NURS 309 Acute Type 1 Diabetes-1

The nurse is caring for a diabetic patient in the ED. The patient's lab values include serum glucose 353 mg/dL, positive serum ketones, and positive urine ketones. What complication does the nurse suspect? A. DKA B. HHS C. Hyperglycemia D. Hypoglycemia

A. DKA

A nurse is planning to teach facts about hyperglycemia to a client with the diagnosis of diabetes. What information should the nurse include in the discussion about what causes diabetic acidosis? A. Breakdown of fat stores for energy B. Ingestion of too many highly acidic foods C. Excessive secretion of endogenous insulin D. Increased amount of cholesterol in the extracellular compartment

A. Breakdown of fat stores for energy

Which is an independent nursing action that should be included in the plan of care for a client after an episode of ketoacidosis? A. Monitoring for signs of hypoglycemia as a result of treatment B. Withholding glucose in any form until the situation is corrected C. Giving fruit juices, broths, and milk as soon as the client is able to take fluids orally D. Regulating insulin dosage according to the amount of ketones found in the client's urine

A. Monitoring for signs of hypoglycemia as a result of treatment

The patient's urinalysis shows proteinuria. Which pathophysiology does the nurse suspect? A. Nephropathy B. Neuropathy C. Retinopathy D. Gastroparesis

A. Nephropathy

A client has a hypoglycemic reaction to insulin. Which client responses should the nurse document as clinical manifestations of hypoglycemia? SATA A. Pallor B. Tremors C. Glycosuria D. Acetonuria E. Diaphoresis

A. Pallor B. Tremors E. Diaphoresis

Which characteristics describes a needleless insulin injection system? A. The patient must be able to operate the pump, adjust the settings, and respond to alarms B. Insulin is given by jet injection, is absorbed at a faster rate, and has a shorter duration of action C. A continuous subcutaneous infusion of basal dose of insulin is provided D. If a meal is skipped, an additional mealtime dose of insulin is not given

B. Insulin is given by jet injection, is absorbed at a faster rate, and has a shorter duration of action

Why is glucose vital to the body's cells? A. It is used to build cell membranes B. It is used by cells to produce energy C. It affects the process of protein metabolism D. It provides nutrition for genetic material

B. It is used by cells to produce energy

A nurse is caring for a client with a diagnosis of type 1 diabetes who has developed diabetic coma. Which element excessively accumulates in the blood to precipitate the signs and symptoms associated with this condition? A. Sodium bicarbonate, causing alkalosis B. Ketones as a result of rapid fat breakdown, causing acidosis C. Nitrogen from protein catabolism, causing ammonia intoxication D. Glucose from rapid carbohydrate metabolism, causing drowsiness

B. Ketones as a result of rapid fat breakdown, causing acidosis

A patient with type 1 diabetes reports feeling dizzy. What should the nurse do first? A. Check the patient's blood pressure B. Give the patient some orange juice C. Give the patient's morning dose of insulin D. Use a glucometer to check the patient's glucose level

D. Use a glucometer to check the patient's glucose level

A nurse administers the prescribed regular insulin (Novolin R) to a client in diabetic ketoacidosis. In addition, the nurse anticipates that the IV solution prescribed will contain potassium to replenish potassium ions in the extracellular fluid that are being: A. rapidly lost from the body by copious diaphoresis present during coma B. carried with glucose to the kidneys to be excreted in the urine in increased amounts C. quickly used up during the rapid series of catabolic reactions stimulated by insulin and glucose D. moved into the intracellular fluid compartments because of the generalized anabolism induced by insulin and glucose

D. moved into the intracellular fluid compartments because of the generalized anabolism induced by insulin and glucose

A health care provider prescribes 36 units of NPH insulin (Novolin N) and 12 units of regular insulin (Novolin R). The nurse plans to administer these drugs in one syringe. Identify the steps in this procedure by listing the numbers by each picture next to the step below in priority.

Step 1: Inject air equal to NPH dose into NPH vial Step 2: Inject air equal to regular dose into regular vial Step 3: Invert regular insulin bottle and withdraw regular insulin dose Step 4: Invert NPH vial and withdraw NPH dose

A client with type 1 diabetes mellitus has a fingerstick glucose level of 258 mg/dL at bedtime. A prescription for sliding scale regular insulin (Novolin R) exists. What should the nurse do? A. Call the health care provider B. Encourage the intake of fluids C. Administer the insulin as prescribed D. Give the client a half cup of orange juice

C. Administer the insulin as prescribed

A client has a glycosylated hemoglobin measurement of 6%. What should the nurse conclude about this client when planning a teaching plan based on the results of this laboratory test? A. Is experiencing a rebound hyperglycemia B. Needs the insulin changed to a different type C. Has followed the treatment plan as prescribed D. Requires further teaching regarding nutritional guidelines

C. Has followed the treatment plan as prescribed

Which factors differentiate diabetic ketoacidosis (DKA) from hyperglycemic-hyperosmolar state (HHS)? SATA A. Sudden versus gradual onset B. Amount of ketones produced C. Serum bicarbonate levels D. Amount of volume depletion E. Dosage of insulin needed F. Level of hyperglycemia

A. Sudden versus gradual onset B. Amount of ketones produced F. Level of hyperglycemia

In determining if a patient is hypoglycemic, in addition to checking the patient's blood glucose, the nurse assesses the patient for which characteristics? SATA A. Nausea B. Hunger C. Irritability D. Tremors E. Profuse perspiration F. Rapid, deep respirations

B. Hunger C. Irritability D. Tremors E. Profuse perspiration

A nurse identifies that the client is experiencing a hypoglycemic reaction. Which nursing intervention should this nurse implement to relieve the symptoms associated with this reaction? A. Giving 4 oz of fruit juice B. Administering 5% dextrose solution IV C. Withholding a subsequent dose of insulin D. Providing a snack of cheese and dry crackers

A. Giving 4 oz of fruit juice

People from which cultures tend to have a higher incidence of DM? SATA A. Mexican American B. African American C. Caucasian D. American Indian E. Eastern European F. Alaskan Indian

A. Mexican American B. African American D. American Indian F. Alaskan Indian

A client with type 1 diabetes comes to the clinic because of concerns regarding erratic control of blood glucose with the prescribed insulin therapy. The client has been experiencing a sudden fall in the blood glucose level, followed by a sudden episode of hyperglycemia. Which complication of insulin therapy should the nurse conclude that the client is experiencing? A. Somogyi effect B. Dawn phenomenon C. Diabetic ketoacidosis D. Hyperosmolar nonketotoic syndrome

A. Somogyi effect

What must the nurse teach a patient with type 1 DM about preventing the loss of insulin potency? SATA A. "Avoid exposing insulin to temperatures below 36F or above 86F" B. "Freeze bottles of insulin for long-term storage" C. "Always shake NPH insulin to assure it is evenly cloudy" D. "Do not expose insulin to heat or light" E. "Insulin glargine (Lantus) should be stored in the refrigerator" F. "A slight loss in potency may occur for bottles in use for more than 30 days"

A. "Avoid exposing insulin to temperatures below 36F or above 86F" D. "Do not expose insulin to heat or light" E. "Insulin glargine (Lantus) should be stored in the refrigerator"

A client with diabetes asks the nurse whether the new forearm stick glucose monitor gives the same results as a fingerstick. What is the nurse's best response to this question? A. "There is no difference between readings" B. "These types of monitors are meant for children" C. "Readings are on a different scale for each monitor" D. "Faster readings can be obtained from a fingerstick"

A. "There is no difference between readings"

The RN is orienting a new graduate nurse who is providing diabetes education for a patient about insulin injection. For which teaching statement by the new nurse must the RN intervene? A. "To prevent lipohypertrophy, be sure to rotate injection sites from the abdomen to the thighs" B. "To correctly inject the insulin, lightly grasp a fold of skin and inject at a 90-degree angle" C. "Always draw your regular insulin into the syringe first before your NPH insulin" D. "Avoid injecting the insulin into scarred sites because those areas slow the absorption rate of insulin"

A. "To prevent lipohypertrophy, be sure to rotate injection sites from the abdomen to the thighs"

The nurse is caring for a patient with DM. The patient's urine is positive for ketones. What does the nurse instruct the patient with regard to exercise? A. "When urine ketones are present, you should not exercise" B. "You may exercise as long as serum ketones are low positive" C. "If you exercise now, be sure to perform aerobic exercises" D. "Exercise is always a good option because it helps with glucose utilization"

A. "When urine ketones are present, you should not exercise"

The nurse is caring for a patient with diabetes who is developing diabetic ketoacidosis (DKA). Which task delegation or assignment is most appropriate? A. Ask the unit clerk to page the health care provider to come to the unit B. Ask the LPN/LVN to administer IV push insulin according to a sliding scale C. Ask the unlicensed assistive personnel (UAP) to hang a new bag of normal saline D. Ask the UAP to get the patient a cup of orange juice

A. Ask the unit clerk to page the health care provider to come to the unit

The nurse is caring for an older patient with type 1 diabetes and diabetic retinopathy. What is the nurse's priority concern for assessing this patient? A. Assess ability to measure and inject and to monitor blood glucose levels B. Assess for damage to motor fibers, which can result in muscle weakness C. Assess which modifiable risk factors can be reduced D. Assess for albuminuria, which may indicate kidney disease

A. Assess ability to measure and inject and to monitor blood glucose levels

A patient with diabetic ketoacidosis is on an insulin drip of 50 units of regular insulin in 250 mL of normal saline. The current blood glucose level is 549 mg/dL. According to insulin protocol, the insulin drip needs to be changed to 8 units per hour. At what rate does the nurse set the pump? A. 40 mL/hr B. 50 mL/hr C. 60 mL/hr D. 75 mL/hr

A. 40 mL/hr

A nurse is caring for a client with diabetes who is scheduled for a radiographic study requiring contrast. Which should the nurse expect the health care provider to prescribe? A. Acetylcysteine (Acetdote) before the test B. Renal-friendly contrast medium for the test C. Forced diuresis with mannitol (Osmitrol) after the test D. Hydration with dextrose and water throughout the test

A. Acetylcysteine (Acetdote) before the test

In which situation does the nurse teach a patient to perform urine ketone testing? SATA A. Acute illness or stress B. When blood glucose levels are above 200 mg/dL C. When symptoms of diabetic ketoacidosis (DKA) are present D. To evaluate the effectiveness of diabetic ketoacidosis (DKA) treatment E. When a diabetic patient is in a weight-loss program F. When a diabetic patient has a diagnosis of hypergylcemic-hyperosmolar state (HHS)

A. Acute illness or stress C. When symptoms of diabetic ketoacidosis (DKA) are present E. When a diabetic patient is in a weight-loss program

Which infection control measures must the nurse teach a patient who will be performing SMBG? SATA A. Always wash hands before monitoring glucose B. Regular cleaning of the meter is critical C. Do not reuse lancets D. Do not share blood glucose monitoring equipment E. Sterilize blood glucose monitor before each use F. Family members who help with testing should wear gloves

A. Always wash hands before monitoring glucose B. Regular cleaning of the meter is critical C. Do not reuse lancets D. Do not share blood glucose monitoring equipment F. Family members who help with testing should wear gloves

A nurse is assessing a client with diabetic ketoacidosis. Which clinical manifestations should the nurse expect? SATA A. Dry skin B. Abdominal pain C. Kussmaul respirations D. Absence of ketones in the urine E. Blood glucose level of less than 100 mg/dL

A. Dry skin B. Abdominal pain C. Kussmaul respirations

The unlicensed assistive personnel (UAP) reports to the RN that a patient with type 1 diabetes has a question about exercise. What important point would the RN be sure to teach this patient? SATA A. Exercise guidelines are based on blood glucose and urine ketone levels B. Be sure to test your blood glucose only after exercising C. You can exercise vigorously if your blood glucose is between 100 and 250 mg/dL D. Exercise will help resolve the presence of ketones in your urine E. A 5-to 10-minute warm-up and cool-down period should be included in your exercise F. For unplanned exercise, increased intake of carbohydrates is usually needed

A. Exercise guidelines are based on blood glucose and urine ketone levels C. You can exercise vigorously if your blood glucose is between 100 and 250 mg/dL E. A 5-to 10-minute warm-up and cool-down period should be included in your exercise F. For unplanned exercise, increased intake of carbohydrates is usually needed

An LPN/LVN is assigned to administer rapid-acting insulin, lispro, to a patient with type 1 diabetes. What essential information would the RN be sure to tell the LPN/LVN? A. Give this insulin when the food tray has been delivered and the patient is ready to eat B. Only give this insulin for fingerstick glucose reading is above 200 mg/dL C. This insulin mimics the basal glucose control of the pancreas D. Rapid-acting insulin is the only insulin that can be given subcutaneously or IV

A. Give this insulin when the food tray has been delivered and the patient is ready to eat

Which are signs and symptoms of mild hypoglycemia? SATA A. Headache B. Weakness C. Cold, clammy skin D. Irritability E. Pallor F. Tachycardia

A. Headache B. Weakness D. Irritability

A patient is admitted with a blood glucose level of 900 mg/dL. IV fluids and insulin are administered. Two hours after treatment is initiated, the blood glucose level is 400 mg/dL. Which complication is the patient most at risk for developing? A. Hypoglycemia B. Pulmonary embolus C. Renal shutdown D. Pulmonary edema

A. Hypoglycemia

A client is admitted to the hospital with a diagnosis of diabetic ketoacidosis. What is the initial intervention that the nurse should expect the health care provider to prescribe for this client? A. IV fluids B. Potassium C. NPH insulin (Novolin N) D. Sodium polystyrene sulfonate (Kayexalate)

A. IV fluids

A nurse is caring for several clients with type 1 diabetes and they each have a prescription for a specific type of insulin. Which insulin does the nurse conclude has the fastest onset of action? A. Insulin lispro (Humalog) B. Insulin glargine (Lantus) C. NPH insulin (Novolin N) D. Regular insulin (Novolin R)

A. Insulin lispro (Humalog)

A nurse concludes that a client has a hypoglycemic reaction to insulin. Which clinical findings support this conclusion? SATA A. Irritability B. Glycosuria C. Dry, hot skin D. Heart palpitations E. Fruity odor of breath

A. Irritability D. Heart palpitations

Which statements about type 1 DM are accurate? SATA A. It is an autoimmune disorder B. Most people with type 1 DM are obese C. Age of onset is typically younger than 30 D. Etiology may be attributed to viral infections E. It can be treated with oral antidiabetic medications and insulin F. It involves insulin resistance that progresses leading to decreased beta cell secretion of insulin

A. It is an autoimmune disorder C. Age of onset is typically younger than 30 D. Etiology may be attributed to viral infections

A client with untreated type 1 diabetes mellitus may lapse into a coma because of acidosis. An increase in which component in the blood is a direct cause of this type of acidosis? A. Ketones B. Glucose C. Lactic acid D. Glutamic acid

A. Ketones

SMBG levels is most important in which patients? SATA A. Patients taking multiple daily insulin injections B. Patients with mild well-controlled type 2 diabetes C. Patients with hypoglycemic unawareness D. Patients using a portable infusion device for insulin administration E. Patients with acute illnesses F. Pregnant patients

A. Patients taking multiple daily insulin injections C. Patients with hypoglycemic unawareness D. Patients using a portable infusion device for insulin administration E. Patients with acute illnesses F. Pregnant patients

The nurse is caring for a patient recovering from DKA. Which patient care task could be delegated to the unlicensed assistive personnel (UAP)? A. Record urine output every hour B. Assess mental status every hour C. Assess central venous pressure very 30 minutes D. Teach patient about causes of DKA

A. Record urine output every hour

A patient will be using an external insulin pump. What instruction does the nurse give the patient about the pump? A. SMBG levels should be done three or more times a day B. The insulin supply must be replaced every 2-4 weeks C. The pump's battery should be checked on a regular weekly schedule D. The needle site must be changed every day

A. SMBG levels should be done three or more times a day

The RN is caring for a patient with diabetes admitted with hypoglycemia that occurred at home. Which teaching points for treatment of hypoglycemia at home would the nurse include in a teaching plan for the patient and family before discharge? SATA A. Signs and symptoms of hypoglycemia include hunger, irritability, weakness, headache, and blood glucose less than 60 mg/dL B. Treat hypoglycemia with 4 to 8 g of carbohydrate such as glucose tablets or 1/4 cup of fruit juice C. Retest blood glucose in 30 minutes D. Repeat the carbohydrate treatment if the symptoms do not resolve E.Eat a small snack of carbohydrate and protein if the next meal is more than an hour away F. If the patient has severe hypoglycemia, does not respond to treatment, and is unconscious, transport to the emergency department (ED)

A. Signs and symptoms of hypoglycemia include hunger, irritability, weakness, headache, and blood glucose less than 60 mg/dL D. Repeat the carbohydrate treatment if the symptoms do not resolve E.Eat a small snack of carbohydrate and protein if the next meal is more than an hour away F. If the patient has severe hypoglycemia, does not respond to treatment, and is unconscious, transport to the emergency department (ED)

A client admitted to the emergency department has ketones in the blood and urine. Which situation associated with this physiologic finding should the nurse's focus when collecting additional data about this client? A. Starvation B. Alcoholism C. Bone healing D. Positive nitrogen balance

A. Starvation

Which are common causes of hypoglycemia? SATA A. Too much insulin compared with food intake and physical activity B. Increased food intake especially after missed or delayed meals C. Insulin injected at the wrong time relative to food intake and physical activity D. Decreased insulin sensitivity as a result of regular exercise and weight loss E. Decreased insulin clearance from progressive kidney failure F. Decrease liver glucose production after alcohol ingestion

A. Too much insulin compared with food intake and physical activity C. Insulin injected at the wrong time relative to food intake and physical activity E. Decreased insulin clearance from progressive kidney failure F. Decrease liver glucose production after alcohol ingestion

A client is learning alternate site testing (AST) for glucose monitoring. Which client statement indicates to the nurse that additional teaching is necessary? A. "I need to rub my forearm vigorously until warm before testing this site" B. "The fingertip is preferred for glucose monitoring if hyperglycemia is suspected" C. "Alternate site testing is unsafe if I am experiencing a rapid change in glucose level" D. "I have to make sure that my current glucose monitoring can be used at an alternative site"

B. "The fingertip is preferred for glucose monitoring if hyperglycemia is suspected"

A nurse is monitoring a client's fasting plasma glucose (FPG) level. At which FPG level should the nurse identify that the client has prediabetes? A. 70 mg/dL B. 100 mg/dL C. 130 mg/dL D. 160 mg/dL

B. 100 mg/dL

The RN is serving as preceptor to a new graduate nurse who has recently passed the RN licensure (NCLEX) examination. The new nurse has only been on the unit for 2 days. Which patient should be assigned to the new graduate nurse? A. A 68-year-old patient with diabetes who is showing signs of hyperglycemia B. A 58-year-old patient with diabetes who has cellulitis of the left ankle C. A 49-year-old patient with diabetes just returned for the postanesthesia care unit after a below-the-knee amputation D. A 72-year-old patient with diabetes with diabetic ketoacidosis who is receiving insulin

B. A 58-year-old patient with diabetes who has cellulitis of the left ankle

From which injection site is insulin absorbed most rapidly? A. Buttocks B. Abdomen C. Deltoid D. Thigh

B. Abdomen

Which actions can the school nurse delegate to an experienced unlicensed assistive personnel (UAP) who is working with a 7-year-old child with type 1 diabetes in an elementary school? SATA A. Obtaining information about the child's usual inulin use from the parents B. Administering oral glucose tablets when blood glucose level falls below 60 mg/dL C. Teaching the child about what foods have high carbohydrate levels D. Obtaining blood glucose readings using the child's blood glucose monitor E. Reminding the child to have a snack after the physical education class F. Assessing the child's knowledge level about his or her type 1 diabetes

B. Administering oral glucose tablets when blood glucose level falls below 60 mg/dL D. Obtaining blood glucose readings using the child's blood glucose monitor E. Reminding the child to have a snack after the physical education class

A patient has been diagnosed with DM. Which aspects does the nurse consider in formulating the teaching plan for this patient? SATA A. Covering all needed information in one teaching session B. Assessing visual impairment regarding insulin labels and markings on the syringe C. Assessing manual dexterity to determine if the patient is able to draw insulin into a syringe D. Assessing patient motivation to learn and comprehend instructions E. Assessing the patients ability to read printed material F. Assisting patient to choose an SMBG device that is best for their level of visual impairment

B. Assessing visual impairment regarding insulin labels and markings on the syringe C. Assessing manual dexterity to determine if the patient is able to draw insulin into a syringe D. Assessing patient motivation to learn and comprehend instructions E. Assessing the patients ability to read printed material F. Assisting patient to choose an SMBG device that is best for their level of visual impairment

What glucose level range does the American Association of Clinical Endocrinologists recommend for a critically ill patient? A. Between 100 and 130 mg/dL B. Between 140 and 180 mg/dL C. Between 180 and 200 mg/dL D. Between 200 and 240 mg/dL

B. Between 140 and 180 mg/dL

A patient with type 1 DM is planning to travel by air and asks the nurse about preparations for the trip. What does the nurse tell the patient to do? A. Pack insulin and syringes in a labeled, crushproof kit in the checked luggage B. Carry all necessary diabetes supplies in a clearly identified pack abroad the plane C. Ask the flight attendant to put the insulin in the galley refrigerator once on the plane D. Take only minimal supplies and get the prescription filled at his or her destination

B. Carry all necessary diabetes supplies in a clearly identified pack abroad the plane

A patient with diabetes has hot, dry skin; rapid and deep respirations; and a fruity odor to his breath. The charge nurse observes a newly graduate RN performing all of the following tasks. Which action requires that the charge nurse intervene immediately? A. Checking the patient's fingerstick glucose level B. Encouraging the patient to drink orange juice C. Checking the patient's order for sliding-scale insulin dosing D. Assessing the patient's vital signs every 15 minutes

B. Encouraging the patient to drink orange juice

The nurse is responsible for the care of a patient with diabetes who is unable to swallow, is unconscious and seizing, and has a blood glucose of less than 20 mg/dL. Which actions are most appropriate responses for this patient at this time? SATA A. Check the chart for the patient's most recent A1C level B. Give glucagon 1 mg subcutaneously or intramuscularly (IM) C. Repeat the dose of glucagon in 10 minutes if the patient remains unconscious D. Apply aspiration precautions because glucagon can cause vomiting E. Give the patient an oral simple sugar or snack F. Notify the health care provider (HCP) immediately

B. Give glucagon 1 mg subcutaneously or intramuscularly (IM) C. Repeat the dose of glucagon in 10 minutes if the patient remains unconscious D. Apply aspiration precautions because glucagon can cause vomiting F. Notify the health care provider (HCP) immediately

The patient asks the nurse "Why am I getting glucagon?" Which response by the nurse is most accurate? A. Glucagon competes for insulin at the receptor sites B. Glucagon frees glucose from hepatic stores of glycogen C. Glucagon supplies glycogen directly to the vital tissues D. Glucagon is a glucose substitute for rapid replacement

B. Glucagon frees glucose from hepatic stores of glycogen

Which insulins are considered to have a rapid onset of action? SATA A. Novolin 70/30 B. Glulisine C. Humulin N D. Aspart E. Lispro F. Glargine

B. Glulisine D. Aspart E. Lispro

The nurse is teaching a newly diagnosed patient with type 1 DM. Which topics are considered survival information to be taught during the initial phase of DM education? SATA A. In-depth discussion of DM pathophysiology B. Learning how to prepare and administer insulin C. Sick day management rules D. Recognition of hypoglycemia and hyperglycemia E. Discussion of the actions of insulin F. Monitoring blood glucose and urine ketones

B. Learning how to prepare and administer insulin C. Sick day management rules D. Recognition of hypoglycemia and hyperglycemia F. Monitoring blood glucose and urine ketones

A nurse is assessing a client with a diagnosis of hypoglycemia. What clinical manifestations support this diagnosis? SATA A. Thirst B. Palpitations C. Diaphoresis D. Slurred speech E. Hyperventilation

B. Palpitations C. Diaphoresis D. Slurred speech

A patient with type 1 diabetes mellitus presents to the emergency department (ED) with a blood sugar of 640 mg/dL and reports being constantly thirsty and having to urinate "all of the time." How does the nurse document this subjective finding? A. Polydipsia and polyphagia B. Polydipsia and polyuria C. Polycoria and polyuria D. Polyphagia and polyesthesia

B. Polydipsia and polyuria

A nurse is caring for a postoperative client who has diabetes. Which is the most common cause of diabetic ketoacidosis the nurse needs to consider when caring for this client? A. Emotional stress B. Presence of infection C. Increased insulin dose D. Inadequate food intake

B. Presence of infection

The diabetic patient experiences early morning hyperglycemia (Somogyi effect) as a result of the counter-regulatory response to hypoglycemia. What action will the nurse expect for this condition? SATA A. Administer a 10 pm dose of intermediate-acting insulin B. Provide an evening snack to ensure adequate dietary intake C. Evaluate insulin dosage and exercise program D. Add an oral antidiabetic drug to patient's regimen E. Increase blood glucose checks to every 2 hours around the clock F. Diagnosis is accomplished by blood glucose monitoring during the night

B. Provide an evening snack to ensure adequate dietary intake C. Evaluate insulin dosage and exercise program F. Diagnosis is accomplished by blood glucose monitoring during the night

Which actions should the nurse delegate to an unlicensed assistive personnel (UAP) for a client with diabetic ketoacidosis? SATA A. Checking fingerstick glucose results every hour B. Recording intake and output every hour C. Measure vital signs every 15 minutes D. Assessing for indications of fluid imbalance E. Notifying the provider of changes in glucose level F. Assisting the client to reposition every 2 hours

B. Recording intake and output every hour C. Measure vital signs every 15 minutes F. Assisting the client to reposition every 2 hours

A nurse working in the diabetes clinic is evaluating a client's success with managing the medical regimen. Which is the best indication that a client with type 1 diabetes is successfully managing the disease? A. Reduction in excess body weight B. Stabilization of the serum glucose C. Demonstrated knowledge of the disease D. Adherence to the prescription for insulin

B. Stabilization of the serum glucose

Which are characteristics of regular insulin? SATA A. This insulin does not have a peak time B. When mixing types of insulin, this insulin is always drawn first C. This insulin is given once daily for basal insulin coverage D. This insulin should be given 30 minutes before meals E. This insulin should not be diluted or mixed with any other insulin F. This insulin should be gently rolled between the hands before it is drawn up

B. When mixing types of insulin, this insulin is always drawn first D. This insulin should be given 30 minutes before meals

The postoperative patient with DM has experienced relatively good glucose control during hospitalization. Suddenly the patient has an unexpected increase in blood glucose level. What should the nurse suspect? A. Family bringing in food for patient consumption B. Wound infection occurring before fever C. Postoperative rise in glucose due to new drugs D. Respiratory infection acquired from a visitor

B. Wound infection occurring before fever

When assessing a patient with hyperglycemia the nurse would evaluate the patient for changes in which electrolyte? A. Sodium B. Chloride C. Potassium D. Magnesium

C. Potassium

The patient has a history of hypoglycemic unawareness. What specific information must the nurse stress when teaching this patient about SMBG? A. "Alternative site monitoring will allow you to use other sites than your fingertips" B. "SMBG monitoring will help you to avoid episodes of hypoglycemia" C. "You should avoid the use of alternative site monitoring when doing SMBG" D. "Today's meter systems require a very small blood sample"

C. "You should avoid the use of alternative site monitoring when doing SMBG"

A client with diabetes is being taught to self-administer a subcutaneous injection of insulin. Identify the preferred site for the self-administration of this drug. A. Back of forearm B. Buttocks C. Abdomen D. Thigh

C. Abdomen

A patient has been receiving insulin in the abdomen for 3 days. On day 4, where does the nurse give the insulin injection? A. Deltoid B. Thigh C. Abdomen, but in an area different from the previous day's injection D. Abdomen, in the same area s the previous day's injection

C. Abdomen, but in an area different from the previous day's injection

A nurse is caring for a client admitted to the hospital for diabetic ketoacidosis. Which clinical findings related to this event should the nurse document in the client's clinical record? SATA A. Sweating B. Retinoplasty C. Acetone breath D. Increased arterial bicarbonate level E. Decreased arterial carbon dioxide level

C. Acetone breath E. Decreased arterial carbon dioxide level

A nurse is collecting information about a client who has type 1 diabetes and who is being admitted because of diabetic ketoacidotic coma. Which factors can predispose a client to this condition? SATA A. Taking too much insulin B. Getting too much exercise C. Excessive emotional stress D. Running a fever with the flu E. Eating fewer calories than prescribed

C. Excessive emotional stress D. Running a fever with the flu

After a 2-hour glucose challenge, which result demonstrates impaired glucose tolerance? A. Less than 100 mg/dL B. Less than 140 mg/dL C. Greater than 140 mg/dL D. Greater than 250 mg/dL

C. Greater than 140 mg/dL

A nurse is caring for a client newly diagnosed with type 1 diabetes. When the health care provider tries to regulate this client's insulin regimen, the client experiences episodes of hypoglycemia and hyperglycemia and 15 g of a simple sugar is prescribed. What is the reason this is administered when a client experiences hypoglycemia? A. Inhibits glycogenesis B. Stimulates release of insulin C. Increases blood glucose levels D. Provides more storage of glucose

C. Increases blood glucose levels

A nurse is caring for a client with type 1 diabetes, and the health care provider prescribes one tube of glucose gel. What is the primary reason for the administration of glucose gel to this client? A. Diabetic acidosis B. Hyperinsulin secretion C. Insulin-induced hypoglycemia D. Idiosyncratic reactions to insulin

C. Insulin-induced hypoglycemia

Which statement is true about insulin? A. It is secreted by alpha cells in the islets of Langerhans B. It is a catabolic hormone that builds up glucagon reserves C. It is necessary for glucose transport across cell membranes D. It is stored in muscles and converted to fat for storage

C. It is necessary for glucose transport across cell membranes

A patient with hyperglycemia displays a rapid and deep respiratory pattern. The nurse would describe this as which respiratory pattern? A. Tachypnea B. Cheyne-Stokes respiration C. Kussmaul respiration D. Biot respiration

C. Kussmaul respiration

An LPN/LVN is assigned to perform assessments on two patients with diabetes. Assessments reveals all of these findings. Which finding would the RN instruct the LPN/LVN to report immediately? A. Fingerstick glucose reading of 185 mg/dL B. Numbness and tingling in both feet C. Profuse perspiration D. Bunion on left great toe

C. Profuse perspiration

What type of insulin is used in the emergency treatment of diabetic ketoacidosis (DKA) and hyperglycemic-hyperosmolar state (HHS)? A. NPH B. Lente C. Regular D. Protamine zinc

C. Regular

Glucagon is used primarily to treat the patient with which disorder? A. Diabetic ketoacidosis (DKA) B. Idiosyncratic reaction to insulin C. Severe hypoglycemia D. Hyperglycemic-hyperosmolar state (HHS)

C. Severe hypoglycemia

A client is diagnosed with diabetic ketoacidosis. Which insulin should the nurse expect the health care provider to prescribe? A. Insulin lispro (Humalog) B. Insulin glargine (Lantus) C. NPH Insulin (Novolin N) D. Regular insulin (Novolin R)

D. Regular insulin (Novolin R)

Early treatment of diabetic ketoacidosis (DKA) and hyperglycemic-hyperosmolar state (HHS) includes IV administration of which fluid? A. Glucagon B. Potassium C. Bicarbonate D. Saline

D. Saline

A patient with type 1 DM is taking a mixture of NPH and regular insulin at home. The patient has been NPO for surgery since midnight. What action does the nurse take regarding the patient's morning dose of insulin? A. Administer the dose that is routinely prescribed at home because the patient has type 1 DM and needs the insulin B. Administer half the dose because the patient is NPO C. Hold the insulin with all the other medications because the patient is NPO and there is no need for insulin D. Contact the health care provider for an order regarding the insulin

D. Contact the health care provider for an order regarding the insulin

A client's blood gases reflect diabetic ketoacidosis. Which clinical indicator should the nurse expect to identify when monitoring this client's laboratory values? A. Increased pH B. Decreased PO2 C. Increased PCO2 D. Decreased HCO3

D. Decreased HCO3

A 25-year-old female patient with type 1 DM tells the nurse, "I have two kidneys and I'm still young, I expect to be around for a long time, so why should I worry about my blood sugar?" What is the nurse's best response? A. "You have little to worry about as long as your kidneys keep making urine" B. "You should discuss this with your provider because you are being unrealistic" C. "You would be right if your diabetes was managed with insulin" D. "Keeping your blood sugar under control now can help to prevent damage to both kidneys

D. "Keeping your blood sugar under control now can help to prevent damage to both kidneys

According to the American Diabetes Association (ADA), which laboratory finding is most indicative of DM? A. Fasting blood glucose = 80 mg/dL B. 2-hour postprandial blood glucose = 110 mg/dL C. 1-hour glucose tolerance blood glucose = 110 mg/dL D. 2-hour glucose tolerance blood glucose = 210 mg/dL

D. 2-hour glucose tolerance blood glucose = 210 mg/dL

A patient will be using rapid acting insulin injected by an external insulin pump. What does the nurse tell the patient about the pump? A. SMBG levels can be done only twice a day B. The insulin supply must be replaced every 2-4 weeks C. The pump's battery life should be checked on a regular weekly schedule D. Be sure to match your insulin dose to the carbohydrate (CHO) content of your diet

D. Be sure to match your insulin dose to the carbohydrate (CHO) content of your diet

A urine specimen is needed to test for the presence of ketones in a client who is diabetic. What should the nurse do when collecting this specimen from a urinary retention catheter? A. Disconnect the catheter and drain the urine into a clean container B. Clean the drainage valve and remove the urine from the catheter bag C. Wipe the catheter with alcohol and drain the urine into a sterile test tube D. Clamp the catheter, cleanse the port, and use a sterile syringe to remove urine

D. Clamp the catheter, cleanse the port, and use a sterile syringe to remove urine

A client's problem with ineffective control of type 1 diabetes is identified when a sudden decrease in blood glucose level is followed by rebound hyperglycemia. What should the nurse do when this event occurs? A. Give the client a glass of orange juice B. Seek an order to increase the insulin dose at bedtime C. Encourage the client to eat smaller, more frequent meals D. Collaborate with the health care provider to alter the insulin prescription

D. Collaborate with the health care provider to alter the insulin prescription

The experience unlicensed assistive personnel (UAP) has been delegated to take vital signs and check fingerstick glucose on a postoperative patient with diabetes. Which vital sign change would the RN instruct the UAP to report immediately? A. Blood pressure increase from 132/80 to 138/83 mm Hg B. Temperature increase from 98.4 to 99 C. Respiratory rate increase from 18 to 22 breaths/min D. Glucose increase from 190 to 236 mg/dL

D. Glucose increase from 190 to 236 mg/dL

Which laboratory test is the best indicator of a patient's average blood glucose level and/or compliance with the DM regimen over the last 3 months? A. Postprandial blood glucose test B. Oral glucose tolerance test (OGTT) C. Casual blood glucose test D. Glycosylated hemoglobin (HbA1c)

D. Glycosylated hemoglobin (HbA1c)

The nurse would observe the patient with untreated hyperglycemia for which condition? A. Respiratory acidosis B. Metabolic Alkalosis C. Respiratory alkalosis D. Metabolic acidosis

D. Metabolic acidosis

While working in the diabetes clinic, the RN obtains the following information about an 8-year-old patient with type 1 diabetes. Which finding is most important to address when planning child and parent education? A. Most recent hemoglobin, A1C level of 7.8% B. Many questions about diet choices from parents C. Child's participation in soccer practice after school 2 days a week D. Morning preprandial glucose range of 55 to 70 mg/dL

D. Morning preprandial glucose range of 55 to 70 mg/dL