of the vessels.

3

A client is brought to the emergency department in an unresponsive state, and a diagnosis of hyperglycemic hyperosmolar nonketotic syndrome is made. The nurse would immediately prepare to initiate which of the following anticipated physician's prescriptions? 1. Endotracheal intubation 2. 100 units of NPH insulin 3. Intravenous infusion of normal saline 4. Intravenous infusion of sodium bicarbonate

3

A client with type I diabetes is placed on an insulin pump. The most appropriate short-term goal when teaching this client to control the diabetes is: 1) adhere to the medical regimen 2) remain normoglycemic for 3 weeks 3) demonstrate the correct use of the administration equipment. 4) list 3 self care activities that are necessary to control the diabetes"

3

The client diagnosed with Type I diabetes is found lying unconscious on the floor of the bathroom. Which interventions should the nurse implement first? A. Administer 50% dextrose IVP. B. Notify the health-care provider. C. Move the client to ICD. D. Check the serum glucose level.

A

"The risk factors for type 1 diabetes include all of the following except: "a. Diet b. Genetic c. Autoimmune d. Environmental"

A

"When assessing the patient experiencing the onset of symptoms of type 1 diabetes, which question should the nurse ask? a. ""Have you lost any weight lately?"" b. ""Do you crave fluids containing sugar?"" c. ""How long have you felt anorexic?"" d. ""Is your urine unusually dark-colored?""

A

A 63-year-old patient is newly diagnosed with type 2 diabetes. When developing an education plan, the nurse's first action should be to a. assess the patient's perception of what it means to have type 2 diabetes. b. demonstrate how to check glucose using capillary blood glucose monitoring. c. ask the patient's family to participate in the diabetes education program. d. discuss the need for the patient to actively participate in diabetes management.

A

A client who is started on metformin and glyburide would have initially presented with which symptoms? a. Polydispisa, polyuria, and weight loss b. weight gain, tiredness, & bradycardia c. irritability, diaphoresis, and tachycardia d. diarrhea, abdominal pain, and weight loss

A

A client with diabetes melllitus has a blood glucose of 644mg/dl. The nurse intreprets that this client is most at risk of developing which type of acid base imbalance? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory Acidosis D. Respiratory Alkalosis"

A

A patient newly diagnosed with Type I DM is being seen by the home health nurse. The doctors orders include: 1200 calorie ADA diet, 15 units NPH insulin before breakfast, and check blood sugar qid. When the nurse visits the patient at 5 pm, the nurse observes the man performing blood sugar analysis. The result is 50 mg/dL. The nurse would expect the patient to be a. confused with cold, clammy skin an pulse of 110 b. lethargic with hot dry dkin and rapid deep respirations c. alert and cooperative with BP of 130/80 and respirations of 12 d. short of breath, with distended neck veins and bounding pulse of 96.

A

A patient using a split mixed-dose insulin regimen asks the nurse about the use of intensive insulin therapy to achieve tighter glucose control. The nurse should teach the patient that a. intensive insulin therapy requires three or more injections a day in addition to an injection of a basal long-acting insulin. b. intensive insulin therapy is indicated only for newly diagnosed type 1 diabetics who have never experienced ketoacidosis. c. studies have shown that intensive insulin therapy is most effective in preventing the macrovascular complications characteristic of type 2 diabetes. d. an insulin pump provides the best glucose control and requires about the same amount of attention as intensive insulin therapy.

A

A patient with type 1 diabetes has been using self-monitoring of blood glucose (SMBG) as part of diabetes management. During evaluation of the patient's technique of SMBG, the nurse identifies a need for additional teaching when the patient a. chooses a puncture site in the center of the finger pad. b. washes the puncture site using soap and water. c. says the result of 130 mg indicates good blood sugar control. d. hangs the arm down for a minute before puncturing the site.

A

A patient with type 2 diabetes that is controlled with diet and metformin (Glucophage) also has severe rheumatoid arthritis (RA). During an acute exacerbation of the patient's arthritis, the health care provider prescribes prednisone (Deltasone) to control inflammation. The nurse will anticipate that the patient may a. require administration of insulin while taking prednisone. b. develop acute hypoglycemia during the RA exacerbation. c. have rashes caused by metformin-prednisone interactions. d. need a diet higher in calories while receiving prednisone.

A

Amitriptyline (Elavil) is prescribed for a diabetic patient with peripheral neuropathy who has burning foot pain occurring mostly at night. Which information should the nurse include when teaching the patient about the new medication? a. Amitriptyline will help prevent the transmission of pain impulses to the brain. b. Amitriptyline will improve sleep and make you less aware of nighttime pain. c. Amitriptyline will decrease the depression caused by the pain. d. Amitriptyline will correct some of the blood vessel changes that cause pain.

A

An external insulin pump is prescribed for a client with DM. The client asks the nurse about the functioning of the pump. The nurse bases the response on the information that the pump: a. Gives small continuous dose of regular insulin subcutaneously, and the client can self-administer a bolus with an additional dosage from the pump before each meal. b. Is timed to release programmed doses of regular or NPH insulin into the bloodstream at specific intervals. c. Is surgically attached to the pancreas and infuses regular insulin into the pancreas, which in turn releases the insulin into the bloodstream. d. Continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels"

A

Blood sugar is well controlled when Hemoglobin A1C is... a. Below 7% b. Between 12%-15% c. Less than 180 mg/dL d. Between 90 and 130 mg/dL"

A

While hospitalized and recovering from an episode of diabetic ketoacidosis, the patient calls the nurse and reports feeling anxious, nervous, and sweaty. Based on the patient's report, the nurse should a. obtain a glucose reading using a finger stick. b. administer 1 mg glucagon subcutaneously. c. have the patient eat a candy bar. d. have the patient drink 4 ounces of orange juice.

A

The nurse is educating a pregnant client who has gestational diabetes. Which of the following statements should the nurse make to the client? Select all that apply. "a. Cakes, candies, cookies, and regular soft drinks should be avoided. b. Gestational diabetes increases the risk that the mother will develop diabetes later in life. c. Gestational diabetes usually resolves after the baby is born. d. Insulin injections may be necessary. e. The baby will likely be born with diabetes f. The mother should strive to gain no more weight during the pregnancy.

ABCD

One of the benefits of Glargine (Lantus) insulin is its ability to: a. Release insulin rapidly throughout the day to help control basal glucose. b. Release insulin evenly throughout the day and control basal glucose levels. c. Simplify the dosing and better control blood glucose levels during the day. d. Cause hypoglycemia with other manifestation of other adverse reactions.

B

A patient with type 1 diabetes who uses glargine (Lantus) and lispro (Humalog) insulin develops a sore throat, cough, and fever. When the patient calls the clinic to report the symptoms and a blood glucose level of 210 mg/dl, the nurse advises the patient to a. use only the lispro insulin until the symptoms of infection are resolved. b. monitor blood glucose every 4 hours and notify the clinic if it continues to rise. c. decrease intake of carbohydrates until glycosylated hemoglobin is less than 7%. d. limit intake to non-calorie-containing liquids until the glucose is within the usual range.

B

A patient with type 2 diabetes is scheduled for an outpatient coronary arteriogram. Which information obtained by the nurse when admitting the patient indicates a need for a change in the patient's regimen? a. The patient's most recent hemoglobin A1C was 6%. b. The patient takes metformin (Glucophage) every morning. c. The patient uses captopril (Capoten) for hypertension. d. The patient's admission blood glucose is 128 mg/dl.

B

"A client is taking Humulin NPH insulin daily every morning. The nurse instructs the client that the mostlikely time for a hypoglycemic reaction to occur is: A) 2-4 hours after administration B) 4-12 hours after administration C) 16-18 hours after administration D) 18-24 hours after administration

B

A 1200-calorie diet and exercise are prescribed for a patient with newly diagnosed type 2 diabetes. The patient tells the nurse, "I hate to exercise! Can't I just follow the diet to keep my glucose under control?" The nurse teaches the patient that the major purpose of exercise for diabetics is to a. increase energy and sense of well-being, which will help with body image. b. facilitate weight loss, which will decrease peripheral insulin resistance. c. improve cardiovascular endurance, which is important for diabetics. d. set a successful pattern, which will help in making other needed changes.

B

A diabetic patient is started on intensive insulin therapy. The nurse will plan to teach the patient about mealtime coverage using _____ insulin. a. NPH b. lispro c. detemir d. glargine

B

A newly diagnosed type 1 diabetic patient likes to run 3 miles several mornings a week. Which teaching will the nurse implement about exercise for this patient? a. "You should not take the morning NPH insulin before you run." b. "Plan to eat breakfast about an hour before your run." c. "Afternoon running is less likely to cause hypoglycemia." d. "You may want to run a little farther if your glucose is very high."

B

A patient with newly diagnosed type 2 diabetes mellitus asks the nurse what ""type 2"" means in relation to diabetes. The nurse explains to the patient that type 2 diabetes differs from type 1 diabetes primarily in that with type 2 diabetes: a. the pt is totally dependent on an outside source of insulin b. there is a decreased insulin secretion and cellular resistance to insulin that is produced c. the immune system destroys the pancreatic insulin-producing cells d. the insulin precurosr that is secreted by the pancreas is not activated by the liver

B

Which of the following things must the nurse working with diabetic clients keep in mind about Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS)? A. This syndrome occurs mainly in people with Type I Diabetes B. It has a higher mortality rate than Diabetic Ketoacidosis C. The client with HHNS is in a state of overhydration D. This condition develops very rapidly

B

Which of these laboratory values noted by the nurse when reviewing the chart of a diabetic patient indicates the need for further assessment of the patient? a. Fasting blood glucose of 130 mg/dl b. Noon blood glucose of 52 mg/dl c. Glycosylated hemoglobin of 6.9% d. Hemoglobin A1C of 5.8%

B

"The nurse is working with an overweight client who has a high-stress job and smokes. This client has just received a diagnosis of Type II Diabetes and has just been started on an oral hypoglycemic agent. Which of the following goals for the client which if met, would be most likely to lead to an improvement in insulin efficiency to the point the client would no longer require oral hypoglycemic agents? "a. Comply with medication regimen 100% for 6 months b. Quit the use of any tobacco products by the end of three months c. Lose a pound a week until weight is in normal range for height and exercise 30 minutes daily d. Practice relaxation techniques for at least five minutes five times a day for at least five months"

C

"Which of the following persons would most likely be diagnosed with diabetes mellitus? A 44-year-old.. A. Caucasian Woman B. Asian Woman C. African-American woman D. Hispanic Male

C

A client is brought to the emergency room in an unresponsive state, and a diagnosis of hyperglycemic hyperosmolar nonketotic syndrome is made. The nurse would immediately prepare to initiate which of the following anticipated physician's orders? a) endotracheal intubation b) 100 units of NPH insulin c) intravenous infusion of normal saline d) intravenous infusion of sodium bicarbonate

C

A patient who has just been diagnosed with type 2 diabetes is 5 ft 4 in (160 cm) tall and weighs 182 pounds (82 kg). A nursing diagnosis of imbalanced nutrition: more than body requirements is developed. Which patient outcome is most important for this patient? a. The patient will have a diet and exercise plan that results in weight loss. b. The patient will state the reasons for eliminating simple sugars in the diet. c. The patient will have a glycosylated hemoglobin level of less than 7%. d. The patient will choose a diet that distributes calories throughout the day.

C

A type 1 diabetic patient who was admitted with severe hypoglycemia and treated tells the nurse, "I did not have any of the usual symptoms of hypoglycemia." Which question by the nurse will help identify a possible reason for the patient's hypoglycemic unawareness? a. "Do you use any calcium-channel blocking drugs for blood pressure?" b. "Have you observed any recent skin changes?" c. "Do you notice any bloating feeling after eating?" d. "Have you noticed any painful new ulcerations or sores on your feet?"

C

The nurse is having difficulty obtaining a capillary blood sample from a client's finger to measure blood glucose using a blood glucose monitor. Which procedure will increase the blood flow to the area to ensure an adequate specimen? a. Raise the hand on a pillow to increase venous flow. b. Pierce the skin with the lancet in the middle of the finger pad. c. Wrap the finger in a warm cloth for 30-60 seconds. d. Pierce the skin at a 45-degree angle.

C

"The nurse caring for a 54-year-old patient hospitalized with diabetes mellitus would look for which of the following laboratory test results to obtain information on the patient's past glucose control? a. prealbumin level b. urine ketone level c. fasting glucose level d. glycosylated hemoglobin level

D

"The principal goals of therapy for older patients who have poor glycemic control are: "A. Enhancing quality of life. B. Decreasing the chance of complications. C. Improving self-care through education. D. All of the above."

D

A college student who has type 1 diabetes normally walks each evening as part of an exercise regimen. The student now plans to take a swimming class every day at 1:00 PM. The clinic nurse teaches the patient to a. delay eating the noon meal until after the swimming class. b. increase the morning dose of neutral protamine Hagedorn (NPH) insulin on days of the swimming class. c. time the morning insulin injection so that the peak occurs while swimming. d. check glucose level before, during, and after swimming.

D

A frail elderly patient with a diagnosis of type 2 diabetes mellitus has been ill with pneumonia. The cliet's intake has been very poor, and she is admitted to the hospital for observation and management as needed. What is the most likely problem with this patient? A. Insulin resistance has developed. B. Diabetic ketoacidosis is occuring. C. Hypoglycemia unawareness is developing. D. Hyperglycemic hyperosmolar non-ketotic coma.

D

A hospitalized diabetic patient receives 12 U of regular insulin mixed with 34 U of NPH insulin at 7:00 AM. The patient is away from the nursing unit for diagnostic testing at noon, when lunch trays are distributed. The most appropriate action by the nurse is to a. save the lunch tray to be provided upon the patient's return to the unit. b. call the diagnostic testing area and ask that a 5% dextrose IV be started. c. ensure that the patient drinks a glass of milk or orange juice at noon in the diagnostic testing area. d. request that the patient be returned to the unit to eat lunch if testing will not be completed promptly.

D

A patient with type 1 diabetes has received diet instruction as part of the treatment plan. The nurse determines a need for additional instruction when the patient says, a. ""I may have an occasional alcoholic drink if I include it in my meal plan."" b. ""I will need a bedtime snack because I take an evening dose of NPH insulin."" c. ""I will eat meals as scheduled, even if I am not hungry, to prevent hypoglycemia."" d. ""I may eat whatever I want, as long as I use enough insulin to cover the calories.

D

A patient with type 1 diabetes has received diet instruction as part of the treatment plan. The nurse determines a need for additional instruction when the patient says, a. "I may have an occasional alcoholic drink if I include it in my meal plan." b. "I will need a bedtime snack because I take an evening dose of NPH insulin." c. "I will eat meals as scheduled, even if I am not hungry, to prevent hypoglycemia." d. "I may eat whatever I want, as long as I use enough insulin to cover the calories."

D

A program of weight loss and exercise is recommended for a patient with impaired fasting glucose (IFG). When teaching the patient about the reason for these lifestyle changes, the nurse will tell the patient that a. the high insulin levels associated with this syndrome damage the lining of blood vessels, leading to vascular disease. b. although the fasting plasma glucose levels do not currently indicate diabetes, the glycosylated hemoglobin will be elevated. c. the liver is producing excessive glucose, which will eventually exhaust the ability of the pancreas to produce insulin, and exercise will normalize glucose production. d. the onset of diabetes and the associated cardiovascular risks can be delayed or prevented by weight loss and exercise.

D

An adolescent client with type I diabetes mellitus is admitted to the emergency department for treatment of diabetic ketoacidosis. Which assessment findings should the nurse expect to note? a) sweating and tremors b) hunger and hypertension c) cold, clammy skin and irritability d) fruity breath and decreasing level of consciousness

D

An external insulin pump is prescribed for a client with diabetes mellitus and the client asks the nurse about the functioning of the pump. The nurse bases the response on the information that the pump: a) is timed to release programmed doses of regular or NPH insulin into the bloodstream at specific intervals b) continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels c) is surgically attached to the pancreas and infuses regular insulin into the pancreas, which in turn releases the insulin into the bloodstream d) gives a small continuously dose of regular insulin subcutaneously, and the client can self-administer a bolus with an additional dose form the pump before each meal

D

Proliferative retinopathy is often treated using: a. Tonometry b. Fluorescein angiogram c. Antibiotics d. Laser surgery

D

The nurse working in the physician's office is reviewing lab results on the clients seen that day. One of the clients who has classic diabetic symptoms had an eight-hour fasting plasma glucose test done. The nurse realizes that diagnostic criteria developed by the American Diabetes Association for diabetes include classic diabetic symptoms plus which of the following fasting plasma glucose levels? a. Greater than 106 mg/dl b. Greater than 126 mg/dl c. Higher than 140 mg/dl d. Higher than 160 mg/dl

D

When taking a health history, the nurse screens for manifestations suggestive of diabetes type I. Which of the following manifestations are considered the primary manifestations of diabetes type I and would be most suggestive of diabetes type I and require follow-up investigation? a. Excessive intake of calories, rapid weight gain, and difficulty losing weight b. Poor circulation, wound healing, and leg ulcers, c. Lack of energy, weight gain, and depression d. An increase in three areas: thirst, intake of fluids, and hunger

D

When working in the community, the nurse will recommend routine screening for diabetes when the person has one or more of seven risk criteria. Which of the following persons that the nurse comes in contact with most needs to be screened for diabetes based on the seven risk criteria? a. A woman who is at 90% of standard body weight after delivering an eight-pound baby b. A middle-aged Caucasian male c. An older client who is hypotensive d. A client with an HDL cholesterol level of 40 mg/dl and a triglyceride level of 300 mg/dl

D

client newly diagnosed with diabetes mellitus has been stabilized with daily insulin injections. A nurse prepares a discharge teaching plan regarding the insulin and plans to reinforce which of the following concepts? a) always keep insulin vials refrigerated b) ketones in the urine signify a need for less insulin c) increase the amount of insulin before unusual exercise d) systematically rotate insulin injections within one anatomic site

D