NUR 120: Diabetes Test

The client has an order for Humalog 30 units SQ before meals. Your supply is a 3 mL prefilled cartridge, 100 units/mL. How many mLs will you administer? (Round to the tenths)

0.3mL

The doctor's orders state: "Infuse .9% NS at 150mL/hr for 8 hours, then decrease fluids to 100mL/hr for 10 hours, then decrease fluids to 75mL/hr for 7 hours." Based on this order, how much fluid will the client have received after 13 hours?

1.7 L

The client is to receive 20 mEq of KCL p.o. every morning. The pharmacy sends a bottle labeled 30 mEq/15 mL. How many mL will the nurse administer?

10

The client is in HHS and is receiving a bolus of 0.9% NS infusing at a rate of 1000 mL/hr. The doctor's order states: "Give a 2 Liter bolus and then decrease IV fluids to 150 mL/hr." How long will the bolus infuse for?

2 hours

The client is prescribed metformin (Glucophage) 600 mg daily. The dose is divided into three equal doses and taken 30 minutes before meals, for the last 2 weeks. The patient's blood glucose levels remain too high, so the doctor adjusted the dose to a total of 900 mg daily, divided into three equal doses and taken 30 minutes before meals. The client has a supply of 150mg tablets that she wants to complete prior to filling the new prescription. How many tablets will the client take for each dose?

2 tablets

The nurse is educating the client who was just diagnosed with type 2 diabetes mellitus. What education will the nurse give in regard to disease management?

A. "A low-carb diet is ideal for most diabetics." B. "It is important that I teach you how to self-administer insulin." C. "We should focus on your diet and exercise and see what modifiable risk factors we can change." D. "You will not need to check your own blood sugar levels at this time." Ans:C

The diabetic client asks the nurse, "Why is exercise important for me?" What is the best response by the nurse?"

A. "As long as you lose weight through dieting, exercise can be limited." B. "You are a type 1 diabetic so exercising is not a priority." C. "Exercise increases your insulin sensitivity." D. "Exercise can help decrease your blood pressure and increase your lipid levels." Ans:C

A nurse teaches a client with diabetes mellitus who is experiencing numbness and reduced sensation. Which statement would the nurse include in this client's teaching to prevent injury?

A. "Check your blood glucose level before each meal." B. "Examine your feet using a mirror every day." C. "Use a bath thermometer to test the water temperature." D. "Rotate your insulin injection sites every week." Ans:C

When teaching a client recently diagnosed with type 1 diabetes mellitus, the client states, "I will never be able to stick myself with a needle." How would the nurse respond?

A. "Everyone gets used to giving themselves injections. It really does not hurt." B. "Tell me what it is about the injections that are concerning you." C. "Your disease will not be managed properly if you refuse to administer the shots." D. "I can give your injections to you while you are here in the hospital." Ans:B

After teaching a client with diabetes mellitus to inject insulin, the nurse assesses the patient's understanding. Which statement made by the client indicates a need for additional teaching?

A. "I can reach my thigh the best, so I will use the different areas of my thighs." B. "The lower abdomen is the best location because it is closest to the pancreas." C. "Changing injection sites from the thigh to the arm will change absorption rates." D. "By rotating the sites in one area, my chance of having a reaction is decreased." Ans:B

After teaching a client who has diabetes mellitus and proliferative retinopathy, nephropathy, and peripheral neuropathy, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the teaching?

A. "I used to run for exercise; I will start training for a marathon." B. "I should look into swimming or water aerobics to get my exercise." C. "I have so many complications; exercising is not recommended." D. "I will exercise more frequently because I have so many complications." Ans:B

After teaching a young adult client newly diagnosed with type 2 diabetes mellitus, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the need for eye examinations?

A. "I will see the eye doctor when I have a vision problem and yearly after age 40." B. "My vision will change quickly. I should see the ophthalmologist twice a year." C. "Diabetes can cause blindness, so I should see the ophthalmologist yearly and when I have vision changes." D. "I should continue seeing the ophthalmologist as I usually do." Ans:C

A nurse teaches a client with type 2 diabetes mellitus who is prescribed glipizide (Glucotrol). Which statement would the nurse include in this client's teaching?

A. "If you miss a dose of this drug, you can double the next dose." B. "Discontinue the medication if you develop a urinary infection." C. "Change positions slowly when you get out of bed." D. "Avoid taking nonsteroidal anti-inflammatory drugs (NSAIDs)." Ans:D

The nurse is educating the nursing student on the importance of insulin in blood glucose regulation. Which statement by the nurse is correct regarding insulin?

A. "Insulin is secreted by alpha cells in the islets of Langerhans." B. "It is necessary for glucose transport across cell membranes." C. "It is stored in muscles and converted to fat for storage." D. "It is a catabolic hormone that builds up glucagon reserves." Ans:B

A nurse teaches a client with type 1 diabetes mellitus. Which statement would the nurse include in this client's teaching to decrease the client's insulin needs?

A. "Limit your fluid intake to 2 L a day." B. "Walk at a moderate pace for 1 mile daily." C. "Limit your carbohydrate intake to 80 g a day." D. "Animal organ meat is high in insulin." Ans:B

The nurse is caring for a patient with type 2 diabetes. That patient has recently had insulin injections added to his medication regimen due to elevated A1C levels. Which of the following statements made by this patient indicates an understanding of teaching regarding A1C? Select all that apply

A. "Lowering my A1C means that I am managing my diabetes better." B. "I will need to get my A1C checked quarterly due to my medication change." C. "My A1C level should be between 7 and 8%." D. "Next time I need to remain NPO after midnight for more accurate results." E. "I will need to get my A1C checked twice a year." Ans:A,B

A nurse teaches a client who is diagnosed with diabetes mellitus. Which statement would the nurse include in this client's plan of care to delay the onset of microvascular and macrovascular complications?

A. "Maintain tight glycemic control and prevent hyperglycemia." B. "Restrict your fluid intake to no more than 2 L a day." C. "Limit your intake of protein to prevent ketoacidosis." D. "Prevent hypoglycemia by eating a bedtime snack." Ans:A

After teaching a client who is newly diagnosed with type 2 diabetes mellitus, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching?

A. "My intake of saturated fats should be no more than 10% of my total calorie intake." B. "I should increase my intake of vegetables with higher amounts of dietary fiber." C. "My intake of water is not restricted by my treatment plan or medication regimen." D. "I should decrease my intake of protein and eliminate carbohydrates from my diet." Ans:D

A nurse teaches a client with diabetes mellitus about foot care. Which statements would the nurse include in this client's teaching? Select all that apply.

A. "Soak your feet in a tub each evening." B. "Treat any blisters or sores with Epsom salts." C. "Wash your feet every other day." D. "Trim toenails straight across with a nail clipper." E. "Do not walk around barefoot." Ans:D,E

A nurse teaches a client who is prescribed an insulin pump. Which statement would the nurse include in this client's discharge education?

A. "Store the insulin in the freezer until you need it." B. "Test your urine daily for ketones." C. "Use only buffered insulin in your pump." D. "Change the needle every 3 days." Ans:D

A nurse teaches a client with diabetes mellitus about sick-day management. Which statement would the nurse include in this client's teaching?

A. "Try to continue your prescribed exercise regimen even if you are sick." B. "If vomiting, do not use insulin or take your oral antidiabetic agent." C. "When ill, avoid eating or drinking to reduce vomiting and diarrhea." D. "Monitor your blood glucose levels at least every 4 hours while sick." Ans:D

A nurse teaches a client about self-monitoring of blood glucose levels. Which statement would the nurse include in this client's teaching to prevent bloodborne infections?

A. "Wash your hands after completing each test." B. "Use gloves when monitoring your blood glucose." C. "Blot excess blood from the strip with a cotton ball." D. "Do not share your monitoring equipment." Ans:D

A nurse cares for a client with diabetes mellitus who is visually impaired. The client asks, "Can I ask my niece to prefill my syringes and then store them for later use when I need them?" How would the nurse respond?

A. "Yes. Syringes can be filled with insulin and stored for a month in a location that is protected from light." B. "No. Insulin syringes cannot be prefilled and stored for any length of time outside of the container." C. "Insulin reacts with plastic, so prefilled syringes are okay, but you will need to use glass syringes." D. "Yes. Prefilled syringes can be stored for 3 weeks in the refrigerator in a vertical position with the needle pointing up." Ans:D

A nurse cares for a client with diabetes mellitus who asks, "Why do I need to administer more than one injection of insulin each day?" How would the nurse respond?

A. "You need to start with multiple injections until you become more proficient at self-injection." B. "A single dose of insulin would be too large to be absorbed, predictably putting you at risk for insulin shock." C. "A regimen of a single dose of insulin injected each day would require that you eat fewer carbohydrates." D. "A single dose of insulin each day would not match your blood insulin levels and your food intake patterns." Ans:D

A nurse cares for a client who has type 1 diabetes mellitus. The client asks, "Is it okay for me to have an occasional glass of wine?" How would the nurse respond?

A. "You should not drink alcohol because it will make you hungry and overeat." B. "Because of poor kidney function, people with diabetes should avoid alcohol." C. "One glass of wine is okay with a meal." D. "Drinking any wine or alcohol will increase your insulin requirements." Ans:C

A nurse is teaching a client with diabetes mellitus who asks, "Why is it necessary to maintain my blood glucose levels no lower than about 60 mg/dL (3.3 mmol/L)?" How would the nurse respond?

A. "Your brain needs a constant supply of glucose because it cannot store it." B. "Without a minimum level of glucose, your body does not make red blood cells." C. "Glucose in the blood prevents the formation of lactic acid and prevents acidosis." D. "Glucose is the only fuel used by the body to produce the energy that it needs." Ans:A

A nurse cares for a client who has diabetes mellitus. The nurse administers 6 units of regular insulin and 10 units of NPH insulin at 07:00. At which time would the nurse assess the client for potential problems related to the NPH insulin?

A. 16:00 B. 23:00 C. 08:00 D. 20:00 Ans:A

The nurse is caring for a diabetic client whose finger stick blood sugar was 216 at 12:00pm. The nurse has the following two orders:1.) Give subcutaneous Novolog 10 units before meals at 0800, 1200, and 1600.2.) Give subcutaneous Novolog per sliding scale before meals at 0800, 1200, and 1600: blood sugar 150 - 199: give 3 units, 200 - 249: give 6 units, 250 - 299: give 9 units, 300 or greater: give 12 units How many total units of insulin will the nurse administer to this client?

A. 22 units of Novolog B. 10 units of Novolog C. 19 units of Novolog D. 16 units of Novolog Ans:D

A nurse prepares to administer prescribed regular and NPH insulin. Place the nurse's actions in the correct order to administer these medications.1. Inspect bottles for expiration dates.2. Gently roll the bottle of NPH between the hands.3. Wash your hands.4. Inject air into the regular insulin.5. Withdraw the NPH insulin.6. Withdraw the regular insulin.7. Inject air into the NPH bottle.8. Clean rubber stoppers with an alcohol swab.

A. 8, 1, 3, 2, 4, 6, 7, 5 B. 2, 3, 1, 8, 7, 5, 4, 6 C. 3, 1, 2, 8, 7, 4, 6, 5 D. 1, 3, 8, 2, 4, 6, 7, 5 Ans:C

A nurse assesses a client who has diabetes mellitus and notes that the client is awake and alert, but shaky, diaphoretic, and weak. Five minutes after administering a half-cup (120 mL) of orange juice, the client's clinical manifestations have not changed. What action would the nurse take next?

A. Administer a half-ampule of dextrose 50% intravenously. B. Administer 1 mg of glucagon intramuscularly. C. Administer another half-cup (120 mL) of orange juice. D. Administer 10 units of regular insulin subcutaneously. Ans:C

A nurse reviews the chart and new prescriptions for a client with diabetic ketoacidosis: Vital Signs and AssessmentLaboratory ResultsMedicationsBlood pressure: 90/62 mm HgPulse: 120 beats/minRespiratory rate: 28 breaths/minUrine output: 20 mL/hr via catheterSerum potassium: 2.6 mEq/L (2.6 mmol/L)Potassium chloride 40 mEq/L (40 mmol/L) IV bolus STATIncrease IV fluid to 100 mL/hr What action would the nurse take?

A. Administer the potassium first before increasing the infusion flow rate. B. Increase the intravenous rate and then consult with the provider about the potassium prescription. C. Administer the potassium and then consult with the provider about the fluid prescription. D. Increase the intravenous flow rate before administering the potassium. Ans:B

A nurse provides diabetic education at a public health fair. Which disorders would the nurse include as complications of diabetes mellitus? Select all that apply

A. Cirrhosis B. Stroke C. Respiratory failure D. Blindness E. Kidney failure Ans:B,D,E

The nurse is educating the diabetic client on macrovascular complications. What education will the nurse provide to the diabetic client to prevent macrovascular complications? Select all that apply

A. Discuss the importance of weight loss B. Goal BP of 155/90 or less C. Monitor for protein in the urine D. Smoking cessation E. Increase carbohydrate consumption Ans:A,C,D

A preoperative nurse assesses a client who has type 1 diabetes mellitus prior to a surgical procedure. The client's blood glucose level is 160 mg/dL (8.9 mmol/L). What action would the nurse take?

A. Draw blood gases to assess the metabolic state. B. Administer a bolus of regular insulin IV. C. Call the surgeon to cancel the procedure. D. Document the finding in the client's chart. Ans:D

A nurse prepares to administer insulin to a client at 18:00. The client's medication administration record contains the following information:• Insulin glargine: 12 units daily at 18:00• Regular insulin: 6 units QID at 06:00, 12:00, 18:00, 24:00Based on the client's medication administration record, what action would the nurse take?

A. Draw up and inject the insulin glargine first, wait for 20 minutes, and then draw up and inject the regular insulin. B. First draw up the dose of regular insulin, then draw up the dose of insulin glargine in the same syringe, mix, and inject the two insulins together. C. Draw up and inject the insulin glargine first, and then draw up and inject the regular insulin. D. First draw up the dose of insulin glargine, then draw up the dose of regular insulin in the same syringe, mix, and inject the two insulins together. Ans:C

A nurse assesses a client with diabetes mellitus and notes that the client only responds to a sternal rub by moaning, has a capillary blood glucose of 33 g/dL (1.8 mmol/L), and has an intravenous line that is infiltrated with 0.45% normal saline. What action would the nurse take first?

A. Encourage the patient to drink orange juice. B. Insert a new intravenous access line. C. Administer 25 mL dextrose 50% (D50) IV push. D. Administer 1 mg of intramuscular glucagon. Ans:D

A nurse assesses a client who has a 15-year history of diabetes and notes decreased tactile sensation in both feet. What action would the nurse take first?

A. Examine the client's feet for signs of injury. B. Assess tactile sensation in the client's hands. C. Document the finding in the client's chart. D. Notify the healthcare provider. Ans:A

A nurse develops a dietary plan for a client with diabetes mellitus and new-onset microalbuminuria. Which component of the client's diet would the nurse decrease?

A. Fats B. Proteins C. Total calories D. Carbohydrates Ans:B

An emergency department nurse assesses a client with ketoacidosis. Which clinical manifestation would the nurse correlate with this condition?

A. Oral temperature of 102° F (38.9° C) B. Severe orthostatic hypotension C. Increased rate and depth of respiration D. Extremity tremors followed by seizure activity Ans:C

The nurse is caring for four diabetic clients. Which task would be appropriate to delegate to the PCT?

A. Perform hourly blood sugar checks on a hyperglycemic client B. Verify the infusion rate on IV insulin infusion pump C. Check on the client complaining of anxiety and palpitations. D. Monitor a client with a blood glucose of 68 mg/dl for tremors and irritability Ans:A

A nurse assesses a client with diabetes mellitus 3 hours after a surgical procedure and notes that the client's breath has a "fruity" odor. What action would the nurse take?

A. Perform meticulous pulmonary hygiene care. B. Encourage the patient to use an incentive spirometer. C. Increase the patient's intravenous fluid flow rate. D. Consult the provider to test for ketoacidosis. Ans:D

A nurse reviews the medication list of a client recovering from a computed tomography (CT) scan with IV contrast to rule out small bowel obstruction. Which medication would alert the nurse to contact the provider and withhold the prescribed dose?

A. Pioglitazone (Actos) B. Metformin (Glucophage) C. Glipizide (Glucotrol) D. Glimepiride (Amaryl) Ans:B

The nurse understands the importance of distinguishing diabetic ketoacidosis (DKA) and hyperglycemic-hyperosmolar syndrome (HHS). Which fluid should be administered in early treatment intravenously for both conditions?

A. Potassium B. Normal Saline C. Glucagon D. Bicarbonate Ans:B

At 4:45 PM, a nurse assesses a client with diabetes mellitus who is recovering from an abdominal hysterectomy 2 days ago. The nurse notes that the client is confused and diaphoretic. The nurse reviews the assessment data provided in the chart below: Capillary Blood Glucose Testing (AC/HS)Dietary IntakeAt 06:30—95At 11:30—70At 16:30—47Breakfast: 10% eaten—patient states that she is not hungryLunch: 5% eaten—patient is nauseous; vomits once After reviewing the client's assessment data, which action is appropriate at this time?

A. Provide a glass of orange juice and encourage the client to eat dinner. B. Assess the client's oxygen saturation level and administer oxygen. C. Reorient the client and apply a cool washcloth to the client's forehead. D. Administer dextrose 50% intravenously and reassess the client. Ans:D

The nurse is caring for the diabetic client who complains of sweating at night and who has hyperglycemic episodes in the morning. The nurse suspects that the client is experiencing the Somogyi effect. What interventions would the nurse potentially implement? Select all that apply

A. Provide an evening snack and check blood sugars every 2 hours B. Increase the client's protein intake C. Monitor insulin regimens D. Provide an evening snack E. Decrease nighttime insulin doses Ans:C,D,E

An adult client comes into the clinic for a fasting blood glucose test. The results of this test are 127mg/dL. Which of the following interventions would be most appropriate?

A. Send the patient home as this is a normal finding B. Take a finger stick blood sugar in 1 hour for accuracy C. Start the patient on metformin (Glucophage) as ordered D. Repeat another fasting blood glucose in a few weeks. Ans:D

A nurse reviews laboratory results for a client with diabetes mellitus who is prescribed an intensified insulin regimen:• Fasting blood glucose: 75 mg/dL (4.2 mmol/L)• Postprandial blood glucose: 200 mg/dL (11.1 mmol/L)• Hemoglobin A1c level: 5.5%How would the nurse interpret these laboratory findings?

A. Signs of insulin resistance B. Increased risk for developing hyperglycemia C. Good control of blood glucose D. Increased risk for developing ketoacidosis Ans:C

A nurse assesses a client who is experiencing diabetic ketoacidosis (DKA). For which manifestations would the nurse monitor the client? Select all that apply.

A. Tachycardia B. Orthostatic hypotension C. Deep and fast respirations D. Dependent pulmonary crackles E. Decreased urine output Ans:A,C

The nurse is reviewing labs on a 40-year-old newly admitted client. The labs are as follows: A1C 5.3%, fasting glucose 98, and WBCs 6500. What can the nurse conclude from these findings?

A. The client has diabetes B. The client has type 2 diabetes C. The client's labs are within normal limits D. The client is pre-diabetic Ans:C

The nursing student asks the nurse, "What is the goal in treating a patient with diabetes?" What is the nurse's best response?

A. The goal is to prevent blindness B. The goal is to maintain optimal blood sugar levels C. The goal is for the client to lose 10% of their body fat D. The goal is to lower their A1C by 3% Ans:B