Diabetes (Adult and Pediatric)
A nurse is providing discharge teaching to a client who experienced DKA. which of the following should the nurse include in teaching? (select all that apply) A. Drink 3 L of fluids daily B. Monitor blood glucose every 4hr when ill C. Administer insulin as prescribed when ill D. Notify the provider when blood glucose is 200 mg/dL E. Report ketones in the urine after 24 hr of illness
A. drink 3 L of fluids daily B. monitor blood glucose every 4hr when ill C. admin insulin as prescribed when ill E. report ketones in urine after 24 hr of illness Drinking 3L of fluids daily may prevent dehydration if client develops DKA. Blood glucose tends to increase during illness so monitor often. Illness often causes blood glucose to increase. Administer regular doses of insulin. The provider should be notified if there are ketones in urine after 24 hr of illness. Notify the provider when blood glucose is greater than 240 mg/dL, not 200 mg/dL
An adolescent with diabetes receives 30 units of Humulin N insulin at 7:00 a.m. The nurse would monitor for a hypoglycemic episode at what time? a. At bedtime b. At midmorning c. Before supper d. After breakfast
C. Before supper
The nurse checks on her patient who is diaphoretic, shaking, and is not making sense. What is the nurse's priority? A. Administer insulin B. Call the physician C. Administer glucagon D. Check the patient's blood sugar
D •Always assess!!!! CHECK THE BLOOD SUGAR!!!!
An insulin pump can be programmed to deliver a bolus: a) to cover food or a high BG b) to cover exercise or treat low blood sugar c) to cover exercise or treat high blood sugar
a - to cover food or a high BG
The nurse at a community health care clinic is teaching parents about measures to take take to prevent and manage obesity in children. The nurse determines that the parents need additional teaching if they indicate that they will implement which measures? (pg 292 q 606) Select all that apply. a. Use foods as a reward. b. Offer options of healthy foods. c. Avoid eating at fast-food restaurants. d. Keep unhealthy food out of the house. e. Allow eating times in between meals and snack times. f. Establish consistent times for meals and snacks.
a and e
The clinic nurse instructs a client with diabetes mellitus about how to prevent diabetic ketoacidosis on days when the client is feeling ill. Which statement by the client indicates the need for further instructions? (pg 303 q 631) a. "I need to stop my insulin if I am vomiting." b. "I need to eat 10 to 15 g of carbohydrates every 1 to 2 hours." c. "I need to call my physician if I am ill for more than 24 hours." d. "I need to drink small quantities of fluid every 14 to 30 minutes. "
a. "I need to stop my insulin if I am vomiting." Rationale: The client needs to be instructed to take insulin, even if he or she is vomiting, and unable to eat.
The nurse is reviewing home care instructions with an older client who has type 1 diabetes mellitus and a history of diabetic ketoacidosis (DKA). The client's spouse is present when the instructions are given. Which statement by the spouse indicates that further teaching is necessary? (pg. 341 q 726) a. "If he is vomiting, I shouldn't give him any insulin." b. "I should bring him to the physician's office if he develops a fever." c. "If the grandchildren are sick, they probably shouldn't come to visit." d. "I should call the doctor if he has nausea or abdominal pain lasting for more than 1 or 2 days."
a. "If he is vomiting, I shouldn't give him any insulin."
A with diabetes mellitus receives Humulin R regular insulin 8 units subcutaneously at 7:30 am. The nurse should be most alert to signs of hypoglycemia at what time during the day? (pg. 184 q 370) a 9:30 am to 11:30am b. 11:30 am to 1:30 pm c. 1:30 pm to 3:30 pm d. 330 pm to 5:30pm
a. 9:30 am to 11:30 am Rationale: Humulin R regular insulin is a short-acting insulin. Its onset of action occurs in a half hour and peaks in 2 - 4 hours. Its duration of action is 4 - 6 hours. A hypoglycemic reaction will most likely occur at peak time, which in this situation is between 9:30 am and 11:30 am.
A client with diabetes mellitus has a blood glucose level of 644 mg/dL. The nurse interprets 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. Metabolic acidosis Rationale: Diabetes mellitus can lead to metabolic acidosis. When the body does not have sufficient circulating insulin, the blood glucose level rises. At the same time the cells of the body use all available glucose. The body then breaks down glycogen and fat for fuel. The by-products of fat metabolism are acidotic and can lead to the condition knows as diabetic ketoacidosis.
The nurse provides information to a client with diabetes mellitus who is taking insulin about the manifestations of hypoglycemia. Which manifestations should the nurse include in the information? Select all that apply. (pg 188, q 381) a. Hunger b. Sweating c. Weakness d. Nervousness e. Cool, clammy skin f. Increased urinary output
a. b. c. d. e
The nurse is instructing a client with type 1 diabetes mellitus about the management of hypoglycemic reactions. The nurse instructs the client that hypoglycemia most likely occurs during what time interval after insulin administration? (pg 354 q 758) a. peak b. onset c. duration d. anytime
a. peak Rationale: Insulin reactions are most likely to occur during the peak time after insulin administration, when the medication is at its maximum action. Peak action depends on the type of insulin, the amount administered, the injection site, and other factors.
A nurse is teaching a client who had been newly diagnosed with diabetes mellitus about blood glucose monitoring. The nurse teaches the client to report glucose levels that consistently exceed which level? (pg 337, q 716) a. 150 mg/dL b. 200 mg/dL c. 250 mg.dL d. 350 mg/dL
c. 250 mg/dL Rationale: The normal blood glucose level ranges from 70 - 110 mg/dL.
During illness you should check for ketones: a) every 2 hours b) every 4 hours c) every time you urinate
c. every time you urinate
A child has fluid volume deficit. The nurse performs an assessment and determines that the child is improving and the deficit is resolving if which finding is noted? a. The child has no tears. b. Urine specific gravity is 1.030. c. Urine output is less than 1 ml/kg/hour. d. Capillary refill is less than 2 seconds.
d. Capillary refill is less than 2 seconds.
The nurse is monitoring a client who was diagnosed with type 1 diabetes mellitus and is being treated with NPH and regular insulin. Which client complaints would alert the nurse to the presence of a possible hypoglycemic reaction? Select all that apply. A. Tremors B. Anorexia C. Irritability D. Nervousness E. Hot, dry skin F. Muscle cramps
A, C, D Decreased blood glucose levels produce autonomic nervous system symptoms, which are manifested classically as nervousness, irritability, and tremors. Option E is more likely to occur with hyperglycemia. Options B and F are unrelated to the signs of hypoglycemia. In hypoglycemia, usually the client feels hunger.
A client arrives in the hospital emergency department in an unconscious state. As reported by the spouse, the client has diabetes mellitus and began to show symptoms of hypoglycemia. A blood glucose level is obtained for the client, and the result is 40 mg/dl. Which medication should the nurse anticipate to be prescribed for the client? A. Glucagon B. Humulin N insulin C. Humulin R insulin D. Glyburide
A A blood glucose lower that 50 mg/dL is considered to be critically low. Glucagon is used to treat hypoglycemia because it increases blood glucose levels. Humulin N insulin and Humulin R insulin would lower the client's blood glucose and would not be an appropriate treatment for hypoglycemia. Glyburide is an oral hypoglycemic agent used to treat type 2 diabetes mellitus and would not be given to a client with hypoglycemia. Additionally, an oral medication would not be administered to an unconscious client.
The nurse is reviewing laboratory results for the clinic patients to be seen today. Which patient meets the diagnostic criteria for diabetes mellitus? A. A 48-yr-old woman with a hemoglobin A1C of 8.4% B. A 58-yr-old man with a fasting blood glucose of 111 mg/dL C. A 68-yr-old woman with a random plasma glucose of 190 mg/dL D. A 78-yr-old man with a 2-hour glucose tolerance plasma glucose of 184 mg/dL
A Criteria for a diagnosis of diabetes mellitus include a hemoglobin A1C of 6.5% or greater, fasting plasma glucose level of 126 mg/dL or greater, 2-hour plasma glucose level of 200 mg/dL or greater during an oral glucose tolerance test, or classic symptoms of hyperglycemia or hyperglycemic crisis with a random plasma glucose of 200 mg/dL or greater.
The nurse administers 30 units of NPH insulin at 7:00 am to a client with a blood glucose level of 200 mg/dl. The nurse monitors the client for a hypoglycemic reaction, knowing that NPH insulin peaks in approximately how many hours following administration? (pg 574 q 1264) a. 1 hour b. 2 to 3 hours c. 4 to 12 hours d. 16 to 24 hours
c. 4 to 12 hours Rationale: NPH is an intermediate-acting insulin with a peak time in 4 to 12 hours.
A nurse is preparing to administer the morning doses of glargine (Lantus) insulin and regular (Humulin R) insulin to a client who has a blood glucose of 278 mg/dL. Which of the following is an appropriate nursing action? A. Draw up the regular insulin and then the glargine insulin in the same syringe. B. Draw up the glargine insulin then the regular insulin in the same syringe. C. Draw up and administer regular and glargine insulin in separate syringes. D. Administer the regular insulin, wait 1 hr, and then administer the glargine insulin.
A. INCORRECT: These insulins are not compatible. They should not be drawn up in the same syringe. B. INCORRECT: These insulins are not compatible. They should not be drawn up in the same syringe. C. CORRECT: Administer each insulin as a separate injection. These insulins are not compatible and should not be drawn up in the same syringe. D. INCORRECT: These insulins should be administered at the same time. Regular insulin is short‑acting and should lower the blood glucose level in a short period of time. Glargine insulin is long‑acting and administered once a day
A nurse is reviewing the laboratory findings for a client who has hyperglycemic hyperosmolar state (HHS). Which of the following is an expected finding for this client? A. Serum sodium 143 mEq/L B. Serum Glucose 635 mg/dL C. Serum BUN 15 mg/dL D. Serum pH. 7.35
A. INCORRECT: This finding is within the expected reference range. An expected finding for a client who has HHS is an elevated serum sodium due to dehydration. B. CORRECT: Extreme hyperglycemia is an expected finding for a client who has HHS. C. INCORRECT: This finding is within the expected reference range. An elevated BUN is an expected finding for a client who has HHS. D. INCORRECT: A pH greater than 7.4 is an expected finding for a client who has HHS>
A nurse is reviewing sick day management with a parent of a child who has type 1 diabetes mellitus. Which of the following should the nurse include in the teaching? (Select all that apply.) (ATI) A. Monitor blood glucose levels every 3 hr. B. Discontinue taking insulin until feeling better. C. Drink 8 oz of fruit juice every hour. D. Test urine for ketones. E. Call the health care provider if blood glucose is greater than 240 mg/dL.
A. Monitor blood glucose levels every 3 hr. D. Test urine for ketones. E. Call the health care provider if blood glucose is greater than 240 mg/dL.
The nurse is preparing a plan of care for a client with diabetes mellitus who has hyperglycemia. The nurse places highest priority on which client problem? A. Lack of knowledge B. Inadequate fluid volume C. Compromised family coping D. Inadequate consumption of nutrients
B An increased blood glucose level will cause the kidneys to excrete the glucose in the urine. This glucose is accompanied by fluids and electrolytes, causing an osmotic diuresis leading to dehydration. This fluid loss must be replaced when it becomes severe. Options A, C, and D are not related specifically to the subject of the question
A nurse is preparing a teaching plan for a client with diabetes mellitus regarding proper foot care. Which instruction is included in the plan? A. Soak feet in hot water B. Apply a moisturizing lotion to dry feet but not between the toes C. Always have a podiatrist cut your toenails, never cut them yourself D. Avoid using mild soap on the feet
B Applying lotion between the toes can create moisture and can increase the risk of a fungal infection
The nurse has taught a patient admitted with diabetes principles of foot care. The nurse evaluates that the patient understands the principles of foot care if the patient makes what statement? A. "I should only walk barefoot in nice dry weather." B. "I should look at the condition of my feet every day." C. "I am lucky my shoes fit so nice and tight because they give me firm support." D. "When I am allowed up out of bed, I should check the shower water with my toes."
B Patients with diabetes mellitus need to inspect their feet daily for broken areas that are at risk for infection and delayed wound healing. Properly fitted (not tight) shoes should be worn at all times. Water temperature should be tested with the hands first.
A nurse is teaching an adolescent who has diabetes about clinical manifestations of hypoglycemia. Which of the following should be included int he teaching? (Select all that apply.) (ATI) A. Increased urination B. Hunger C. Signs of dehydration D. Irritability E. Sweating and pallor F. Kussmaul respirations
B. Hunger D. Irritability E. Sweating and pallor
A child's fasting blood glucose levels range between 100 and 120 mg/dL (5.7 and 6.9 mmol/L) daily. The before-dinner blood glucose levels are between 120 and 130 mg/dL (6.9 and 7.4 mmol/L), with no reported episodes of hypoglycemia. Mixed insulin is administered before breakfast and before dinner. The nurse should make which interpretation about these findings? a. Exercise should be increased to reduce blood glucose levels. b. Insulin doses are appropriate for food ingested and activity level. c. Dietary needs are being met for adequate growth and development. d. Dietary intake should be increased to avoid hypoglycemic reactions.
B. Insulin doses are appropriate for food ingested and activity level.
A nurse is reviewing laboratory reports of a client who has hyperglycemic-hyperosmolar state (HHS). Which of the following is an expected finding? A. Serum pH 7.2 B. Serum osmolarity 350 mOsm/L C. Serum potassium 3.8 mg/dL D. Serum creatinine 0.8 mg/dL
B. Serum Osmolarity 350 mOsm/L a client who has HHS would have a serum osmolarity greater than 320 mOsm/L pH of 7.2 is an indication of DKA. Potassium 3.8 is within expected reference range. A client who has HHS would have decreased potassium due to diuresis. Creatinine 0.8 is within range. A client who has HHS would have a level greater than 1.5 mg/dL
A nurse is assessing a client who has DKA and ketones in the urine. Which of the following are expected findings? (select all that apply) A. Weight gain B. fruity odor of breath C. Abdominal pain D. Kussmaul Respirations E. Metabolic acidosis
B. fruity odor of breath C. abdominal pain D. Kussmaul Respirations E. metabolic acidosis Fruity odor of breath is a manifestation of elevated ketone levels. Abdominal pain is a GI manifestation of increased ketones and acidosis. Kussmaul respirations are an attempt to excrete carbon dioxide and acid when in metabolic acidosis. Metabolic acidosis is caused from glucose, protein, and fat breakdown, which produces ketones
A nurse is caring for a child who has type 1 diabetes. Which of the following is a clinical manifestation of diabetic ketoacidosis? (Select all that apply.) (ATI) A. Blood glucose 58 mg/dL B. Weight gain C. Dehydration D. Mental confusion E. Fruity breath
C. Dehydration D. Mental confusion E. Fruity breath
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 which information about the pump? A. Is timed to release programmed doses of short-duration 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 continuous dose of short-duration insulin subcutaneously, and the client can self-administer a bolus with an additional dose from the pump before each meal
D An insulin pump provides a small continuous dose of short-duration (rapid or short-acting) insulin subcutaneously throughout the day and night, and the client can self-administer a bolus with an additional dose from the pump before each meal as needed. Short-duration insulin is used in an insulin pump. An external pump is not attached surgically to the pancreas.
The home care nurse is visiting a child newly diagnosed with diabetes mellitus. The nurse is instructing the child and parents regarding actions to take if hypoglycemic reactions occur. The nurse should tell the child to take which action? a. Administer glucagon immediately if shakiness is felt. b. Drink 8 ounces of diet cola at the first sign of weakness. c. Report to a hospital emergency department if the blood glucose is 60 mg/dL. d. Carry hard candies whenever leaving home in case a hypoglycemic reaction occurs
D. Carry hard candies whenever leaving home in case a hypoglycemic reaction occurs.
An adolescent with type 1 diabetes mellitus has been chosen for the school's cheerleading squad. The adolescent visits the school nurse to obtain information regarding adjustments needed in the treatment plan for diabetes. What should the school nurse instruct the student to do? a. Eat half the amount of food normally eaten. b. Take two times the amount of prescribed insulin on practice and game days. c. Eat six graham crackers or drink a cup of orange juice prior to practice or game time. d. Take the prescribed insulin 1 hour prior to practice or game time rather than in the morning.
c. Eat six graham crackers or drink a cup of orange juice prior to practice or game time.
The nurse in an outpatient diabetes clinic is monitoring a client with type 1 diabetes mellitus. Today's blood work reveals a glycosylated hemoglobin level of 10%(hgb A1C). The nurse creates a teaching plan on the basis of the understanding that this result indicates which of the following? (pg 354 q 757) a. A normal value that indicate the client is managing blood glucose control well. b. A value that does not offer information regarding the client's management of the disease. c. A low value that indicates that the client is not managing blood glucose control very well. d. A high value that indicates that the client is not managing blood glucose control very well.
d. A high value that indicates that the client is not managing blood glucose control very well. Rationale: The glycosylated hemoglobin level should be at 7%. or less.
A school-age child with type 1 diabetes mellitus has soccer practice and the school nurse provides instructions regarding how to prevent hypoglycemia during practice. Which should the school nurse tell the child to do? a. Eat twice the amount normally eaten at lunchtime. b. Take half the amount of prescribed insulin on practice days. c. Take the prescribed amount insulin at noontime rathe than in the morning. d. Eat a small box of raisins or drink a cup of orange juice before soccer practice.
d. Eat a small box of raisins or drink a cup of orange juice before soccer practice.
The home health nurse visits a client with a diagnosis of type 1 diabetes mellitus. The client relates a history of vomiting and diarrhea and tells the nurse that no food has been consumed for the last 24 hours. Which additional statement by the client indicates a need for further teaching? A. "I need to stop my insulin." B. "I need to increase my fluid intake." C. "I need to monitor my blood glucose every 3 to 4 hours." D. "I need to call the health care provider (HCP) because of these symptoms."
A When a client with diabetes mellitus is unable to eat normally because of illness, the client still should take the prescribed insulin or oral medication. The client should consume additional fluids and should notify the HCP. The client should monitor the blood glucose level every 3 to 4 hours. The client should also monitor the urine for ketones.
A nurse is presenting information to a group of clients about nutrition habits that prevent type 2 diabetes mellitus. Which of the following should the nurse include in the information? (Select all that apply.) A. Eat less meat and processed foods. B. Decrease intake of saturated fats. C. Increase daily fiber intake. D. Limit saturated fat intake to 15% of daily caloric intake. E. Include omega-3 fatty acids in the diet.
A. CORRECT: Healthy nutrition should include decreasing the consumption of meats and processed foods, which can prevent diabetes and hyperlipidemia. B. CORRECT: Healthy nutrition should include lowering LDL by decreasing intake of saturated fats, which can prevent diabetes and hyperlipidemia. C. CORRECT: Healthy nutrition should include increasing dietary fiber to control weight gain and decrease the risk of diabetes and hyperlipidemia. D. INCORRECT: The recommendation for saturated fat intake is no more than 7% of total daily caloric intake. E. CORRECT: Healthy nutrition should include omega-3 fatty acids for secondary prevention of diabetes and heart disease.
A nurse is teaching foot care to a client who has diabetes mellitus. Which of the following information should the nurse include in the teaching? (Select all that apply.) A. Remove calluses using over-the-counter remedies. B. Apply lotion between toes. C. Perform nail care after Bathing. D. Trim toenails straight across. E Wear closed-toe shoes
A. INCORRECT: A podiatrist should remove calluses or corns. Commercial over-the-counter remedies can increase the risk for tissue injury and an infection. B. INCORRECT: Applying lotion between the toes increases moisture for growth of micro-organisms, which can lead to infection C. CORRECT: Perform nail care after bathing, when toe natils are soft and easier to trim. D. CORRECT: Trim toenails straight across to prevent injury to soft tissue of the toes. E. CORRECT: Wear closed-toe shoes to prevent injury to soft tissue of the toes and feet.
A nurse is reviewing the health record of a client who has hyperglycemic-hyperosmolar state (HHS). Which of the following data confirms this diagnosis? (select all that apply) A. Evidence of recent MI B. BUN 35 mg/dL C. Takes a calcium channel blocker D. age 77 years old E. no insulin production
A. evidence of recent MI B. BUN 35 mg/dL C. takes a calcium channel blocker D. age 77 The client who has type 2 diabetes mellitus and had a MI is at risk for developing HHS. This is due to increased hormone production during illness or stress, which can stimulate the liver to produce glucose and decrease the effects of insulin. The client who has type 2 diabetes mellitus may be at risk for developing HHS when the BUN is 35 mg/dL b/c it is an indication of decreased kidney function and inability of the kidney to filter high levels of blood glucose into the urine. A calcium channel blocker is one of several meds that increase risk. The older adult client is at risk for developing type 2 diabetes and may be unaware of associated symptoms, increasing risk for HHS.
The nurse is reviewing laboratory results for a patient with a 15-year history of type 2 diabetes. Which result reflects the expected pattern accompanying macrovascular disease as a complication of diabetes? A. Increased triglyceride levels B. Increased high-density lipoproteins (HDL) C. Decreased low-density lipoproteins (LDL) D. Decreased very-low-density lipoproteins (VLDL)
ANS: A Macrovascular complications of diabetes include changes to large- and medium-sized blood vessels. They include cerebrovascular, cardiovascular, and peripheral vascular disease. Increased triglyceride levels are associated with these macrovascular changes. Increased HDL, decreased LDL, and decreased VLDL are positive in relation to atherosclerosis development.
A client is brought to the emergency department in an unresponsive state, and a diagnosis of hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is made. The nurse would immediately prepare to initiate which of the following anticipated physician's prescriptions? a. Endotracheal intubation b. 100 units of NPH insulin c. Intravenous infusion of normal saline d. Intravenous infusion of sodium bicarbonate
C. Intravenous infusion of normal saline Rationale: The primary goal of treatment in HHNS is to rehydrate the client to restore fluid volume and to correct electrolyte deficiency. Intravenous fluid replacement is similar to that administered in DKA and begins with IV infusion of normal saline. Regular insulin, not NPH insulin, would be administered. The use of sodium bicarbonate to correct acidosis is avoided because it can precipitate a further drop in serum potassium levels. Intubation and mechanical ventilation are not required to treat HHNS.
The nurse is assisting a patient with newly diagnosed type 2 diabetes to learn dietary planning as part of the initial management of diabetes. The nurse would encourage the patient to limit intake of which foods to help reduce the percent of fat in the diet? A. Cheese B. Broccoli C. Chicken D. Oranges
A Cheese is a product derived from animal sources and is higher in fat and calories than vegetables, fruit, and poultry. Excess fat in the diet is limited to help avoid macrovascular changes.
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: A. Excessive thirst B. Weight gain C. Constipation D. Excessive hunger E. Urine retention F. Frequent, high-volume urination
A, D, F Classic signs of diabetes mellitus include polydipsia (excessive thirst), polyphagia (excessive hunger), and polyuria (excessive urination). Because the body is starving from the lack of glucose the cells are using for energy, the client has weight loss, not weight gain. Clients with diabetes mellitus usually don't present with constipation. Urine retention is only a problem is the patient has another renal-related condition.
A 6-year-old child with diabetes mellitus and the child's mother come to the health care clinic for a routine examination. The nurse evaluates the data collected during this visit to determine if the child has been euglycemic since the last visit. Which information is the most significant indicator of euglycemia? a. Daily glucose monitor log b. Glycosylated hemoglobin (hemoglobin A1c) c. Dietary history for the previous week d. Fasting blood glucose performed on the day of the clinic visit
B. Glycosylated hemoglobin (hemoglobin A1c)
The nurse is providing foot care instructions to a patient. What should be included? Select all that apply A. Inspect feet daily for cuts and blisters B. Being barefoot is allowed as long as clean socks are worn C. Do not go more then 3 days without washing feet D. Do not apply lotion between the toes E. Cut toenails evenly and be sure to cut down the corners F. Avoid prolonged sitting, standing and crossing of the legs
A, D, F • Diabetics should inspect their feet daily to assess for signs of infection and poor wound healing. • They should not go barefoot! • They should wash their feet everyday • Putting lotion between the toes creates moisture and attracts fungus • Toenails should be cut evenly but the corners should NOT be cutdown • They should avoid prolonged sitting, standing and leg crossing to prevent complications
A nurse is caring for a client who has blood glucose of 52 mg/dL. The client is lethargic but arousable. Which of the following actions should the Nurse perform first? (ATI) A. Recheck Blood glucose in 15 min. B. Provide a carbohydrate and protein food. C. Provide 4 oz grape juice. D. Report findings to the provider.
A. INCORRECT: Blood glucose is rechecked in 15 min after a rapidly absorbed carbohydrate is ingested, but is not the priority nursing action. B. INCORRECT: A carbohydrate and protein food is given to the client if the next meal is more than 1 hr away after the blood glucose returns to a normal range. This is not the priority Nursing action. C. CORRECT: The client's acute need for a rapidly absorbed carbohydrate. such as grape juice, takes priority when treating the blood glucose 52 mg/dL. D. INCORRECT: Reporting the findings to the provider is not the priority action.
A nurse is preparing to administer a dose of aspart insulin (NovoLog) to a client who has type 1 diabetes mellitus. Which of the following is an appropriate action by the nurse? (ATI) A. Check the client's blood glucose immediately after breakfast. B. Administer the insulin when breakfast arrives. C. Hold breakfast for 1 hr after insulin administration. D. Clarify the prescription because insulin should not be administered at this time.
A. INCORRECT: Blood glucose should checked prior to insulin administration to prevent an episode of hypoglycemia. B. CORRECT: Administer aspart insulin when breakfast arrives to avoid a hypoglycemic episode. Apart insulin is rapid-acting, and the client should eat immediately after the nurse administers the medication. C. INCORRECT: Aspart insulin is rapid-acting and is administered 5 to 10 min before breakfast. Breakfast should be available at the time injection. D. INCORRECT: Aspart insulin is administered at breakfast time and can be prescribed for administration 2 to 3 times a day.
A nurse is assisting with the care of a client who has diabetic ketoacidosis. The nurse should anticipate that the client's condition will be treated initially with which of the following IV solutions? A. Dextrose 5% in 0.9% sodium chloride B. 0.45% sodium chloride C. 0.9% sodium chloride D. Dextrose 5% in 0.45% sodium chloride
A. INCORRECT: The nurse should add glucose to the IV infusion when the serum glucose is 250 mg/dL, not 350 mg/dL, to prevent hypoglycemia and minimize cerebral edema. B. INCORRECT: The admistration of an IV infusion of 0.45% sodium chloride should follow the isotonic fluid and is used as maintenance fluids. C. CORRECT: The nurse should anticipate that the client's conditon will be intially treated with a rapid infusion of 0.9% sodium chloride, an isotonic fluid, to mainatin blood perfusion to vital organs. D. INCORRECT: The nurse should add glucose to the IV infusion when the serum glucose is 250 mg?dL, not 350 mg/dL, to prevent hypoglycemia and minimize cerebral edema.
The nurse is teaching a patient with type 2 diabetes mellitus how to prevent diabetic nephropathy. Which statement made by the patient indicates that teaching has been successful? A. "Smokeless tobacco products decrease the risk of kidney damage." B. "I can help control my blood pressure by avoiding foods high in salt." C. "I should have yearly dilated eye examinations by an ophthalmologist." D. "I will avoid hypoglycemia by keeping my blood sugar above 180 mg/dL."
B Diabetic nephropathy is a microvascular complication associated with damage to the small blood vessels that supply the glomeruli of the kidney. Risk factors for the development of diabetic nephropathy include hypertension, genetic predisposition, smoking, and chronic hyperglycemia. Patients with diabetes are screened for nephropathy annually with a measurement of the albumin-to-creatinine ratio in urine; a serum creatinine is also needed.
The nurse teaches a client with diabetes mellitus about differentiating between hypoglycemia and ketoacidosis. The client demonstrates an understanding of the teaching by stating that a form of glucose should be taken if which symptoms develop? Select all that apply A. Polyuria B. Shakiness C. Palpitations D. Blurred vision E. Light headedness F. Fruity breath odor
B, D, E Shakiness, palpitations, and lightheadedness are signs of hypoglycemia and would indicate the need for food or glucose. Polyuria, blurred vision, and a fruity breath odor are signs of hyperglycemia
The nurse is teaching the parent of a preschool child how to administer the child's insulin injection. The child will be receiving 2 units of Humulin R insulin and 12 units of Humulin N insulin every morning. How should the nurse instruct the parents to prepare the insulin? a. Draw the insulin into separate syringes. b. Draw the Humulin R insulin first and then the Humulin N insulin into the same syringe. c. Draw the Humulin N insulin first and then the Humulin R insulin into the same syringe. d. Check blood glucose first, and if the result is between 80 and 120 mg/dL, withhold the insulin injection.
B. Draw the Humulin R insulin first and then the Humulin N insulin into the same syringe.
A client with type 1 diabetes mellitus is to begin an exercise program, and the nurse is providing instructions regarding the program. Which instruction should the nurse include in the teaching plan? A. Try to exercise before mealtimes. B. Administer insulin after exercising. C. Take a blood glucose test before exercising. D. Exercise is best performed during peak times of insulin.
C A blood glucose test performed before exercising provides the client with information regarding the need to consume a snack before exercising. Exercising during the peak times of insulin or before mealtime places the client at risk for hypoglycemia. Insulin should be administered as prescribed
A client with type 1 diabetes mellitus calls the nurse to report recurrent episodes of hypoglycemia with exercising. Which statement by the client indicates an inadequate understanding of the peak action of NPH insulin and exercise? A. "The best time for me to exercise is after I eat." B. "The best time for me to exercise is after breakfast." C. "The best time for me to exercise is mid- to late afternoon." D. "The best time for me to exercise is after my morning snack."
C A hypoglycemic reaction may occur in response to increased exercise. Clients should avoid exercise during the peak time of insulin. NPH insulin peaks at 4 to 12 hours; therefore, afternoon exercise takes place during the peak of the medication. Options A, B, and D do not address peak action times.
You are admitting a patient with complaints of abdominal pain, nausea, and vomiting. A proximal bowel obstruction is suspected. Which acid-base imbalance do you anticipate in this patient? A. Metabolic Acidosis B. Respiratory Alkalosis C. Metabolic Alkalosis D. Respiratory Acidosis
C Because gastric secretions are rich in HCl acid, the patient who is vomiting will lose a significant amount of gastric acid and be at an increased risk for metabolic alkalosis.
A client is admitted to a hospital with a diagnosis of diabetic ketoacidosis (DKA). The initial blood glucose level was 950 mg/dl. A continuous intravenous infusion of short-acting insulin is initiated, along with intravenous rehydration with normal saline. The serum glucose level is now 240 mg/dl. The nurse would next prepare to administer which item? A. Ampule of 50% dextrose B. NPH insulin subcutaneously C. Intravenous fluids containing dextrose D. Phenytoin (Dilantin) for the prevention of seizures
C During management of DKA, when the blood glucose level falls to 250 to 300 mg/dL, the infusion rate is reduced and a dextrose solution is added to maintain a blood glucose level of about 250 mg/dL, or until the client recovers from ketosis. Fifty percent dextrose is used to treat hypoglycemia. NPH insulin is not used to treat DKA. Phenytoin (Dilantin) is not a usual treatment measure for DKA
The patient received regular insulin 10 units subcutaneously at 8:30 PM for a blood glucose level of 253 mg/dl. The nurse plans to monitor this patient for signs of hypoglycemia at which time related to the insulin's peak action? A. 8:40 PM to 9:00 PM B. 9:00 PM to 11:30 PM C. 10:30 PM to 1:30 AM D. 12:30 AM to 8:30 AM
C Regular insulin exerts peak action in 2 to 5 hours, making the patient most at risk for hypoglycemia between 10:30 PM and 1:30 AM.
A patient is newly diagnosed with type 1 diabetes and reports a headache, changes in vision, and being anxious but does not have a portable blood glucose monitor present. Which action should the nurse advise her to take? A. Eat a piece of pizza. B. Drink some diet pop. C. Eat 15 g of simple carbohydrates. D. Take an extra dose of rapid-acting insulin
C When the patient with type 1 diabetes is unsure about the meaning of the symptoms she is experiencing, she should treat herself for hypoglycemia to prevent seizures and coma from occurring. She should also be advised to check her blood glucose as soon as possible. The fat in the pizza and the diet pop would not allow the blood glucose to increase to eliminate the symptoms. The extra dose of rapid-acting insulin would further decrease her blood glucose
A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the emergency department. Which findings would the nurse expect to note as confirming this diagnosis? Select all that apply. A. Increase pH B. Comatose state C. Deep, rapid breathing D. Decreased urine output E. Elevated blood glucose level F. Low plasma bicarbonate level
C, E, F In DKA, the arterial pH is lower than 7.35, plasma bicarbonate is lower than 15 mEq/L, the blood glucose level is higher than 250 mg/dL, and ketones are present in the blood and urine. The client would be experiencing polyuria, and Kussmaul's respirations (deep and rapid breathing pattern) would be present. A comatose state may occur if DKA is not treated, but coma would not confirm the diagnosis
A home care nurse is teaching an adolescent with type 1 diabetes mellitus about insulin administration and rotation sites. Which statement, if made by the adolescent, would indicate effective teaching? a. "I should use only my stomach and my thighs for injections." b. "I need to use a different major site for each insulin injection." c. "I need to use one major site for 2 to 3 weeks before changing major sites." d. "I need to use the same major site for 1 month before rotating to another site."
C. "I need to use one major site for 2 to 3 weeks before changing major sites."
A nurse is teaching a child who has type 1 diabetes mellitus about self care. Which of the following statements by the child indicates understanding of the teaching? (ATI) A. "I should skip breakfast when I am not hungry." B. "I should increase my insulin with exercise." C. "I should drink a glass of milk when I am feeling irritable." D. "I should draw up the NPH insulin into the syringe before the regular insulin."
C. "I should drink a glass of milk when I am feeling irritable."
A nurse is teaching an adolescent who has diabetes about foot care. Which of the following should the nurse include in the teaching? (ATI) A. "You should inspect your feet once a week." B. "You should cut your toe nails in a rounded fashion." C. "You can use cornstarch on your feet." D. "You can use over-the-counter callus removers."
C. "You can use cornstarch on your feet."
An adolescent with type 1 diabetes mellitus is attending a dance in the school gym. The adolescent suddenly becomes flushed and complains of hunger and dizziness. The school nurse, who is present at the dance, takes the child to the nurse's office and performs a blood glucose level test that shows 60 mg/dL (3.4 mmol/L). Which is the initial nursing intervention? a. Call the child's mother. b. Assist the child with administering regular insulin. c. Give the child ½ cup of a sugar-sweetened carbonated beverage. d. Call an ambulance to take the child to the hospital emergency department
C. Give the child ½ cup (120 ml) of a sugar-sweetened carbonated beverage.
A nurse is preparing to administer IV fluids to a client who has DKA. Which of the following is an appropriate nursing action? A. admin an IV infusion of regular insulin at 0.3 U/kg/hr B. admin an IV infusion of .45% sodium chloride C. rapidly admin an IV infusion of 0.9% sodium chloride D. add glucose to the IV infusion when serum glucose is 350 mg/dL
C. rapidly admin an IV infusion of 0.9% sodium chloride The nurse should rapidly admin an IV infusion of 0.9% sodium chloride, an isotonic fluid, as prescribed to maintain blood perfusion to vital organs admin 0.1 unit/kg/hr, not 0.3. administration of 0.45% follows the isotonic fluid. Add glucose when levels are at 250 mg/dL, not 350
The nurse provides instructions to a client newly diagnosed with type 1 diabetes mellitus. The nurse recognizes accurate understanding of measures to prevent diabetic ketoacidosis when the client makes which statement? A. "I will stop taking my insulin if I'm too sick to eat." B. "I will decrease my insulin dose during times of illness." C. "I will adjust my insulin dose according to the level of glucose in my urine." D. "I will notify my health care provider (HCP) if my blood glucose level is higher than 250 mg/dL."
D During illness, the client should monitor blood glucose levels and should notify the HCP if the level is higher than 250 mg/dL. Insulin should never be stopped. In fact, insulin may need to be increased during times of illness. Doses should not be adjusted without the HCP's advice and are usually adjusted on the basis of blood glucose levels, not urinary glucose readings
A client arrives in the hospital emergency department complaining of severe thirst and polyuria. The client tells the nurse that she has a history of diabetes mellitus. A blood glucose level is drawn, and the result is 685 mg/dl. Which intervention should the nurse anticipate to be initially prescribed for the client? A. Glucagon via the subcutaneous route B. Glyburide via the oral route C. Humulin N insulin via the subcutaneous route D. Humulin R insulin via the intravenous (IV) route
D The client is most likely in diabetic ketoacidosis (DKA). Humulin R insulin via the IV route is the preferred treatment for DKA. Humulin R insulin is a short-acting insulin and can be given intravenously; it is titrated to the client's high blood glucose levels. Glucagon is used to treat hypoglycemia, and glyburide is an oral hypoglycemia agent used to treat diabetes mellitus type 2. Humulin N insulin is an intermediate-acting insulin and is not appropriate for the emergency treatment of DKA
The nurse is evaluating a diabetic client's understanding of the signs of hyperglycemia. Which statement by the client reflects an understanding? (pg 651 q 1470) a. "I may become diaphoretic and faint." b. "I may notice signs of fatigue, dry skin, and increased urination." c. "I need to take an extra diabetic pill if my blood glucose is greater than 300." d. "I should restrict my fluid intake if my blood glucose is greater than 250 mg."
b. "I may notice signs of fatigue, dry skin, and increased urination." Rationale: Fatigue, dry skin, polyuria, and polydipsia are classic symptoms of hyperglycemia.
A mother brings her 3-week-old infant to a clinic for a phenylketonuria rescreening blood test. The test indicates a serum phenylalanine level of 1 mg/dL (60.5 mcmol/L). The nurse reviews this result and makes which interpretation? a. it is positive. b. Its is negative. c. It is inconclusive. d. It requires rescreening at age 6 weeks.
b. It is negative.
The nurse is caring for an obese client on a weight loss program. Which method should the nurse use to most accurately assess the program's effectiveness? (pg. 52) a. Weight the client. b. Monitor intake and output. c. Check serum protein levels. d. Calculate daily caloric intake.
a. Weight the client.
The nurse provides discharge instructions for a client beginning oral hypoglycemic therapy. Which statements if made by the client indicate a need for further instructions? Select all that apply. (pg. 120) a. "If I am ill, I should skip my daily dose." b. If I overeat, I will double my dosage of medication. c. Oral agents are effective in managing Type 2 diabetes. d. If I become pregnant I will discontinue my medication. e. Oral hypoglycemic medications will cause my urine to turn orange. f. My mediations are used to manage my diabetes along with diet and exercise.
a. b. d. e. Rationale: Clients are instructed that oral agents are used in addition to diet and exercise as therapy for diabetes. During illness or periods of intense stress, the client should be instructed to monitor his or her blood glucose level frequently and should contact the health care provider if the blood glucose is elevated because insulin may be needed to prevent acute hyperglycemia symptoms.
Regular insulin by continuous intravenous (IV) infusion prescribed for a client with a blood glucose level of 700 mg/dL. How should the nurse administer this medication? (pg 217 q 443) a. Mix the solution in 5% dextrose. b. Change the solution every 6 hours. c. Infuse the medication via an electronic infusion pump. d. Titrate the infusion according to the client's urine glucose levels.
c. Infuse the medication via an electronic infusion pump. Rationale: Insulin is administered via an infusion pump to prevent inadvertent overdose and subsequent hypoglycemia.
A 9-year-old child is newly diagnosed with type 1 diabetes mellitus. The nurse is planning for home care with the child and his family and determines that which is an age-appropriate activity for the child for health maintenance? ( pg 570 q 1252) a. Administering insulin drawn up by an adult. b. Self- administering insulin with adult supervision. c. Making independent decisions with regard to sliding-scale coverage of insulin. d. Having an adult assist in the self-administration of insulin and glucose monitoring.
b. Self- administering insulin with adult supervision. Rationale: School-age children have the cognitive and motor skills to draw up and administer insulin with adult supervision. Developmentally, they do not have the maturity to make independent decisions such as sliding- scale coverage without adult validation.
The nurse is caring for a client with newly diagnosed type 1 diabetes. Which component of a teaching plan is most important initially? a. Knowledge of the diabetic diet. (pg. 376 q 811) b. Understanding of the diagnosis. c. Monitoring of blood glucose levels. d. Correct technique for administering insulin.
b. Understanding of the diagnosis. Rationale: Before educating about a disease process, it is important that the client understands the components of the disease process.
A client is prescribed glipizide (Glucotrol) once daily. What intended effect of this medication should the nurse observe for? (pg 556 q 1225) a. Weight loss b. Resolution of infection c. Decreased blood glucose d. Decreased blood pressure
c. Decreased blood glucose Rationale: Glipizide is an oral hypogylcemic agent that is taken in the morning.
The mother of a 6-year-old child who has type 1 diabetes mellitus calls a clinic nurse and tells the nurse that the child has been sick. The mother reports that she checked the child's urine and it was positive for ketones. The nurse should instruct the mother to take which action? a. Hold the next dose of insulin. b. Come to the clinic immediately. c. Encourage the child to drink liquids. d. Administer an additional dose of regular insulin.
c. Encourage the child to drink liquids.
The home care nurse is developing a plan of care for an older client with type 1 diabetes mellitus who has gastroenteritis. To maintain food and fluid intake to prevent dehydration, which action should the nurse take? (pg. 88) a. Offer water only until the client is able to tolerate solid foods. b. Withhold all fluids until vomiting has ceased for at least four hours. c. Encourage the client to take 8 -12 ounces of fluid every hour while awake. d. Maintain a clear liquid diet for at least 5 days before advancing to solids to allow inflammation of the bowel to dissipate.
c. Encourage the client to take 8 -12 ounces of fluid every hour while awake. Rationale: Dehydration needs to be prevented in the client with type 1 diabetes mellitus because of the risk of diabetic ketoacidosis (DKA).
The nurse should implement which interventions for a child older than 2 years with type 1 diabetes mellitus who has a blood glucose level of 60 mg/dL (3.4 mmol/L)? Select all that apply. a. Administer regular insulin. b. Encourage the child to ambulate. c. Give the child a teaspoon of honey. d. Provide electrolyte replacement therapy intravenously. e. Wait 30 minutes and confirm the blood glucose reading. f. Prepare to administer glucagon subcutaneously if unconsciousness occurs.
c. Give the child a teaspoon of honey. f. Prepare to administer glucagon subcutaneously if unconsciousness occurs.
The nurse is caring for a client with type 1 diabetes mellitus. Because the client is at risk for hypoglycemia, which instructions should the nurse teach the client to follow? (pg 357, q 765) a. Monitor the urine for acetone b. Report any feelings of drowsiness. c. Keep glucose tablets and subcutaneous glucagon available. d. Omit the evening dose of NPH insulin if the client has been exercising.
c. Keep glucose tablets and subcutaneous glucagon available. Rationale: Glucose tablets are taken when hypoglycemic reaction occurs. Glucagon (GlucaGen) is administered subcutaneously if the client loses consciousness and is unable to take glucose by mouth.
The nurse is teaching a client how to mix regular insulin and NPH insulin in the same syringe. Which action should the nurse tell the client to take? (pg 659 q 1491) a. Draw up the NPH insulin into the syringe first. b. Keep both bottles in the refrigerator at all times. c. Rotate the NPH insulin bottle in the hands before mixing. d. Take all the air out of the insulin bottles before mixing.
c. Rotate the NPH insulin bottle in the hands before mixing. Rationale: The NPH insulin bottle needs to be rotated for at least 1 minute between both hands. This resuspends the insulin. The nurse should NOT shake the bottles. Shaking causes foaming and bubbles to form, which may trap particles of insulin and alter the dosage.
A male client is admitted to the hospital with DKA. The client's daughter says to the nurse, "My mother died last month last month , and now this this. Iv'e been trying to follow all of the instructions from the doctor, but what have I done wrong?" Which response should the nurse make to the client's daughter? (pg 418 q 914) a. "Tell me what you think you did wrong." b. Maybe we can keep your father in the hospital for awhile longer to give you rest." c. You should talk to he social worker about getting you someone at home who is more capable with managing a diabetic's care." d. "An emotional stress such as your mother's death can trigger DKA in a diabetic client, even though the prescribed regimen is being followed."
d. "An emotional stress such as your mother's death can trigger DKA in a diabetic client, even though the prescribed regimen is being followed." Rationale: Environment, infection, or an emotional stressor can initiate the physiological mechanism of DKA.
The nurse is instructing a client with diabetes mellitus regarding hypoglycemia. Which statement by the client indicates the need for further instructions? (pg 303 q 632) a. "Hypoglycemia can occur at any time of the day or night." b. "I can drink 6-8 ounces of milk if hypoglycemia occurs." c. "If I feel sweaty or shaking, I might be experiencing hypoglycemia." d. "If hypoglycemia occurs, I need to take my regular insulin as prescribed."
d. "If hypoglycemia occurs, I need to take my regular insulin as prescribed." Rationale: Insulin is not taken as a treatment for hypoglycemia, because the insulin will lower the blood glucose level instead.
The nurse develops a plan of care for an older client with diabetes mellitus. The nurse plans to complete which action first? (pg 326 q 687) a. Structure menus for adherence to diet. b. Teach with videotapes showing insulin administration to ensure competence. c. Encourage dependence on others to prepare the client for the chronicity of the disease. d. Assess the client's ability to read label markings on syringes and blood glucose monitoring equipment.
d. Assess the client's ability to read label markings on syringes and blood glucose monitoring equipment. Rationale: the nurse first assesses the client's ability for self-care. Structuring menus for the client promotes dependence. Allowing the client to have hands-on experience rather than teaching and videos is more effective. Independence should be encouraged.
An adolescent client with type 1 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 irritability. d. Fruity breath odor, and decreasing level of consciousness.
d. Fruity breath odor and decreasing level of consciousness
A client with newly diagnosed type 1 diabetes mellitus has been seen for 3 consecutive days in the emergency department with hyperglycemia. During the assessment, the client says to the nurse, "I'm sorry to keep bothering you every day, but I just can't give myself those awful shots." Which therapeutic response should the nurse make? (pg 377 q 812) a. "I couldn't give myself a shot either." b. "You must learn to give yourself the shots." c. "Let me see if we can change your medication." d. "Has someone given you instructions on how to perform them?"
d. Has someone given you instructions on how to perform them?"
A child with type 1 diabetes mellitus is brought to the emergency department by the mother, who states that the child has been complaining of abdominal pain and has been lethargic. Diabetic ketoacidosis is diagnosed. Anticipating the plan of care, the nurse prepares to administer which type of intravenous (IV) infusion? a. Potassium infusion. b. NPH insulin infusion. c. 5% dextrose infusion. d. Normal Salin infusion.
d. Normal saline infusion
The nurse has just administered ibuprofen to a child with a temperature of 102°F (38.8°C). The nurse should also take which action? a. Withhold oral fluids for 8 hours. b. Sponge the child with cold water. c. Plan to administer salicylate (aspirin) in 4 hours. d. Remove excess clothing and blankets from the child.
d. Remove excess clothing and blankets from the child.