NSG132 Chapter 49 Diabetes Mellitus

A client is ordered exenatide 500 mcg subcutaneous twice daily. The pharmacy has delivered 2 mg in 2 mL vial. How many mL would the nurse administer? (Please round answer to the nearest tenth)

0.5 mL

A client in diabetic ketoacidosis is ordered 5 units of insulin intravenously per hour. The pharmacy has delivered 125 units in 250 mL normal saline. The nurse would administer how many mL per hour? (Please round to the nearest whole number)

10 mL/hr

A client is ordered canagliflozin 100 mg daily. The pharmacy has delivered 50mg scored tablets. The nurse would correctly administer how many tablets? (Please round to the nearest whole number)

2 tablets

The nurse has been teaching a client with type 2 diabetes about managing blood glucose levels and taking pramlintide. Which statement indicates the teaching was effective? A) "This medication will help me stay full longer." B) "This medication will keep my liver from storing glucose." C) "This medication will block hormones to keep me making insulin." D) "This medication will make my insulin work better on the muscles."

A) "This medication will help me stay full longer."

While a nurse are performing an admission assessment on a client with type 2 diabetes, the client tells you that he routinely drinks 3 beers a day. What is a nurse's priority follow-up question at this time? A) "When during the day do you drink your beers?" B) "Have you ever had a lipid profile completed?" C) "Do you drink any other forms of alcohol?" D) "Do you have any days when you do not drink?"

A) "When during the day do you drink your beers?"

A client diagnosed with type 2 diabetes is admitted to the intensive care unit with hyperosmolar hyperglycemic syndrome. Which assessment data should the nurse expect the client to exhibit? A) Dry mucous membranes. B) Kussmaul's respirations. C) Ketone breath odor. D) Diarrhea and epigastric pain.

A) Dry mucous membranes.

A nurse is teaching a client with diabetes about their diet. Which of the following diet information would be included in the teaching? A) Each meal should contain 45-60 grams of carbohydrates, to maintain glycemic control. B) Foods with a high glycemic index are necessary to prevent hyperglycemia. C) A female client can have two alcoholic drinks a day to maintain cardiovascular effects. D) High protein diets are excellent for the client with type 2 diabetes for weight loss.

A) Each meal should contain 45-60 grams of carbohydrates, to maintain glycemic control.

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) Fluid volume deficit B) Imbalanced nutrition C) Knowledge deficit D) Compromised family coping

A) Fluid volume deficit

A client is found unconscious with a Medic-Alert bracelet indicating type 1 diabetes mellitus. What is the highest priority nursing intervention? A) Give glucagon B) Perform CPR C) Administer insulin D) Feed the client orange juice

A) Give glucagon

Which action should the nurse take after a 36-year-old client treated with intramuscular glucagon for hypoglycemia regains consciousness? A) Give the client a snack of peanut butter and crackers. B) Have the client drink a glass of orange juice or nonfat milk. C) Administer a continuous infusion of 5% dextrose for 24 hours. D) Assess the client for symptoms of hyperglycemia.

A) Give the client a snack of peanut butter and crackers.

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) Intravenous fluids containing dextrose. B) NPH insulin subcutaneously C) henytoin (Dilantin) for the prevention of seizures D) Ampule of 50% dextrose

A) Intravenous fluids containing dextrose.

A client with type 1 diabetes has an unusually high morning glucose measurement, and the health care provider wants the client evaluated for possible Dawn phenomenon. The nurse will plan to A) Perform a blood glucose at 0300 to assess for hyperglycemia. B) Administer evening dose of insulin at 2130. C) Teach client to awaken before 0600. D) Assess for hypoglycemia between 0200-0400.

A) Perform a blood glucose at 0300 to assess for hyperglycemia.

A client is admitted with diabetes mellitus, malnutrition, and cellulitis. The client's potassium level is 5.6 mEq/L. The nurse understands that what could be contributing factors for this laboratory result (select all that apply)? A) The level may be raised as a result of metabolic ketoacidosis caused by hyperglycemia. B) The level is consistent with renal insufficiency that can develop with renal nephropathy. C) The patient may be excreting extra sodium and retaining potassium because of malnutrition. D) This level demonstrates adequate treatment of the cellulitis and effective serum glucose control. E) The level may be increased as a result of dehydration that accompanies hyperglycemia.

A, B, C, E

Which are appropriate therapies for clients with diabetes mellitus? (Select all that apply) A) Use of ACE inhibitors to treat neuropathy B) Use of statins to treat dyslipidemia C) Use of serotonin agonists to decrease appetite. D) Use of laser photocoagulation to treat retinopathy. E) Use of diuretics to treat neuropathy.

A, B, D

A nurse is caring for a newly diagnosed client with type 1 diabetes. Which of the following information is essential to include in discharge teaching? (Select all that apply.) A) Hypoglycemia prevention, symptoms, and treatment. B) Elimination of sugar from the diet. C) Use of a self monitoring blood glucose monitor. D) Need to increase physical activity. E) Insulin administration.

A,C,E

To monitor for complications in a patient with type 2 diabetes, which tests will the nurse in the diabetic clinic schedule at least annually (select all that apply)? A) Monofilament testing of the foot B) Chest x-ray C) Complete blood count (CBC) D) Urine for microalbuminuria E) Blood pressure F) Serum creatinine

A,D,E,F

The nurse has been teaching the client to administer a dose of 10 units of regular insulin and 28 units of NPH insulin. The statement by the client that indicates a need for additional instruction is, A) "I do not need to aspirate the plunger to check for blood before injecting insulin." B) "I need to rotate injection sites among my arms, legs, and abdomen each day." C) "I will buy the 0.5 mL syringes because the line markings will be easier to see." D) "I should draw up the regular insulin first after injecting air into the NPH bottle."

B) "I need to rotate injection sites among my arms, legs, and abdomen each day."

Which of the following statements by a person who has diabetes mellitus shows the nurse that the client has an adequate understanding of foot care? A) "I have a corn on my left foot, so I am going to go to the pharmacy to get something for it right away." B) "I used to take a shower every other night but now I am going to wash and examine my feet every night." C) "I like to use a heating pad at night as I always have cold feet." D) "I am looking forward to the summer when I can go barefoot in my house at the beach."

B) "I used to take a shower every other night but now I am going to wash and examine my feet every night."

A nurse administers a client's morning dose of regular insulin at 0730. The nurse should anticipate observing the client for a hypoglycemic reaction at which of the following times? A) 1230 B) 0930 C) 2330 D) 1630

B) 0930

The plan of care for a diabetic client includes all of these interventions. Which intervention should a nurse delegate to a nursing assistant? A) Discussing community resources for diabetic outpatient care B) Checking to make sure that the client's bath water is not too hot C) Assessing the client's technique for drawing insulin into a syringe D) Teaching the client to perform daily foot inspection

B) Checking to make sure that the client's bath water is not too hot

An LPN is to administer rapid-acting insulin (Lispro) to a client with type 1 diabetes. What essential information would a nurse be sure to tell the LPN? A) Rapid-acting insulin is the only insulin that can be given subcutaneously or intravenously (IV). B) Give this insulin after the client's food tray has been delivered. C) This insulin mimics the basal glucose control of the pancreas. D) Only give this insulin if the client's fingerstick glucose reading is above 200 mg/dL.

B) Give this insulin after the client's food tray has been delivered.

A client is admitted to the emergency room with serum glucose of 965 mg/dL. The nurse suspects that the client has diabetic ketoacidosis rather than hyperosmolar hyperglycemic syndrome based on the finding of A) Polyuria B) Kussmaul respirations C) Diabetic foot ulcer D) Poor skin turger

B) Kussmaul respirations

A client is admitted with diabetic ketoacidosis (DKA) and has a serum potassium level of 2.9 mEq/L. Which action prescribed by the health care provider should the nurse take first? A) Obtain urine glucose and ketone levels. B) Place the client on a cardiac monitor. C) Infuse regular insulin at 20 U/hr. D) Administer IV potassium supplements.

B) Place the client on a cardiac monitor.

The nurse is interviewing a new client with diabetes who receives rosiglitazone. What is most important for the nurse to report immediately to the health care provider? The client A) has a history of emphysema. B) chest pressure when walking. C) blood pressure is 154/92. D) blood glucose is 86 mg/dL

B) chest pressure when walking.

A 55-year-old female client with type 2 diabetes has a nursing diagnosis of imbalanced nutrition: more than body requirements. Which goal is most important for this client? The client will A) Choose a diet that distributes calories throughout the day. B) reach a glycosylated hemoglobin level of less than 7%. C) state the reasons for eliminating simple sugars in the diet. D) follow a diet and exercise plan that results in weight loss.

B) reach a glycosylated hemoglobin level of less than 7%.

When a client who takes metformin (Glucophage) to manage type 2 diabetes develops an allergic rash from an unknown cause, the health care provider prescribes prednisone (Deltasone). The nurse will anticipate that the client may A) develop acute hypoglycemia while taking the prednisone. B) require administration of insulin while taking prednisone. C) need a diet higher in calories while receiving prednisone. D) have rashes caused by metformin-prednisone interactions.

B) require administration of insulin while taking prednisone.

Which finding indicates a need to contact the health care provider before the nurse administers metformin? The client/client's A) blood glucose level is 174 mg/dL. B) has gained 2 lb (0.9 kg) since yesterday. C) blood urea nitrogen (BUN) level is 52 mg/dL. D) is scheduled for a chest x-ray in an hour.

C) blood urea nitrogen (BUN) level is 52 mg/dL.

A nursing diagnosis for a client with newly diagnosed diabetes is Risk for Injury related to sensory alterations. Which key points should a nurse include in the teaching plan for this client? (Select all that apply.) A) "Only a podiatrist should trim your toenails." B) "Be sure that your shoes fit properly." C) "Nylon socks are best to prevent friction on your toes from shoes." D) "Clean and inspect your feet every day." E) "Report any nonhealing skin breaks to your doctor."

B,D,E

The nurse has been teaching a client with type 2 diabetes about managing blood glucose levels and taking glipizide (Glucotrol). Which client statement indicates a need for additional teaching? A) "When I am ill, I may have to take insulin to control my blood sugar." B) "Other medications besides the Glucotrol may affect my blood sugar." C) "If I overeat at a meal, I will still take the usual dose of medication." D) "My diabetes won't cause complications because I don't need insulin."

C) "If I overeat at a meal, I will still take the usual dose of medication."

The client with type 2 diabetes is "nothing by mouth" (NPO) for a cardiac catheterization. An LPN/LVN who is administering medications to this client asks a nurse whether the client should receive the ordered repaglinide. What is a nurse's best response? A) "No, because this drug may cause the client to experience gastrointestinal symptoms such as nausea." B) "Yes, because this drug will increase the client's insulin secretion and prevent hyperglycemia." C) "No, because this drug should be given 1 to 30 minutes before meals and the client is NPO." D) "Yes, because this drug should be taken 3 times a day whether the client eats or not."

C) "No, because this drug should be given 1 to 30 minutes before meals and the client is NPO."

The nurse has been teaching a client with type 2 diabetes about managing blood glucose levels and taking canafliflozin. Which client statement indicates the teaching was effective? A) "This medication will keep me from absorbing glucose in my gut." B) "This medication will make my pancreas produce more insulin." C) "This medication will keep glucose from being absorbed in my kidneys." D) "This medication will help my muscles use glucose."

C) "This medication will keep glucose from being absorbed in my kidneys."

A nurse receives report on the following four clients. Which client would the nurse see first? A) A 42 year old type 2 diabetic requiring 6 units of glargine insulin. B) A 35 year old Type 1 diabetic with a foot ulcer complaining of pain C) A 82 year old type 2 diabetic with acute renaol failure and a blood glucose of 60 mg/dL D) A 56 year old type 1 diabetic with Kussmaul respirations.

C) A 82 year old type 2 diabetic with acute renaol failure and a blood glucose of 60 mg/dL

The nurse is preparing to teach a 43-year-old man who is newly diagnosed with type 2 diabetes about home management of the disease. Which action should the nurse take first? A) Discuss the need for the client to actively participate in diabetes management. B) Ask the client's family to participate in the diabetes education program. C) Assess the client's perception of what it means to have diabetes mellitus. D) Demonstrate how to check glucose using capillary blood glucose monitoring.

C) Assess the client's perception of what it means to have diabetes mellitus.

A college student who has type 1 diabetes normally walks each evening as part of an exercise regimen. The student now plans to take a swimming class every day at 1300. The clinic nurse teaches the client to A) Delay eating the noon meal until after the swimming class. B) Time the morning insulin injection so that the peak occurs while swimming. C) Check glucose level before, during and after swimming. D) Increase the morning dose of neutral protamine insulin (NPH) on the days of swimming class.

C) Check glucose level before, during and after swimming.

A nurse is attending a bridal shower for a friend when another guest starts to tremble and complain of dizziness. The nurse notices a medical alert bracelet for diabetes. What will be the nurse's best action? A) Offer the guest a chocolate B) Activate EMS C) Give the guest a glass of orange juice. D) Encourage the guest to eat some baked ziti.

C) Give the guest a glass of orange juice.

A client recieved 10 units regular insulin at 0700. At 1030 the unlicensed assistive personnel (UAP) tells the nurse the client has a headache and is really acting "funny." Which intervention should the nurse implement first? A) Have the client drink 8 ounces of orange juice. B) Prepare to administer one ampule of 50% dextrose intravenously. C) Go to the client's room and assess the client for hypoglycemia. D) Instruct the UAP to obtain the blood glucose level.

C) Go to the client's room and assess the client for hypoglycemia.

A client with type 1 diabetes asks a nurse about autonomic neuropathy. The nurse would instruct the client that autonomic neuropathy A) Can lead to an eating disorder including anorexia nervosa or bulemia. B) Should be assessed using a monofilament test of the feet and lower extremities C) May cause painless myocardial infarction due to neuropathy of the heart D) Includes an overactive bladder requiring frequent urination

C) May cause painless myocardial infarction due to neuropathy of the heart

A client with diabetic ketoacidosis had repeat arterial blood gases (ABG) drawn 24 hours after initiation of regular insulin infusion. The results are pH 7.30 PaCO2 38 PaO2 95 O2 saturation 99% HCO3 18. The nurse would interpret the results to be which of the following imbalances? A) Respiratory Acidosis B) Metabolic Alkalosis C) Metabolic Acidosis D) Respiratory Alkalosis

C) Metabolic Acidosis

A client is admitted to the hospital with possible new onset diabetes Type 1. Which of the following laboratory results would the nurse need to assess further? A) Hemoglobin A1C 10% B) Blood Pressure 132/96 C) Pre-prandial blood sugar 65 mg/dL D) Fasting blood glucose 154 mg/dL

C) Pre-prandial blood glucose 65 mg/dL

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

C) The onset of diabetes and the associated cardiovascular risks can be delayed or prevented by weight loss and exercise.

A client with type 1 diabetes has been using self-monitoring of blood glucose (SMBG) as part of diabetes management. During evaluation of the client's technique of SMBG, the nurse identifies a need for additional teaching when the client A) Reports a result of 130 mg/dL as a sign of good blood sugar control. B) Hangs the arm down for a minute before puncturing the site. C) Washes the puncture site using soap and water. D) Chooses a puncture site in the center of the finger pad.

D) Chooses a puncture site in the center of the finger pad.

Glyburide is prescribed for a client whose Type 2 diabetes has not been controlled with diet and exercise. When teaching the client about glyburide, the nurse explains that A) Glyburide should be taken even when the blood glucose level is low in the morning B) The client should not take glyburide for 48 hours after receiving contrast media C) Glyburide decreases glucagon secretion D) Glyburide stimulates insulin production and release from the pancreas

D) Glyburide stimulates insulin production and release from the pancreas

A client is scheduled to begin treatment with metformin (Glucophage). A nurse plans to closely monitor which laboratory values? A) MUGA scan results B) Cardiac enzymes C) Renal perfusion studies D) Liver function tests

D) Liver function tests

A nurse is teaching a client with new onset type 1 diabetes about symptoms. The nurse explains that polydipsia and polyruia are due primarily to A) the release of ketones from cells during fat metabolism. B) damage to the kidneys from exposure to high levels of glucose. C) changes in RBC's resulting from attachment of excess glucose to hemoglobin. D) fluid shifts resulting from the osmotic effect of hyperglycemia.

D) fluid shifts resulting from the osmotic effect of hyperglycemia.

Which client action indicates a good understanding of the nurse's teaching about the use of an insulin pump? The client A) takes the pump off at bedtime and starts it again each morning B) changes the location of the insertion site every week. C) plans for a diet that is less flexible when using the insulin pump. D) programs the pump for an insulin bolus after eating.

D) programs the pump for an insulin bolus after eating.