Metabolism/ Diabetes
A nurse is interviewing a client with type 2 DM. which statement by the client indicates an understanding of the treatment for this disorder?
1. "I take oral insulin instead of shots." •2. "By taking these medications, I am able to eat more." •3. "When I become ill I need to increase the number of pills I take." •4. "The medications I'm taking help release the insulin I already make." 4.
The famil y of a bedridden client with type 2 DM and chronic renal failure calls a nurse to report the following symptoms: headache, polydipsia, and increased lethargy. To determine a possible diagnosis, the nurse asks the family which most important question?
1. "What is the client's urine output?" •2. "What is the client's blood glucose level?" •3. "Has there been any change in the dietary intake?" •4. "Have you increased the amount of fluids provided?" .2
A home health nurse visits a client with a diagnosis of Type 1 DM. The client relates a history of vomitting and diarrhea and tells the nurse that no food has been consumed for 36 hours. Which additional staement by the client indicates a need for further teaching.
1. " I need to stop my insulin." •2. "I need to increase my fluid intake." •3. "I need to monitor my blood glucose every 3-4 hours." •4. "I need to call the physican because of these symptoms." 1.
A nurse provides instructions to a client newly diagnosed with Type 1 DM. The nurse recognizes accurate understanding of measures to prevent diabetic ketoacidosis when the client states:
1. "I will stop taking my insulin if I'm too sick to eat." •2. "I will decrease my insulin dose during times of illness." •3. "I will adjust my insulin dose according to the level of glucose in my urine." •4. "I will notify my physician if my blood glucose level is higher than 250." •4 •During illness, the client should monitor blood glucose levels and should notify the physician if the level is higher then 250.
A client with type 1 DM 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?
1. "The best time for me to exercise is after I eat." •2. "The best time for me to exercise is after breakfast." •3. "The best time for me to exercise is mid to late afternoon." •4. "The best time for me to exercise is after my morning snack." •3 •A hypoglycemic reaction may occur in response to increased exercise. Clients should avoid exercise during the peak time of insulin.
A client with DM demonstrates acute anxiety when first admitted for the treatment of hyperglycemia. The appropriate intervention to decrease the client's anxiety is to:
1. Administer a sedative •2. Convey empathy, trust, and respect toward the client. •3. Ignore the signs and symptoms of anxiety so that they will soon disappear. •4. Make sure that the client knows all the correct medical terms to understand what is happening 2. •The appropriate intervention is to address the client's feelings related to the anxiety.
A client newly diagnosed with DM 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?
1. Always keep insulin vials refrigerated. •2. Ketones in the urine signify a need for less insulin. •3. Increase the amount of insulin before usual exercise. •4. Systematically rotate insulin injections within one anatomic site. .3 •Insulin doses should not be adjusted nor increased before unusual exercise.
A nurse is assisting a client with DM who is recovering from diabetic ketoacidosis (DKA). In the acute phase, the priority nursing action is to prepare to:
1. Correct the acidosis •2. Apply a monitor for an electrocardiogram •3. Administer 5% dextrose intravenously •4. Administer regular insulin intravenously •4 •Lack of insulin is the primary cause of DKA, IV fluid administration (normal saline initially), potassium replacement, and followed by correcting acidosis.
A client is brought to the ER in an unresponsive state, and a diagnosis of hyperglycemic hyperosmolar nonketoic syndrome is made. The nurse would immediately prepare to initiate which of the following anticipated physician's order?
1. Endotracheal intubation •2. 100 units of NPH Insulin •3. Intravenous infusion of normal saline •4. Intravenous infusion of sodium bicarbonate •3 •The primary goal is to rehydrate the patient and to replace electrolyte imbalance
After several diagnostic tests, a client is diagnosed with diabetes insipidus. A nurse performs an assessment on the client, knowing that which symptom is most indicative of this disorder?
1. Fatigue •2. Diarrhea •3. Polydipsia •4. Weight gain •3 •Polydipsia and polyuria are classic symptoms of Diabetes Insipidus.
A nurse is preparing a plan of care for a client with DM who has hyperglycemia. The priority nursing diagnosis would be:
1. Fluid volume, deficient •2. Family processes, dysfunctional •3. Nutrition: less than body requirements, imbalanced •4. Knowledge, deficient: disease process and treatment 1. •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.
An external insulin pump is prescribed for a client with DM and the client asks the nurse about the functioning of the pump. The nurse bases the response on the information that the pump:
1. Is timed to release programmed doses of regular or NPH insulin into the bloodstream at specific intervals. 2. Continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels. 3. Is surgically attached to the pancreas and infuses regular insulin into the pancreas, which in turn releases the insulin into the bloodstream. 4. Gives a small continuous dose of regular insulin subcutaneously, and the client can self administer a bolus with an additional dose from the pump before each meal. •4. •An insulin pump provides a small continuous dose of regular 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.
A nurse needs to maintain food and fluid intake to minimize the risk of dehydration in a client with DM who has gastroenteritis. The appropriate nursing intervention is to:
1. Offer water only until the client is able to tolerate solid foods. •2. Withhold all fluids until vomiting has ceased for at least 4 hours. •3. Encourage the client to take 8 to 12 oz of fluid every hour while awake. •4. maintain a clear liquid diet for at least 5 days before advancing to solids to allow inflammation of the stomach and bowels to dissipate. •3 •Small amounts of fluid may be tolerated, even when vomiting is present. The nurse should encourage liquids containing glucose and electrolytes every hour.
A nurse teaches a client with DM about differentiating between hypoglycemia and ketoacidosis. The client demonstrates an understanding of the teaching by stating that glucose will be taken if which of the following symptoms develops?
1. Polyuria 2. Shakiness 3. Blurred vision 4. Fruity breath odor .2 •Shakiness is a sign of hypoglycemia and would iundicate the need for food or glucose.
A nurse is monitoring a client newly diagnosed with DM for signs of complications. Which of the following, if exhibited in the client, would indicate hyperglycemia and warrant physician notification?
1. Polyuria •2. Diaphoresis •3. Hypertension •4. Increased Pulse rate .1 •Classic symptoms of hyperglycemia include polydipsia, polyuria, and polyphagia.
A nurse notes that a client with type 1 DM has lipodystrophy on both upper thighs. The nurse would appropriately inquire whether the client:
1. Rotates sites for injection •2. Administers the insulin at a 45 degree angle. •3. Cleanses the skin with alcohol before each injection •4. Aspirates for blood before injection into the subcutaneous tissue. 1. •Lipodystrophy occurs in some clients with DM when injection sites are used for a prolonged period of time
A nurse is caring for a client with type 1 DM. 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 •Decreased blood glucose levels produce autonomic nervous system symptoms, which are manifested classically as nervousness, irritability, and tremors.
Which are appropriate therapies for patients with diabetes mellitus (select all that apply)? a. use of statins to treat dyslipidemia b. use of diuretics to treat nephropathy c. use of ACE inhibitors to treat nephropathy d. use of serotonin agonists to decrease appetite e. use of laser photocoagulation to treat retinopathy
A, C, E - In patients with diabetes who have microalbuminuria or macroalbuminuria, angiotensin-converting enzyme (ACE) inhibitors (e.g., lisinopril [Prinivil, Zestril]) or angiotensin II receptor antagonists (ARBs) (e.g., losartan [Cozaar]) should be used. Both classes of drugs are used to treat hypertension and have been found to delay the progression of nephropathy in patients with diabetes. The statin drugs are the most widely used lipid-lowering agents. Laser photocoagulation therapy is indicated to reduce the risk of vision loss in patients with proliferative retinopathy, in those with macular edema, and in some cases of nonproliferative retinopathy.
Analyze the following diagnostic findings for your patient with type 2 diabetes. Which result will need further assessment?
A. A1C 9% B. BP 126/80 mm Hg C. FBG 130 mg/dL D. LDL cholesterol 100 mg/dL Answer: A
Which statement made by the patient with type 2 diabetes is accurate?
A. I will limit my alcohol to 1 drink each day. B. I am not allowed to eat any sweets because of my diabetes. C. I can't exercise because I take a blood glucose lowering medication. D. The amount of fat in my diet isn't important. Only carbs raise my blood sugar. Answer: A
You are caring for a patient newly diagnosed with type 1 diabetes. What information is essential to include in your teaching before discharge from the hospital? Select all that apply
A. Insulin administration B. Elimination of sugar from diet. C. Need to reduce physical activity D. Use of portable glucose monitor E. Hyperglycemia prevention, symptoms and treatment. Answer: A, D, E.
A patient with diabetes has a serum glucose level of 824 mg/dL and is unresponsive. After assessing the patient the nurse suspects diabetes-related ketoacidosis rather than hyperosmolar hyperglycemia syndrome based on findings of
A. Polyuria B. Severe dehydration C. Rapid, deep respiration's D. Decreased serum potassium Answer: C
Polydipsia and polyuria related to diabetes are primarily related to:
A. Release of ketones from cells during metabolism. B. Fluids shift from the osmotic effect of hyperglycemia. C. Damage to kidneys from exposure to high glucose levels. D. Changes in RBCs resulting from attachment of excess glucose to hemoglobin. Answer: B
Which statement would be correct for a pt with type 2 diabetes who was admitted to the hospital with pneumonia?
A. The patient must receive insulin therapy to prevent ketoacidosis. B. The patient has islet cell antibodies that have destroyed the pancreases ability to make insulin. C. The patient has minimal or absent endogenous insulin secretion and requires daily insulin injections. D. The pt may have enough endogenous insulin to prevent ketosis but is at risk for hyperosmolar hyperglycemia syndrome. Answer: D
What is the priority action for the nurse to take if the patient with type 2 diabetes complains of blurred vision and irritability?
A. call the physician B. administer insulin as ordered C. check the patient's blood glucose level D. assess for other neurologic symptoms Answer: C
Major long term consequences of type 1&2 diabetes.
Macrovascular (atherosclerotic plaque) Pathology: Possible consequences: Coronary arteries MI Cerebral arteries Stroke Peripheral vessels Peripheral vascular disease Microvascular (capillary damage) Rentinopathy (retinal damage) Par/ comp blind Neuropathy. Autonomic nerve damage (ED, diabetic foot ulcer) Nephropathy (kidney damage). Proteinuria, renal failure
A nurse performs a physical assessment on a client with type 2 DM. Findings include a fasting blood glucose of 120, temperature of 101 F, pulse of 88, respirations of 22, and a BP of 100/72. which finding would be of most concern to the nurse?
Pulse •Respiration •Temperature •Blood Pressure 3. •Elevated temperature is a leading cause of elevated blood glucose levels.
A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in an ER. Which finding would a nurse expect to note as confirming this diagnosis?
•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. •In DKA the pH is lower than 7.35, plasma bicarbonate is lower than 15 mEq, the blood glucose level is higher than 250.
A client with type 2 DM has a blood glucose level higher than 600, and, is complaining of polydipsia, polyuria, weight loss, and weakness. A nurse reviews the physican's documentation and would expect to note which of the following diagnoses?
•1. Hypoglycemia •2. Pheochromocytoma •3. Diabetic Ketoacidosis (DKA) •4. Hyperglycemic hyperosmolar nonketoic syndrome (HHNS) 4. •Hyperglycemic hyperosmolar nonketoic syndrome occurs in clients with type 2 DM. The onset of symptoms may be gradual. The symptoms may include polyuria, polydipsia, dehydration, mental status alterations, weight loss, and weakness.
A nurse is preparing a teaching plan for a client with DM regarding proper foot care. Which instruction is included in the plan?
•1. Soak feet in hot water. •2. Avoid using a mild soap on the feet. •3. Apply a moisturizing lotion to dry feet but not between the toes. •4. Always have a podiatrist cut your toenails; never cut them yourself. •3. Rationale: •The client is instructed to use a moisturizing lotion on the feet and to avoid applying the lotion between the toes.
A hospitalized client with type 1 DM received NPH and regular insulin 2 hrs ago (0730). The client calls the nurse and reports that she is feeling hungry, shaky, and weak. The client ate breakfast at 8am and is due to eat lunch at noon. List in order of priority the actions the nurse would take
•___ Take the clients vital signs •___ Retest the blood glucose level •___ Check the client's blood glucose level •___ Give the client ½ cup of fruit juice to drink •___ Give the client a small snack of carbohydrate and protein •___ document the client's complaints, actions taken, and outcome •3 •4 •1 •2 •5 •6
