Diabetes med surg ati moderate

A nurse is providing teaching to a client with hypertension and type 1 diabetes mellitus who has a new prescription for metoprolol. Which of the following statements by the client indicates an understanding of the teaching? A. "I might have difficulty recognizing when my blood sugar is low." B. "I will have a lower risk of developing an infection while I take this medication." C. "I should be concerned about losing excess weight while I take this medication." D. "I could have more problems with high blood sugar while taking this medication."

Correct Answer: A. "I might have difficulty recognizing when my blood sugar is low." Metoprolol, a beta-adrenergic blocker, is used to treat hypertension. Because it decreases the heart rate, this common manifestation of hypoglycemia can be masked, and hypoglycemia might become more difficult to recognize. The client should be taught to recognize hypoglycemia by other manifestations such as hunger, nausea, and sweating

A nurse is providing teaching to the parents of a school-aged child who has type 1 diabetes mellitus about managing hypoglycemia. Which of the following responses by a parent indicates an understanding of the teaching? A. "I will make sure my child drinks 240 mL (8 oz) of milk as soon as possible." B. "I will give my child 2 units of regular insulin." C. "I will insist that my child lie down to rest for 30 min." D. "I will check my child's urine for glucose twice daily."

Correct Answer: A. "I will make sure my child drinks 240 mL (8 oz) of milk as soon as possible." Giving the child 10 to 15 g of simple carbohydrates such as 240 mL (8 oz) of milk will elevate the blood glucose level and alleviate hypoglycemia

A nurse is caring for a client who has type 1 diabetes mellitus and is scheduled to receive hemodialysis. The client says, "I don't even know why I'm doing this. There is no cure." Which of the following statements should the nurse make? A. "It sounds as though you have given up." B. "Dialysis will help you live longer." C. "You shouldn't complain. You are fortunate to have this option available to you." D. "Let's talk about what you are going to do after dialysis today."

Correct Answer: A. "It sounds as though you have given up." The nurse is using the therapeutic communication technique of restatement to encourage the client's expression of feelings.

A nurse is providing teaching to a client who has type 2 diabetes mellitus about the pathophysiology of the disease. Which of the following statements by the client indicates an understanding of the teaching? A. "My cells are resistant to the effects of insulin." B. "My body breaks down sugars too efficiently." C. "My pancreas does not produce insulin." D. "My body produces antibodies against pancreatic beta cells."

Correct Answer: A. "My cells are resistant to the effects of insulin." A client who has type 2 diabetes mellitus will have resistance to insulin and a decrease in the secretion of insulin by the pancreatic beta cells.

A nurse is caring for 4 newborns. Which of the following newborns is at the greatest risk of hypoglycemia? A. A newborn who is large for gestational age B. A newborn who has an Rh incompatibility C. A newborn who has pathologic jaundice D. A newborn who has fetal alcohol syndrome

Correct Answer: A. A newborn who is large for gestational age Large for gestational age (LGA) newborns have a weight at or above the 90th percentile. One of the most common etiologies of LGA newborns is a mother who is diabetic. LGA newborns, especially those born to mothers who have diabetes, are at an increased risk of hypoglycemia. Other newborns at risk of hypoglycemia are small for gestational age (SGA) newborns (those below the 10th percentile), premature newborns, and newborns who have perinatal hypoxia.

A nurse is checking laboratory values to determine if a client with diabetes mellitus is adhering to the treatment plan. Which of the following tests should the nurse use to make this determination? A. Glycosylated hemoglobin levels B. Urine sugar and acetone levels C. Glucose tolerance test D. Fasting serum glucose

Correct Answer: A. Glycosylated hemoglobin levels Checking glycosylated hemoglobin levels (HbA1c) is an accurate method of determining if the client is routinely compliant. Glycosylated hemoglobin refers to hemoglobin that is connected to glucose. Since the lifespan of an RBC is 4 months, this value will not be affected by recent changes in the client's diet or medication.

A nurse is caring for a client with diabetic ketoacidosis who has a prescription for an intravenous infusion of insulin. The nurse should document that which of the following types of insulin was administered intravenously to treat ketoacidosis? A. Regular insulin B. Insulin lispro C. Insulin aspart D. Insulin glargine

Correct Answer: A. Regular insulin Treatment for diabetic ketoacidosis is directed at correcting hyperglycemia and acidosis. Therefore, the client's insulin levels are restored with an initial IV bolus of regular insulin followed by continuous infusion.

A nurse is providing teaching about exercise to a client who has type 1 diabetes mellitus. Which of the following statements should the nurse include? A. "You should exercise during a peak insulin time." B. "Wear a medical alert identification tag when you exercise." C. "Exercise can decrease the effects of insulin and cause your blood glucose levels to increase." D. "You will get the most benefit from exercise when your glucose levels are higher than normal."

Correct Answer: B. "Wear a medical alert identification tag when you exercise." The client should wear a medical alert identification tag in the event of a hypoglycemic response because exercise can potentiate the effects of insulin and cause blood glucose levels to decrease.

A nurse is planning dietary teaching for a client who has diabetes mellitus. Which of the following actions should the nurse plan to take first? A. Obtain sample menus from the dietitian to give to the client B. Ask the client to identify the types of foods she prefers C. Identify the recommended range of the client's blood glucose level D. Discuss long-term complications that can result from non-adherence to the dietary plan

Correct Answer: B. Ask the client to identify the types of foods she prefers The nurse should apply the nursing process priority-setting framework to plan client care and prioritize nursing actions. Each step of the nursing process builds on the previous step, beginning with an assessment or data collection. Before the nurse can formulate a plan of action, implement a nursing intervention, or notify the provider of a change in the client's status, the nurse must first collect adequate data from the client. Assessing or collecting additional data will provide the nurse with the knowledge to make an appropriate decision. Therefore, the nurse should first ask the client about individual food preferences to provide an opportunity for the nurse to include these foods in her diet. Involving the client in the planning will promote her adherence to the dietary plan.

A nurse is caring for an older adult client who has a new onset of type 2 diabetes mellitus. Which of the following physiological changes can contribute to the development of type 2 diabetes? A. Increased production of insulin by the pancreas B. Decreased sensitivity to the circulating insulin C. Increased rate of glucose metabolism D. Decreased release of glycogen by the liver

Correct Answer: B. Decreased sensitivity to the circulating insulin The pancreas in older adult clients demonstrates reduced tissue sensitivity to circulating insulin, leading to an increased risk of developing type 2 diabetes mellitus.

A nurse is caring for a client who has type 1 diabetes mellitus and a capillary blood glucose reading of 48 mg/dL. Which of the following findings should the nurse expect? A. Kussmaul respirations B. Diaphoresis C. Decreased skin turgor D. Ketonuria

Correct Answer: B. Diaphoresis A client who has a blood glucose level below 70 mg/dL will exhibit manifestations of hypoglycemia. Expected findings associated with hypoglycemia include weakness, hunger, diaphoresis, nausea, shakiness, and confusion.

A nurse is assessing an older adult client during an annual physical. Which of the following client findings should the nurse report to the provider? A. BP 118/76 mmHg B. Fasting blood glucose level 160 mg/dL C. Report of waking to void 2 to 3 times per night D. Report of bowel movement every other day

Correct Answer: B. Fasting blood glucose level 160 mg/dL A fasting blood glucose level of 160 mg/dL is elevated. The nurse should report this value to the provider for further evaluation, as the client might be showing early signs of a tendency for diabetes mellitus.

A nurse is caring for a client who has type 2 diabetes mellitus and is displaying manifestations of hyperglycemia. Which of the following findings indicates the client has hyperglycemia? A. Hunger B. Increased urination C. Cold, clammy skin D. Tremors

Correct Answer: B. Increased urination Increased urination is a manifestation of hyperglycemia due to a deficiency of insulin, which can lead to osmotic diuresis.

A nurse is planning to teach a 9-year-old child who has a new diagnosis of diabetes mellitus. The nurse should identify that school-age children are attempting to master which of the following developmental tasks? A. Initiative vs. guilt B. Industry vs. inferiority C. Trust vs. mistrust D. Identity vs. role confusion

Correct Answer: B. Industry vs. inferiority When planning to teach, the nurse should identify that school-age children are attempting to master the developmental task of industry vs. inferiority. During this stage, children enjoy learning new skills and experiencing the sense of accomplishment that comes with mastery of the skill.

A nurse is teaching a client who has type 2 diabetes mellitus about a prescription for insulin lispro. Which of the following statements should the nurse include in the teaching? A. "The effects of the insulin lispro can last for 8 to 12 hours." B. "Administer insulin lispro 30 to 60 minutes before eating." C. "Insulin lispro has an onset of about 15 minutes." D. "This insulin can be given as a continuous intravenous bolus."

Correct Answer: C. "Insulin lispro has an onset of about 15 minutes." Insulin lispro is a rapid-acting insulin and has an onset of 15 to 30 minutes.

A nurse is providing teaching to a client who has type 2 diabetes mellitus. The client states, "I eat pasta every day. I can't imagine giving it up." Which of the following responses should the nurse provide? A. "Let's discuss this with your doctor; giving up daily pasta may not be necessary." B. "Is there another favorite dish you can substitute?" C. "You don't have to give up pasta; just adjust the amount you eat." D. "You can use no-added-salt tomato products on your pasta."

Correct Answer: C. "You don't have to give up pasta; just adjust the amount you eat." The American Diabetes Association recommends individualizing carbohydrate restriction for each client. A careful assessment of the client's usual dietary practices and modifications is an important part of teaching clients to manage this disorder.

A nurse is caring for a client who has diabetes insipidus. For which of the following findings should the nurse monitor? A. Proteinuria B. Oliguria C. Polyuria D. Glycosuria

Correct Answer: C. Polyuria Diabetes insipidus is characterized by increased thirst (polydipsia) and increased urination (polyuria). A client who has diabetes insipidus will excrete large quantities of urine with a very low specific gravity.

A nurse is providing teaching about food choices to a client who has diabetes mellitus. Which of the following statements by the client indicates an understanding of the teaching? A. "I will need to eliminate sweet desserts from my diet." B. "I should avoid using sucralose in my coffee." C. "I should consume alcohol between meals in moderation." D. "I should replace white bread with whole-grain bread."

Correct Answer: D. "I should replace white bread with whole-grain bread." Clients with diabetes mellitus have the same fiber requirements as the general population. Fiber content can be increased by substituting white bread, which is made with refined grains, with whole-grain bread, which retains the outer layer of the grain that is higher in fiber.

A nurse is providing teaching about foot care to a client who has diabetes mellitus. Which of the following pieces of information should the nurse include in the teaching? A. "Wear nylon socks with shoes." B. "Wear flip flops instead of going barefoot when outside." C. "Apply moisturizing cream between your toes." D. "Wash your feet daily using lukewarm water and soap."

Correct Answer: D. "Wash your feet daily using lukewarm water and soap." A client who has diabetes mellitus should wash the feet daily with lukewarm water and soap. The client should keep the feet clean and free from dirt, which can cause infection, and inspect the feet daily for cuts or calluses, which can develop into a foot ulcer.

A nurse is assessing a client who is postoperative following a craniotomy and has a urine output of 600 mL/hr. The nurse suspects the client has manifestations of diabetes insipidus (DI). Which of the following laboratory values should the nurse plan to obtain to assess for DI? A. Blood urea nitrogen (BUN) B. Blood glucose C. Urine ketones D. Specific gravity

Correct Answer: D. Specific gravity Diabetes insipidus is caused by damage to the hypothalamus or the pituitary gland as a result of cranial surgery, an infection, or a tumor. In this condition, an inadequate amount of antidiuretic hormone is released and results in polyuria. A low specific gravity (1.001 to 1.003) is a manifestation of diabetes insipidus.

A nurse is conducting discharge teaching about foot care for a client who has diabetes mellitus. Which of the following instructions should the nurse include? A. Wear nylon socks with shoes every day B. Trim toenails by rounding the edges of the nail C. Apply lotion between the toes after bathing D. Test water temperature with the wrist

Correct Answer: D. Test water temperature with the wrist The nurse should instruct the client to test water temperature with the wrist or a thermometer to detect if the water is too hot or too cold. Clients with diabetes have peripheral nerve damage, making temperature determinations difficult and increasing the risk of burns.

A nurse completing an assessment on a client. Which of the following findings should the nurse identify as a risk factor for coronary artery disease? (Select all that apply.) A. Hypothyroidism B. Hypertension C. Diabetes mellitus D. Hyperlipidemia E. Tobacco smoking

Correct Answers: B. Hypertension C. Diabetes mellitus D. Hyperlipidemia E. Tobacco smoking A client who has hypertension, diabetes mellitus, hyperlipidemia, or a history of smoking tobacco is at risk for coronary artery disease (CAD). Hypertension and hyperlipidemia can be controlled by diet and exercise, along with medication if needed. Diabetes can cause damage to large and small blood vessels, which leads to poor perfusion, cell death, and organ damage. Diabetes mellitus can be managed by monitoring glucose levels and implementing diet and exercise recommendations. Cholesterol levels, such as total HDL and LDL levels, should be monitored since elevated total serum cholesterol levels increase the risk of a myocardial infarction. Finally, smoking accelerates the rate of the narrowing of the coronary arteries and increases the risk of clot formation. Smoking cessation classes or other forms of treatment can be offered to help the client quit smoking.