Honan Chapter 30: Nursing Management: Diabetes Mellitus

Which instruction about insulin administration should a nurse give to a client? "Always follow the same order when drawing the different insulins into the syringe." "Shake the vials before withdrawing the insulin." "Store unopened vials of insulin in the freezer at temperatures well below freezing." "Discard the intermediate-acting insulin if it appears cloudy."

"Always follow the same order when drawing the different insulins into the syringe."

A client with diabetes mellitus must learn how to self-administer insulin. The physician has ordered 10 units of U-100 regular insulin and 35 units of U-100 isophane insulin suspension (NPH) to be taken before breakfast. When teaching the client how to select and rotate insulin injection sites, the nurse should provide which instruction? "Inject insulin into healthy tissue with large blood vessels and nerves." "Rotate injection sites within the same anatomic region, not among different regions." "Administer insulin into areas of scar tissue or hypertrophy whenever possible." "Administer insulin into sites above muscles that you plan to exercise heavily later that day."

"Rotate injection sites within the same anatomic region, not among different regions."

The nurse is administering lispro insulin. Based on the onset of action, how long before breakfast should the nurse administer the injection? 10 to 15 minutes 30 to 40 minutes 1 to 2 hours 3 hours

10 to 15 minutes

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

180 mg/dL

A client with diabetes comes to the clinic for a follow-up visit. The nurse reviews the client's glycosylated hemoglobin test results. Which result would indicate to the nurse that the client's blood glucose level has been well controlled? 6.5% 7.5% 8.0% 8.5%

6.5%

A health care provider prescribes short-acting insulin for a patient, instructing the patient to take the insulin 20 to 30 minutes before a meal. The nurse explains to the patient that Humulin-R taken at 6:30 AM will reach peak effectiveness by: 8:30 AM. 10:30 AM. 12:30 PM. 2:30 PM.

8:30 AM

After recently being admitted to the emergency department with signs and symptoms of hyperglycemia, a 33-year-old man was subsequently diagnosed with diabetes. The patient's blood sugars have been stabilized, and the man has begun diabetes education with a nurse educator. When working with this patient, the nurse educator should first: Teach the patient about the essential concepts of nutrition Explain the various insulin delivery devices to the patient Ask the patient what questions he currently has about diabetes Ascertain the patient's readiness and willingness to learn

Ascertain the patient's readiness and willingness to learn

A client with long-standing type 1 diabetes is admitted to the hospital with unstable angina pectoris. After the client's condition stabilizes, the nurse evaluates the diabetes management regimen. The nurse learns that the client sees the physician every 4 weeks, injects insulin after breakfast and dinner, and measures blood glucose before breakfast and at bedtime. Consequently, the nurse should formulate a nursing diagnosis of: Impaired adjustment. Defensive coping. Deficient knowledge (treatment regimen). Health-seeking behaviors (diabetes control).

Deficient knowledge (treatment regimen).

During a follow-up visit 3 months after a new diagnosis of type 2 diabetes, a client reports exercising and following a reduced-calorie diet. Assessment reveals that the client has only lost 1 pound and did not bring the glucose-monitoring record. Which value should the nurse measure? Fasting blood glucose level Glucose via a urine dipstick test Glycosylated hemoglobin level Glucose via an oral glucose tolerance test

Glycosylated hemoglobin level

The nurse is educating the client with diabetes on setting up a sick plan to manage blood glucose control during times of minor illness such as influenza. Which is the most important teaching item to include? Increase frequency of glucose self-monitoring. Decrease food intake until nausea passes. Do not take insulin if not eating. Take half the usual dose of insulin until symptoms resolve.

Increase frequency of glucose self-monitoring.

A 30-year-old type 1 diabetic has been admitted to the critical care unit with a diagnosis of diabetic ketoacidosis following a drinking binge over the course of a weekend. The nurse should anticipate that this patient will require what immediate intervention? IV administration of calcium gluconate Subcutaneous administration of 30 units of insulin glargine (Lantus) Oral administration of 2 g of metformin (Glucophage) Rapid administration of intravenous normal saline

Rapid administration of intravenous normal saline

A male client, aged 42, is diagnosed with diabetes mellitus. He visits the gym regularly and is a vegetarian. Which of the following factors is important when assessing the client? The client's consumption of carbohydrates History of radiographic contrast studies that used iodine The client's mental and emotional status The client's exercise routine

The client's consumption of carbohydrates

A 60-year-old client comes to the ED reporting weakness, vision problems, increased thirst, increased urination, and frequent infections that do not seem to heal easily. The physician suspects that the client has diabetes. Which classic symptom should the nurse watch for to confirm the diagnosis of diabetes? Numbness Increased hunger Fatigue Dizziness

increased hunger

A nurse is preparing to administer two types of insulin to a client with diabetes mellitus. What is the correct procedure for preparing this medication? The short-acting insulin is withdrawn before the intermediate-acting insulin. The intermediate-acting insulin is withdrawn before the short-acting insulin. Different types of insulin are not to be mixed in the same syringe. If administered immediately, there is no requirement for withdrawing one type of insulin before another.

The short-acting insulin is withdrawn before the intermediate-acting insulin.

A client has type 1 diabetes. Her husband finds her unconscious at home and administers glucagon, 0.5 mg subcutaneously. She awakens in 5 minutes. Why should her husband offer her a complex carbohydrate snack as soon as possible? To decrease the possibility of nausea and vomiting To restore liver glycogen and prevent secondary hypoglycemia To stimulate her appetite To decrease the amount of glycogen in her system

To restore liver glycogen and prevent secondary hypoglycemia

A client with type 2 diabetes asks the nurse why he can't have a pancreatic transplant. Which of the following would the nurse include as a possible reason? Increased risk for urologic complications Need for exocrine enzymatic drainage Underlying problem of insulin resistance Need for lifelong immunosuppressive therapy

Underlying problem of insulin resistance

When administering insulin to a client with type 1 diabetes, which of the following would be most important for the nurse to keep in mind? Duration of the insulin Accuracy of the dosage Area for insulin injection Technique for injecting

accuracy of the dosage

A nurse is caring for a diabetic patient with a diagnosis of nephropathy. What would the nurse expect the urinalysis report to indicate? Albumin Bacteria Red blood cells White blood cells

albumin

During a class on exercise for clients with diabetes mellitus, a client asks the nurse educator how often to exercise. To meet the goals of planned exercise, the nurse educator should advise the client to exercise: at least once per week. at least three times per week. at least five times per week. every day.

at least three times per week

The nurse is preparing to administer a patient's scheduled dose of Novolin 70/30. When administering this dose of insulin, the nurse should: Ensure that the insulin is not given near a previous injection site Aspirate before injecting the insulin into the patient's subcutaneous tissue Massage the injection site gently for 10 to 15 seconds after administration Use a 3 mL syringe with a 24 gauge, 5/8 to 1-inch needle

ensure insulin is not given near a previous injection site

A nurse is teaching a client with type 1 diabetes how to treat adverse reactions to insulin. To reverse hypoglycemia, the client ideally should ingest an oral carbohydrate. However, this treatment isn't always possible or safe. Therefore, the nurse should advise the client to keep which alternate treatment on hand? Epinephrine Glucagon 50% dextrose Hydrocortisone

glucagon

A client tells the nurse that she has been working hard for the past 3 months to control her type 2 diabetes with diet and exercise. To determine the effectiveness of the client's efforts, the nurse should check: urine glucose level. fasting blood glucose level. serum fructosamine level. glycosylated hemoglobin level.

glycosylated hemoglobin level

A client with diabetes mellitus is receiving an oral antidiabetic agent. The nurse observes for which condition when caring for this client? Polyuria Hypoglycemia Blurred vision Polydipsia

hypoglycemia

The nurse is preparing a presentation for a group of adults at a local community center about diabetes. Which of the following would the nurse include as associated with type 2 diabetes? Onset most common during adolescence Insulin production insufficient Less common than type 1 diabetes Little to no relation to pre-diabetes

insulin production insufficient

A patient who is diagnosed with type 1 diabetes would be expected to: Be restricted to an American Diabetic Association diet. Have no damage to the islet cells of the pancreas. Need exogenous insulin. Receive daily doses of a hypoglycemic agent.

need exogenous insulin

Which clinical characteristic is associated with type 1 diabetes (previously referred to as insulin-dependent diabetes mellitus)? Presence of islet cell antibodies Obesity Rare ketosis Requirement for oral hypoglycemic agents

presence of islet cell antibodies

The client with diabetes asks the nurse why shoes and socks are removed at each office visit. The nurse gives which assessment finding as the explanation for the inspection of feet? Autonomic neuropathy Retinopathy Sensory neuropathy Nephropathy

sensory neuropathy

A client with status asthmaticus requires endotracheal intubation and mechanical ventilation. Twenty-four hours after intubation, the client is started on the insulin infusion protocol. The nurse must monitor the client's blood glucose levels hourly and watch for which early signs and symptoms associated with hypoglycemia? Sweating, tremors, and tachycardia Dry skin, bradycardia, and somnolence Bradycardia, thirst, and anxiety Polyuria, polydipsia, and polyphagia

sweating, tremors, and tachycardia