Nurse 1601 diabetes

Which of the following symptoms do NOT present in hyperglycemia? A. Extreme thirst B. Hunger C. Blood glucose <60 mg/dL D. Glycosuria

C

A nurse provides diabetic education at a public health fair. Which disorders should the nurse include as complications of diabetes mellitus? (Select all that apply.) a. Stroke b. Kidney failure c. Blindness d. Respiratory failure e. Cirrhosis

A, B, C Complications of diabetes mellitus are caused by macrovascular and microvascular changes. Macrovascular complications include coronary artery disease, cerebrovascular disease, and peripheral vascular disease. Microvascular complications include nephropathy, retinopathy, and neuropathy. Respiratory failure and cirrhosis are not complications of diabetes mellitus.

A nurse assesses clients at a health fair. Which clients should the nurse counsel to be tested for diabetes? (Select all that apply.) a. 56-year-old African-American male b. Female with a 30-pound weight gain during pregnancy c. Male with a history of pancreatic trauma d. 48-year-old woman with a sedentary lifestyle e. Male with a body mass index greater than 25 kg/m 2 f. 28-year-old female who gave birth to a baby weighing 9.2 pounds

A, D, E, F Risk factors for type 2 diabetes include certain ethnic/racial groups (African Americans, American Indians, Hispanics), obesity and physical inactivity, and giving birth to large babies. Pancreatic trauma and a 30-pound gestational weight gain are not risk factors.

People from which cultures tend to have a higher incidence of DM? Select all that apply a. Mexican American b. African American c. Caucasian d. American Indian e. Eastern European f. Alaskan Indian

A, b, d, f

The nurse is assessing a patient for diabetic foot problems. What should the nurse include in this assessment? Select all that apply. a. toenails b. Tinea pedis c. Toe contractures d. History of previous ulcer e. Ankle joint range of motion

A,B,D Toenails, tinea pedis, and history of previous ulcers are all important in the assessment for diabetic foot problems. Toe contractures and ankle joint range of motion are not indicative of diabetic foot problems; they are important in assessing the foot, but they are not directly related to diabetes. Test-Taking Tip: Have a general knowledge of which topics are covered and how many questions there are in each topic area. Know the amount of time you will have. Study the sample questions for style and format.

Which are priority interventions for a diabetic patient to reduce modifiable risk factors associated with cardiovascular disease? Select all that apply. a. Ceasing smoking b. Reviewing family history c. Controlling hypertension d. Controlling hyperglycemia e. Controlling high triglycerides

A,C,D,E Priority interventions for a diabetic patient to reduce modifiable risk factors associated with cardiovascular disease include controlling hyperglycemia, hypertension, and high triglycerides as well as smoking cessation. Family history should be reviewed, but it is a nonmodifiable risk factor associated with cardiovascular disease.

A Type 2 diabetic may have all the following signs or symptoms EXCEPT: A. Blurry vision B. Ketones present in the urine C. Glycosuria D. Poor wound healing

B

True or False: The Somogyi effect causes the patient to experience an increase in their blood glucose during the hours of 2-3 am. A. True B. False

B The Somogyi effect causes the patient to experience a DECREASE in their blood glucose during the hours of 2-3 am.

A nurse assesses a client who has diabetes mellitus. Which arterial blood gas values should the nurse identify as potential ketoacidosis in this client? a. pH 7.38, HCO 3 22 mEq/L, PCO 2 38 mm Hg, PO 2 98 mm Hg b. pH 7.28, HCO 3 18 mEq/L, PCO 2 28 mm Hg, PO 2 98 mm Hg c. pH 7.48, HCO 3 28 mEq/L, PCO 2 38 mm Hg, PO 2 98 mm Hg d. pH 7.32, HCO 3 22 mEq/L, PCO 2 58 mm Hg, PO 2 88 mm Hg

B When the lungs can no longer offset acidosis, the pH decreases to below normal. A client who has diabetic ketoacidosis would present with arterial blood gas values that show primary metabolic acidosis with decreased bicarbonate levels and a compensatory respiratory alkalosis with decreased carbon dioxide levels.

A nurse reviews the medication list of a client with a 20-year history of diabetes mellitus. The client holds up the bottle of prescribed duloxetine (Cymbalta) and states, My cousin has depression and is taking this drug. Do you think Im depressed? How should the nurse respond? a. Many people with long-term diabetes become depressed after a while. b. Its for peripheral neuropathy. Do you have burning pain in your feet or hands? c. This antidepressant also has anti-inflammatory properties for diabetic pain. d. No. Many medications can be used for several different disorders.

B Damage along nerves causes peripheral neuropathy and leads to burning pain along the nerves. Many drugs, including duloxetine (Cymbalta), can be used to treat peripheral neuropathy. The nurse should assess the client for this condition and then should provide an explanation of why this drug is being used. This medication, although it is used for depression, is not being used for that reason in this case. Duloxetine does not have antiinflammatory properties. Telling the client that many medications are used for different disorders does not provide the client with enough information to be useful.

Which signs and symptoms of hypoglycemia will a nurse instruct a patient who is prescribed insulin therapy to report? Select all that apply. a. Polyuria b. Tremors c. Polydipsia d. Headache e. Polyphagia

B, D The patient who is prescribed insulin therapy will be instructed to report signs and symptoms of hypoglycemia including headache and tremors. Polydipsia is excess thirst related to dehydration. Polyuria is frequent and excessive urination and results from osmotic diuresis caused by excess glucose in the urine. Polyphagia is excessive eating that occurs because cells receive no glucose, which results in starvation of the cells.

Which of the following insulins can be administered intravenously? A. NPH B. Lantus C. Humulin R D. Novolog

C

The nurse is providing information for a patient diagnosed with proliferative diabetic retinopathy. What exercise should the nurse instruct the patient to avoid? a. Walking b. Swimming c. Weightlifting d. Arm exercises

C Patients diagnosed with proliferative diabetic retinopathy should avoid weightlifting because the heavy lifting could cause complications. Walking, swimming, and arm exercises are not contraindicated.

A patient has a blood glucose of 400. Which of the following medications could be the cause of this? A. Glyburide B. Atenolol C. Bactrim D. Prednisone

D

The _____ ______ secrete insulin which are located in the _______. A. Alpha cells, liver B. Alpha cells, pancreas C. Beta cells, liver D. Beta cells, pancreas

D

A nurse teaches a client who is prescribed an insulin pump. Which statement should the nurse include in this clients discharge education? a. Test your urine daily for ketones. b. Use only buffered insulin in your pump. c. Store the insulin in the freezer until you need it. d. Change the needle every 3 days.

D Having the same needle remain in place through the skin for longer than 3 days drastically increases the risk for infection in or through the delivery system. Having an insulin pump does not require the client to test for ketones in the urine. Insulin should not be frozen. Insulin is not buffered.

What information should be included when teaching a patient with diabetes about foot care? a. It is important to soak your feet once a week. b. It is important to wear the same shoes most days. c. Apply moisturizing cream between your toes and on your feet. d. Check bath water temperature before stepping in the water

D It is important to check bath water temperature prior to stepping into the water. Patients with diabetes should not soak their feet, they should not put moisturizing cream between their toes, and they should avoid wearing the same shoes two days in a row.

A nurse teaches a client with type 1 diabetes mellitus. Which statement should the nurse include in this clients teaching to decrease the clients insulin needs? a. Limit your fluid intake to 2 liters a day. b. Animal organ meat is high in insulin. c. Limit your carbohydrate intake to 80 grams a day. d. Walk at a moderate pace for 1 mile daily.

D Moderate exercise such as walking helps regulate blood glucose levels on a daily basis and results in lowered insulin requirements for clients with type 1 diabetes mellitus. Restricting fluids and eating organ meats will not reduce insulin needs. People with diabetes need at least 130 grams of carbohydrates each day.

What statement or statements are INCORRECT regarding Diabetic Ketoacidosis? A. DKA occurs mainly in Type 1 diabetics. B. Ketones are present in the urine in DKA. C. Cheyne-stokes breathing will always present in DKA. D. Severe hypoglycemia is a hallmark sign in DKA. E. Options C & D

E

a patient asks the nurse how insulin injection site rotation should be accomplished. what is the nurse's BEST response? a. "rotation within one site is preferred to avoid changes in insulin absorption." b. "change rotation sites after a week or two to avoid lipohypertrophy." c. "rotation from site to site each day is best for the most insulin absorption." d. "always rotate insulin injection sites within 4-5 inches from the umbilicus"

a

a patient is admitted with blood glucose level of 900. IV fluids and insulin are administered. Two hours after treatment is initiated, the blood glucose level is 400. Which complication is the patient most at risk for developing? a. hypoglycemia b. pulmonary embolism c. renal shutdown d. pulmonary edema

a

a patient will be using an external insulin pump. which 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

a patient with DKA is on an insulin drip of 50 units of regular insulin in 250 mL of normal saline. the current blood glucose level is 549. According to the insulin protocol, the insulin drip needs to be changed to 8 units per hour. At what rate does the nurse set the pump? a. 40ml/hr b. 50 ml/hr c. 60ml/hr d. 75 ml/hr

a

a patient with diabetes is scheduled to have a blood glucose test the next morning. which instruction does the nurse give the patient? a. eat the usual diet but have nothing after midnight b. take the usual oral hypoglycemic tablet in the morning c. eat a clear liquid breakfast in the morning d. follow the usual diet and medication regimen

a

for which patient should the health care provider avoid prescribing rosiglitazone? a. symptomatic HF b. new-onset asthma c. kidney disease d. hyperthyroidism

a

which class of antidiabetic medication should be taken with the FIRST bite of a meal to be fully effective? a. alpha-glucosidase inhibitors, which include miglitol b. biguanides, which include metformin c. meglitinides, which include nateglinide d. second-generation sulfonylureas, which include glipizide

a

Which complications of DM are considered emergencies? Select all that apply a. Diabetic ketoacidosis (DKA) b. hypoglycemia c. diabetic retinopathy d. hyperglycemic-hyperosmolar state (HHS) e. diabetic neuropathy f. diabetic nephropathy

a, b, d

which statements about type 2 DM are accurate? Select all that apply a. It peaks at about the age of 50 b. most people with type 2 DM are obese c. it typically has an abrupt onset d. people with type 2 DM have insulin resistance e. it can be treated with oral medications and insulin f. presence of metabolic syndrome increases the risk for type 2 DM

a, b, d, e, f

which statements about type 2 DM are accurate? select all that apply a. it peaks at about the age of 50 b. most people with type 2 DM are obese c. it typically has an abrupt onset d. people with type 2 DM have insulin resistance e. it can be treated with oral antidiabetic medications and insulin f. presence of metabolic syndrome increases the risk for type 2 DM

a, b, d, e, f

Which factors differentiate DKA from HHS? select all that apply 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, b, f

Which factors differentiate diabetic ketoacidosis (DKA) from hyperglycemic-hyperosmolar state (HHS)? select all that apply 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, b, f

which statements about type 1 DM are accurate? select all that apply 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 anti diabetic medications and insulin f. it involves insulin resistance that progresses leading to decreased beta cell secretion of insulin

a, c, d

in which situations does the nurse teach a patient to perform urine ketone testing? select all that apply a. acute illness or stress b. when blood glucose levels are above 200 c. when symptoms of DKA are present d. to evaluate the effectiveness of DKA treatment e. when a diabetic patient is in a weight-loss program f. when a diabetic patient has a diagnosis of HHS

a, c, e

the patient with type 2 DM is prescribed sitagliptin for glucose regulation. which key changes does the nurse teach a patient to report to the health care provider immediately? select all that apply a. report any signs of jaundice b. report any sings of bleeding c. report any blue-gray discoloration of the abdomen d. report any cough or flu symptoms e. report any sudden onset of abdominal pain f. report any rash or other signs of allergic reaction

a, c, e, f

A patient with type I DM presents to the ED with a blood sugar of 640 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. polyphasic and polyesthia

b

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

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

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 nutrients for genetic material

b

which class of antidiabetic medication must be held after using contrast media until adequate kidney function is established? a. alpha-glucosidase inhibitors, which include miglitol b. biguanides, which include metformin c. meglitinides, which include nateglinide d. second-generation sulfonylureas, which include glipizide

b

In determining if a patient is hypoglycemic, in addition to checking the patient's blood glucose, the nurse assesses the patient or which characteristics? select all that apply a. nausea b. hunger c. irritability d. tremors e. profuse perspiration f. rapid, deep respirations

b, c, d, e

the nurse is providing discharge teaching to a patient about self-monitoring of blood glucose. what information does the nurse include? select all that apply a. only perform SMBG before breakfast b. wash hands before using the meter c. do a retest if the results seem unusual d. it is okay to reuse lancets in the home setting e. do not share the meter f. how to calibrate the machine

b, c, e, f

which insulins are considered to have a rapid onset of action? select all that apply a. Novolin 70/30 b. glulisine c. Humulin N d. aspart e. lispro f. glargine

b, d, e

which are considered the early signs of diabetic nephropathy? select all that apply a. positive urine RBC b. microalbuminuria c. positive urine glucose d. positive urine WBC e. elevated serum uric acid f. hypertension

b, e, f

In determining if a patient is hypoglycemic, in addition to checking the patient's blood glucose, the nurse assesses the patient for which characteristics? Select all that apply a. nausea b. hunger c. irritability d. tremors e. profuse perspiration f. rapid, deep respirations

b,c,d,e

Which individual is at greatest risk for developing type 2 DM? a. 25-year-old African American woman b. 36-year-old African American man c. 56-year-old Hispanic woman d. 40-year-old Hispanic man

c

a 47-year-old patient with a hx of type 2DM and emphysema who reports smoking three packs of cigarettes per day is admitted to the hospital with a diagnosis of acute pneumonia. the patient is placed on his regular oral antidiabetic agents, sliding-scale insulin, and antibiotic medications. on day 2 of hospitalization, the health care provider orders prednisone therapy. what does the nurse expect the blood glucose to do? a. decrease b. stay the same c. increase d. return to normal

c

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

glucagon is used primarily to treat the patient with which disorder? a. DKA b. idiosyncratic reaction to insulin c. severe hypoglycemia d. HHS

c

what type of insulin is used in the emergency treatment of DKA and HHS? a. NPH b. Lente c. regular d. protamine zinc

c

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

which class of antidiabetic medication should be taken JUST BEFORE or with meals? a. alpha-glucosidase inhibitors, which include miglitol b. biguanides, which include metformin c. meglitinides, which include nateglinide d. second-generation sulfonylureas, which include glipizide

c

which oral agent may cause lactic acidosis in patients with kidney impairment? a. nateglinide b. repaglinide c. metformin d. miglitol

c

According to the American Diabetes Association (ADA), which laboratory finding is most indicative of DM? a. Fasting blood glucose = 80 b. 2-hour postprandial blood glucose = 110 c. 1-hour glucose tolerance blood glucose = 110 d. 2-hour glucose tolerance blood glucose = 210

d

Early treatment of DKA and HHS includes IV admin. of which fluid? a. glucagon b. potassium c. bicarbonate d. saline

d

Early treatment of DKA and HHS includes IV administration of which fluid? a. glucagon b. potassium c. bicarbonate d. saline

d

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

which class of antidiabetic medication is MOST LIKELY to cause hypoglycemia even when hyperglycemia is note present? a. alpha-glucosidase inhibitors, which include miglitol b. biguanides, which include metformin c. meglitinides, which include nateglinide d. second-generation sulfonylureas, which include glipizide

d

the nurse is teaching people in a community education class about modifiable risk factors for type 2 DM. Which factors would the nurse discuss? select all that apply. a. age b. family history c. working in a low-stress environment d. maintaining ideal body weight e. maintaining adequate physical activity f. lack of exercise

d, e, f

The nurse is providing teaching about weight gain secondary to insulin resistance to a patient with type 1 diabetes. What actions by the patient can minimize this complication? a. Calorie restriction b. Increasing insulin c. Decreasing exercise d. Changing administration sites

A To avoid weight gain from insulin resistance, the patient should restrict calories rather than increase insulin. Increasing insulin and decreasing exercise will add to the weight gain. Sites of administration will not affect weight.

A nurse assesses a client who is experiencing diabetic ketoacidosis (DKA). For which manifestations should the nurse monitor the client? (Select all that apply.) a. Deep and fast respirations b. Decreased urine output c. Tachycardia d. Dependent pulmonary crackles e. Orthostatic hypotension

A, C, E DKA leads to dehydration, which is manifested by tachycardia and orthostatic hypotension. Usually clients have Kussmaul respirations, which are fast and deep. Increased urinary output (polyuria) is severe. Because of diuresis and dehydration, peripheral edema and crackles do not occur.

A preoperative nurse assesses a client who has type 1 diabetes mellitus prior to a surgical procedure. The clients blood glucose level is 160 mg/dL. Which action should the nurse take? a. Document the finding in the clients chart. b. Administer a bolus of regular insulin IV. c. Call the surgeon to cancel the procedure. d. Draw blood gases to assess the metabolic state.

A Clients who have type 1 diabetes and are having surgery have been found to have fewer complications, lower rates of infection, and better wound healing if blood glucose levels are maintained at between 140 and 180 mg/dL throughout the perioperative period. The nurse should document the finding and proceed with other operative care. The need for a bolus of insulin, canceling the procedure, or drawing arterial blood gases is not required.

A 36-year-old male is newly diagnosed with Type 2 diabetes. Which of the following treatments do you expect the patient to be started on initially? A. Diet and exercise regime B. Metformin BID by mouth C. Regular insulin subcutaneous D. None, monitoring at this time is sufficient enough

A

A patient newly diagnosed with diabetes is about to be discharged home. You are watching the patient administer insulin. Which of the following actions causes you to re-educate them?* A. They massaged the site after administering the insulin. B. They injected into the fat of their thighs. C. They used an opposite side for injection compared to the last insulin injection. D. They engaged the safety after administering the medication.

A

Type 1 diabetics typically have the following clinical characteristics: A. Thin, young with ketones present in the urine B. Overweight, young with no ketones present in the urine C. Thin, older adult with glycosuria D. Overweight, adult-aged with ketones present in the urine

A

Which of the following statements are INCORRECT about exercise management for the diabetic patient? A. "I will check my blood glucose prior to exercise. If it is less than 200 I will eat a complex carb snack prior to exercising." B. "I plan on exercising for an extended period. So I will check my blood glucose prior, during, and after exercising." C. "My blood glucose is 268 and I have ketones in my urine. Therefore, I will avoid exercising today." D. All of the options are correct statements.

A

The nurse provides education about metformin to a patient with diabetes. What is a symptom of lactic acidosis, a common side effect of this medication? a. Diarrhea b. Restlessness c. Blurred vision d. Increased appetit

A Diarrhea is a common side effect of metformin. Restlessness, blurred vision, and increased appetite are not symptoms of lactic acidosis.

You administered 5 units of Humalog at 0800. What is the ONSET and DURATION of this medication? A. Onset: 15 minutes, Duration: 3 hours B. Onset: 2 hours, Duration: 16 hours C. Onset: 30 minutes, Duration: 1 hour D. Onset: 2 hours, Duration: 24 hours

A Humalog is a rapid-acting insulin. It has an onset: 15 minutes and duration: 3 hours

A patient is scheduled to take 10 units of Humulin N at 1100. When is the patient most susceptible for hypoglycemia?* A. 1900 B. 1300 C. 1130 D. 1500

A Humulin N is an intermediate-acting insulin. The peak of this medication is 8 hours.

The nurse is providing education to a patient about the prevention of hypoglycemia. What signs and symptoms of this complication should be included in the teaching? a. Irritability b. Vomiting c. Positive ketones d. Warm, moist skin

A Irritability is a sign of hypoglycemia. Vomiting, positive ketones, and warm, moist skin are signs of hyperglycemia.

The nurse is providing preoperative instructions to a patient with diabetes. What instructions should the nurse include? a. Sulfonylureas should be discontinued one day before surgery. b. Opioid analgesics are contraindicated in patients with diabetes. c. It is common to have an increased length of stay of 2 to 3 days. d. The goal is to keep preoperative blood glucose to less than 250 mg/dL

A Sulfonylureas should be discontinued one day before surgery. Preoperative blood glucose should be less than 200 mg/dL. Patients do not normally have an increased length of stay; they do sometimes get admitted early. Opiate analgesics are not avoided after surgery.

A patient who has diabetes is nothing by mouth as prep for surgery. The patient states they feel like their blood sugar is low. You check the glucose and find it to be 52. The next nursing intervention would be to: A. Administer Dextrose 50% IV per protocol B. Continue to monitor the glucose C. Give the patient 4 oz of fruit juice D. None, this is a normal blood glucose reading

A This question requires critical thinking because the patient is NPO for surgery and can NOT eat but is experiencing hypoglycemia. Normally, you could give the patient 15 grams of a simple carbohydrate like 4 oz of fruit juice or soda, glucose tablets, gel etc. per hypoglycemia protocol However, the patient can NOT eat due to surgery prep. Therefore the nurse would need to administer Dextrose 50% IV per protocol to help increase the blood glucose and recheck the glucose level.

A nurse teaches a client who is diagnosed with diabetes mellitus. Which statement should the nurse include in this clients 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 liters a day. c. Prevent hypoglycemia by eating a bedtime snack. d. Limit your intake of protein to prevent ketoacidosis.

A Hyperglycemia is a critical factor in the pathogenesis of long-term diabetic complications. Maintaining tight glycemic control will help delay the onset of complications. Restricting fluid intake is not part of the treatment plan for clients with diabetes. Preventing hypoglycemia and ketosis, although important, are not as important as maintaining daily glycemic control.

After teaching a client who is recovering from pancreas transplantation, the nurse assesses the clients understanding. Which statement made by the client indicates a need for additional education? a. If I develop an infection, I should stop taking my corticosteroid. b. If I have pain over the transplant site, I will call the surgeon immediately. c. I should avoid people who are ill or who have an infection. d. I should take my cyclosporine exactly the way I was taught.

A Immunosuppressive agents should not be stopped without the consultation of the transplantation physician, even if an infection is present. Stopping immunosuppressive therapy endangers the transplanted organ. The other statements are correct. Pain over the graft site may indicate rejection. Anti-rejection drugs cause immunosuppression, and the client should avoid crowds and people who are ill. Changing the routine of antirejection medications may cause them to not work optimally.

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 should the nurse respond? a. Yes. Prefilled syringes can be stored for 3 weeks in the refrigerator in a vertical position with the needle pointing up. b. Yes. Syringes can be filled with insulin and stored for a month in a location that is protected from light. c. Insulin reacts with plastic, so prefilled syringes are okay, but you will need to use glass syringes. d. No. Insulin syringes cannot be prefilled and stored for any length of time outside of the container.

A Insulin is relatively stable when stored in a cool, dry place away from light. When refrigerated, prefilled plastic syringes are stable for up to 3 weeks. They should be stored in the refrigerator in the vertical position with the needle pointing up to prevent suspended insulin particles from clogging the needle.

An emergency department nurse assesses a client with ketoacidosis. Which clinical manifestation should the nurse correlate with this condition? a. Increased rate and depth of respiration b. Extremity tremors followed by seizure activity c. Oral temperature of 102 F (38.9 C) d. Severe orthostatic hypotension

A Ketoacidosis decreases the pH of the blood, stimulating the respiratory control areas of the brain to buffer the effects of increasing acidosis. The rate and depth of respiration are increased (Kussmaul respirations) in an attempt to excrete more acids by exhalation. Tremors, elevated temperature, and orthostatic hypotension are not associated with ketoacidosis.

A nurse cares for a client who has a family history of diabetes mellitus. The client states, My father has type 1 diabetes mellitus. Will I develop this disease as well? How should the nurse respond? a. Your risk of diabetes is higher than the general population, but it may not occur. b. No genetic risk is associated with the development of type 1 diabetes mellitus. c. The risk for becoming a diabetic is 50% because of how it is inherited. d. Female children do not inherit diabetes mellitus, but male children will.

A Risk for type 1 diabetes is determined by inheritance of genes coding for HLA-DR and HLA-DQ tissue types. Clients who have one parent with type 1 diabetes are at increased risk for its development. Diabetes (type 1) seems to require interaction between inherited risk and environmental factors, so not everyone with these genes develops diabetes. The other statements are not accurate.

.After teaching a client with diabetes mellitus to inject insulin, the nurse assesses the clients understanding. Which statement made by the client indicates a need for additional teaching? a. The lower abdomen is the best location because it is closest to the pancreas. b. I can reach my thigh the best, so I will use the different areas of my thighs. c. By rotating the sites in one area, my chance of having a reaction is decreased. d. Changing injection sites from the thigh to the arm will change absorption rates.

A The abdominal site has the fastest rate of absorption because of blood vessels in the area, not because of its proximity to the pancreas. The other statements are accurate assessments of insulin administration.

A nurse assesses a client with diabetes mellitus and notes the client only responds to a sternal rub by moaning, has capillary blood glucose of 33 g/dL, and has an intravenous line that is infiltrated with 0.45% normal saline. Which action should the nurse take first? a. Administer 1 mg of intramuscular glucagon. b. Encourage the client to drink orange juice. c. Insert a new intravenous access line. d. Administer 25 mL dextrose 50% (D50) IV push.

A The clients blood glucose level is dangerously low. The nurse needs to administer glucagon IM immediately to increase the clients blood glucose level. The nurse should insert a new IV after administering the glucagon and can use the new IV site for future doses of D50 if the clients blood glucose level does not rise. Once the client is awake, orange juice may be administered orally along with a form of protein such as a peanut butter.

A nurse assesses a client who has diabetes mellitus and notes the client is awake and alert, but shaky, diaphoretic, and weak. Five minutes after administering a half-cup of orange juice, the clients clinical manifestations have not changed. Which action should the nurse take next? a. Administer another half-cup of orange juice. b. Administer a half-ampule of dextrose 50% intravenously. c. Administer 10 units of regular insulin subcutaneously. d. Administer 1 mg of glucagon intramuscularly.

A This client is experiencing mild hypoglycemia. For mild hypoglycemic manifestations, the nurse should administer oral glucose in the form of orange juice. If the symptoms do not resolve immediately, the treatment should be repeated. The client does not need intravenous dextrose, insulin, or glucagon.

The nurse is providing nutritional education to a patient newly diagnosed with diabetes. What should be considered for optimal adherence to the plan? Select all that apply. a. Lifestyle b. Family history c. Financial status d. Cultural background e. Mental health history

A, C, D It is important to include the patient's lifestyle, financial status, and cultural background when making a nutritional plan. Family history and mental health history are not important when determining nutritional plans.

A nurse prepares to administer insulin to a client at 1800. The clients medication administration record contains the following information: Insulin glargine: 12 units daily at 1800 Regular insulin: 6 units QID at 0600, 1200, 1800, 2400 Based on the clients medication administration record, which action should the nurse take? a. Draw up and inject the insulin glargine first, and then draw up and inject the regular insulin. b. Draw up and inject the insulin glargine first, wait 20 minutes, and then draw up and inject the regular insulin. c. 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. 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.

A Insulin glargine must not be diluted or mixed with any other insulin or solution. Mixing results in an unpredictable alteration in the onset of action and time to peak action. The correct instruction is to draw up and inject first the glargine and then the regular insulin right afterward.

A nurse collaborates with the interdisciplinary team to develop a plan of care for a client who is newly diagnosed with diabetes mellitus. Which team members should the nurse include in this interdisciplinary team meeting? (Select all that apply.) a. Registered dietitian b. Clinical pharmacist c. Occupational therapist d. Health care provider e. Speech-language pathologist

A, B, D When planning care for a client newly diagnosed with diabetes mellitus, the nurse should collaborate with a registered dietitian, clinical pharmacist, and health care provider. The focus of treatment for a newly diagnosed client would be nutrition, medication therapy, and education. The nurse could also consult with a diabetic educator. There is no need for occupational therapy or speech therapy at this time.

.A nurse teaches a client with diabetes mellitus about foot care. Which statements should the nurse include in this clients teaching? (Select all that apply.) a. Do not walk around barefoot. b. Soak your feet in a tub each evening. c. Trim toenails straight across with a nail clipper. d. Treat any blisters or sores with Epsom salts. e. Wash your feet every other day.

A, C Clients who have diabetes mellitus are at high risk for wounds on the feet secondary to peripheral neuropathy and poor arterial circulation. The client should be instructed to not walk around barefoot or wear sandals with open toes. These actions place the client at higher risk for skin breakdown of the feet. The client should be instructed to trim toenails straight across with a nail clipper. Feet should be washed daily with lukewarm water and soap, but feet should not be soaked in the tub. The client should contact the provider immediately if blisters or sores appear and should not use home remedies to treat these wounds.

A patient with Type 2 Diabetes is started on the medication Glyburide. Which of the following statements by the patient causes concern?* A. "I will monitor my blood glucose regularly because I know this medication can cause a low blood sugar." B. "I will consume no more than 8 oz. of alcohol per week." C. "I will continue monitoring my diet and participating in exercise while taking this medication." D. "This medication works by stimulating the beta cells in the pancreas to make insulin."

B Glyburide is a sulfonylureas diabetic medication and a patient should NEVER consume alcohol while taking this medication because it can cause severe hypoglycemia.

The nurse is providing teaching to a patient prescribed insulin lispro. How long before a meal is the patient required to inject the insulin lispro? a. 2 hours b. 10 minutes c. 15 minutes d. 30 minutes

B Insulin lispro should be given 10 minutes before meals. If given 15 minutes, 30 minutes, or 2 hours before meal, the patient could experience hypoglycemia during the lag time.

A patient with diabetes has a morning glucose of 50. The patient is sweaty, cold, and clammy. Which of the following nursing interventions is the MOST important? A. Recheck the glucose level B. Give the patient ½ cup (4 oz) of fruit juice C. Call the doctor D. Keep the patient nothing by mouth

B

When is a patient most susceptible to hypoglycemic symptoms after the administration of insulin? A. Onset B. Peak C. Duration D. Duration & Peak

B

Which of the following patient statements about the diabetic diet regime is correct? A. "I'll try to consume about 20% carbs and 40% fats on a daily basis." B. "Foods that are high in mono and poly fats are avocados, olives, and nuts." C. "Meats increase the glycemic index; therefore, I should only consume 5% of them on a daily basis." D. "I should completely avoid starchy vegetables like potatoes and corn."

B

Which of the following statements are true regarding Type 2 diabetes treatment? A. Insulin and oral diabetic medications are administered routinely in the treatment of Type 2 diabetes. B. Insulin may be needed during times of surgery or illness. C. Insulin is never taken by the Type 2 diabetic. D. Oral medications are the first line of treatment for newly diagnosed Type 2 diabetics.

B

A patient is scheduled to take a morning dose of Metformin. The patient is scheduled for surgery tomorrow. Which of the following nursing interventions are correct? A. Administer the medication as ordered. B. Hold the dose and notify the doctor for further orders. C. Administer the medication as ordered but hold the next day's dose. D. Check the patient's blood glucose prior to administering the medication.

B Metformin (Glucophage) is held 48 hours prior to surgery (however a doctor's order is needed for this). Therefore, you should hold the dose and call the doctor for further orders.

A patient is scheduled to take 5 units of Humulin R and 10 units of NPH. What is the proper way of mixing these insulins? A. These insulins cannot be mixed, therefore, should be drawn up in different syringes. B. Draw-up the Humulin R insulin first and then the NPH insulin. C. Draw-up 2.5 units of NPH, then 10 units of Humulin R, and then finish drawing up 2.5 units of NPH. D. Draw-up the NPH insulin first and then the Humulin R insulin.

B Remember when drawing up regular and intermediate insulins...you draw-up clear (regular insulins) to cloudy (NPH intermediate). Remember the mnemonic R.N.

A patient with diabetes is experiencing a blood glucose of 275 when waking. What is a typical treatment for this phenomenon? A. None, this is a normal blood glucose reading. B. The patient may need a night time dose of an intermediate-acting insulin to counteract the morning hyperglycemia. C. A bedtime snack may prevent this phenomenon. D. This is known as the Somogyi effect and requires decreasing the bedtime dose of insulin.

B This is known as the DAWN PHENOMENON and is best treated with a night time dose of an intermediate-acting insulin to counteract the morning hyperglycemia.

A nurse teaches a client with type 2 diabetes mellitus who is prescribed glipizide (Glucotrol). Which statement should the nurse include in this clients teaching? a. Change positions slowly when you get out of bed. b. Avoid taking nonsteroidal anti-inflammatory drugs (NSAIDs). c. If you miss a dose of this drug, you can double the next dose. d. Discontinue the medication if you develop a urinary infection.

B NSAIDs potentiate the hypoglycemic effects of sulfonylurea agents. Glipizide is a sulfonylurea. The other statements are not applicable to glipizide.

A nurse prepares to administer prescribed regular and NPH insulin. Place the nurses 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. 1, 3, 8, 2, 4, 6, 7, 5 b. 3, 1, 2, 8, 7, 4, 6, 5 c. 8, 1, 3, 2, 4, 6, 7, 5 d. 2, 3, 1, 8, 7, 5, 4, 6

B After washing hands, it is important to inspect the bottles and then to roll the NPH to mix the insulin. Rubber stoppers should be cleaned with alcohol after rolling the NPH and before sticking a needle into either bottle. It is important to inject air into the NPH bottle before placing the needle in a regular insulin bottle to avoid mixing of regular and NPH insulin. The shorter-acting insulin is always drawn up first.

.A nurse cares for a client who is diagnosed with acute rejection 2 months after receiving a simultaneous pancreas-kidney transplant. The client states, I was doing so well with my new organs, and the thought of having to go back to living on hemodialysis and taking insulin is so depressing. How should the nurse respond? a. Following the drug regimen more closely would have prevented this. b. One acute rejection episode does not mean that you will lose the new organs. c. Dialysis is a viable treatment option for you and may save your life. d. Since you are on the national registry, you can receive a second transplantation.

B An episode of acute rejection does not automatically mean that the client will lose the transplant. Pharmacologic manipulation of host immune responses at this time can limit damage to the organ and allow the graft to be maintained. The other statements either belittle the client or downplay his or her concerns. The client may not be a candidate for additional organ transplantation.

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? How should the nurse respond? a. Glucose is the only fuel used by the body to produce the energy that it needs. b. Your brain needs a constant supply of glucose because it cannot store it. c. Without a minimum level of glucose, your body does not make red blood cells. d. Glucose in the blood prevents the formation of lactic acid and prevents acidosis.

B Because the brain cannot synthesize or store significant amounts of glucose, a continuous supply from the bodys circulation is needed to meet the fuel demands of the central nervous system. The nurse would want to educate the client to prevent hypoglycemia. The body can use other sources of fuel, including fat and protein, and glucose is not involved in the production of red blood cells. Glucose in the blood will encourage glucose metabolism but is not directly responsible for lactic acid formation.

After teaching a client with type 2 diabetes mellitus, the nurse assesses the clients understanding. Which statement made by the client indicates a need for additional teaching? a. I need to have an annual appointment even if my glucose levels are in good control. b. Since my diabetes is controlled with diet and exercise, I must be seen only if I am sick. c. I can still develop complications even though I do not have to take insulin at this time. d. If I have surgery or get very ill, I may have to receive insulin injections for a short time.

B Clients with diabetes need to be seen at least annually to monitor for long-term complications, including visual changes, microalbuminuria, and lipid analysis. The client may develop complications and may need insulin in the future.

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 should 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 each day would not match your blood insulin levels and your food intake patterns. 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 would be too large to be absorbed, predictably putting you at risk for insulin shock.

B Even when a single injection of insulin contains a combined dose of different-acting insulin types, the timing of the actions and the timing of food intake may not match well enough to prevent wide variations in blood glucose levels. One dose of insulin would not be appropriate even if the client decreased carbohydrate intake. Additional injections are not required to allow the client practice with injections, nor will one dose increase the clients risk of insulin shock.

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 0700. At which time should the nurse assess the client for potential problems related to the NPH insulin? a. 0800 b. 1600 c. 2000 d. 2300

B Neutral protamine Hagedorn (NPH) is an intermediate-acting insulin with an onset of 1.5 hours, peak of 4 to 12 hours, and duration of action of 22 hours. Checking the client at 0800 would be too soon. Checking the client at 2000 and 2300 would be too late. The nurse should check the client at 1600.

What area of the patient's feet would the nurse identify as correct for assessing for plantar ulcers? a. Top of the foot b. Sole of the foot c. Side of the foot d. Between the toes

B Plantar ulcers are usually on the sole or ball of the foot. Plantar ulcers do not form on the top or side of the foot or between the toes.

A nurse assesses a client with diabetes mellitus. Which clinical manifestation should alert the nurse to decreased kidney function in this client? a. Urine specific gravity of 1.033 b. Presence of protein in the urine c. Elevated capillary blood glucose level d. Presence of ketone bodies in the urine

B Renal dysfunction often occurs in the client with diabetes. Proteinuria is a result of renal dysfunction. Specific gravity is elevated with dehydration. Elevated capillary blood glucose levels and ketones in the urine are consistent with diabetes mellitus but are not specific to renal function.

A nurse develops a dietary plan for a client with diabetes mellitus and new-onset microalbuminuria. Which component of the clients diet should the nurse decrease? a. Carbohydrates b. Proteins c. Fats d. Total calories

B Restriction of dietary protein to 0.8 g/kg of body weight per day is recommended for clients with microalbuminuria to delay progression to renal failure. The clients diet does not need to be decreased in carbohydrates, fats, or total calories.

A nurse teaches a client about self-monitoring of blood glucose levels. Which statement should the nurse include in this clients teaching to prevent bloodborne infections? a. Wash your hands after completing each test. b. Do not share your monitoring equipment. c. Blot excess blood from the strip with a cotton ball. d. Use gloves when monitoring your blood glucose.

B Small particles of blood can adhere to the monitoring device, and infection can be transported from one user to another. Hepatitis B in particular can survive in a dried state for about a week. The client should be taught to avoid sharing any equipment, including the lancet holder. The client should be taught to wash his or her hands before testing. The client would not need to blot excess blood away from the strip or wear gloves.

A nurse reviews the chart and new prescriptions for a client with diabetic ketoacidosis: BP 90/62, Pulse 120 RR 28 Urine output 20mL/hr serum potassium 2.6 Meds: 1.Potassium chloride 40mEq IV bolus STAT 2. Increase IV fluid to 100 mL/hr Which action should the nurse take? a. Administer the potassium and then consult with the provider about the fluid order. b. Increase the intravenous rate and then consult with the provider about the potassium prescription. c. Administer the potassium first before increasing the infusion flow rate. d. Increase the intravenous flow rate before administering the potassium

B The client is acutely ill and is severely dehydrated and hypokalemic. The client requires more IV fluids and potassium. However, potassium should not be infused unless the urine output is at least 30 mL/hr. The nurse should first increase the IV rate and then consult with the provider about the potassium.

.A nurse reviews laboratory results for a client with diabetes mellitus who is prescribed an intensified insulin regimen: Fasting blood glucose: 75 mg/dL Postprandial blood glucose: 200 mg/dL Hemoglobin A 1c level: 5.5% How should the nurse interpret these laboratory findings? a. Increased risk for developing ketoacidosis b. Good control of blood glucose c. Increased risk for developing hyperglycemia d. Signs of insulin resistance

B The client is maintaining blood glucose levels within the defined ranges for goals in an intensified regimen. Because the clients glycemic control is good, he or she is not at higher risk for ketoacidosis or hyperglycemia and is not showing signs of insulin resistance.

The nurse has provided education about factors responsible for increased rates of diabetes among minority groups. Which factor identified by the patient indicates a need for further teaching? a. Lifestyle issues b. Increased financial resources c.Mistrust of the health care system d. Lack of knowledge about glucose control and complications

B The reduced financial resources among minority groups are one reason for a higher prevalence of diabetes in these groups. Lifestyle issues, such as an increase in obesity and sedentary lifestyles in the United States, have resulted in increased rates of diabetes among minority groups. Moreover, mistrust of the health care system and lack of knowledge about glucose control and complications have contributed to the increased rate of diabetes among minority groups.

.A nurse cares for a client who is prescribed pioglitazone (Actos). After 6 months of therapy, the client reports that his urine has become darker since starting the medication. Which action should the nurse take? a. Assess for pain or burning with urination. b. Review the clients liver function study results. c. Instruct the client to increase water intake. d. Test a sample of urine for occult blood.

B Thiazolidinediones (including pioglitazone) can affect liver function; liver function should be assessed at the start of therapy and at regular intervals while the client continues to take these drugs. Dark urine is one indicator of liver impairment because bilirubin is increased in the blood and is excreted in the urine. The nurse should check the clients most recent liver function studies. The nurse does not need to assess for pain or burning with urination and does not need to check the urine for occult blood. The client does not need to be told to increase water intake.

.A nurse teaches a client with diabetes mellitus about sick day management. Which statement should the nurse include in this clients teaching? a. When ill, avoid eating or drinking to reduce vomiting and diarrhea. b. Monitor your blood glucose levels at least every 4 hours while sick. c. If vomiting, do not use insulin or take your oral antidiabetic agent. d. Try to continue your prescribed exercise regimen even if you are sick.

B When ill, the client should monitor his or her blood glucose at least every 4 hours. The client should continue taking the medication regimen while ill. The client should continue to eat and drink as tolerated but should not exercise while sick.

The nurse is providing health screening. The nurse determines that the patient with which lab value should receive teaching related to diabetes? a. A 1c of 4.5% b. Fasting blood glucose of 127 mg/dL c. Random blood glucose of 198 mg/dL d. Two-hour glucose of 150 mg/dL during oral glucose tolerance test

B. Fasting blood glucose of 127 mg/dL would indicate that the patient may have diabetes. The A 1c, random blood glucose test, and the two-hour glucose test values are all within normal parameters.

Which of the following patients is at most risk for Type 2 diabetes? A. A 6 year old girl recovering from a viral infection with a family history of diabetes. B. A 28 year old male with a BMI of 49. C. A 76 year old female with a history of cardiac disease. D. None of the options provided.

B. Remember Type 2 diabetes risk factors are related to lifestyle....being obese is a risk factor (BMI >30 in males is considered obese). So, the 28 year old male with a BMI of 49 is most at risk for Type 2.

A patient diagnosed with type 2 diabetes is being seen for routine health screening. The patient has received nutritional education and begun regular exercise. What lab value indicates the patient may need to begin medication therapy? a. Triglyceride level of 130 mg/dL b. Premeal blood glucose level of 120 c. Glycosylated hemoglobin (A1C) 7.0% d. Peak after meal blood glucose level of 170

C An A1C level of 7.0% indicates that the patient's blood glucose levels are not controlled, even with nutrition and exercise. The triglyceride, premeal blood glucose, and peak after meal blood glucose levels are normal.

The nurse is providing education to a patient with a new diagnosis of type 1 diabetes. What action by the patient indicates a need for further teaching? a. Utilizing only the abdomen for injections b. Grasping a skin fold and injecting at a 90-degree angle c. Aspirating for blood return before administering the medication d. Mixing regular human insulin with isophane insulin NPH for injection

C Aspirating for blood return is not indicated with insulin administration. Utilizing the abdomen only for injection (one anatomic site) is preferred to rotation from one area to another to prevent day-to-day changes in absorption. Grasping the skin and injecting at 90 degrees is correct practice. Mixing regular insulin and NPH is acceptable.

The nurse is teaching a patient about the manifestations and emergency treatment of hypoglycemia. In assessing the patient's knowledge, the nurse asks the patient what he or she should do if feeling hungry and shaky. Which response by the patient indicates a correct understanding of hypoglycemia management? a. "I should sit down and rest." b. "I should drink a glass of water." c. "I should eat three graham crackers." d. "I should give myself 1 mg of glucagon.

C Eating three graham crackers is a correct management strategy for mild hypoglycemia. Water or resting does not remedy hypoglycemia. Glucagon should be administered only in cases of severe hypoglycemia.

A patient is scheduled to take 7 units of Humulin R at 0830. You administer Humulin R at 0900 in the right thigh. When do you expect this medication to peak? A. 1300 B. 0930 C. 1100 D. 1700

C Lantus is the only option here that is a LONG-ACTING insulin which has NO peak and a 24 hour duration.

Which of the following insulins has no peak but a duration of 24 hours? A. NPH B. Novolog C. Lantus D. Humulin N

C Lantus is the only option here that is a LONG-ACTING insulin which has NO peak and a 24 hour duration.

A patient taking the medication Precose asks when it is the best time to take this medication. Your response is: A. 1 hour prior to eating B. 1 hour after eating C. With the first bite of food D. At bedtime

C Precose is an alpha-glucoside inhibitor that works by lowering the blood sugar by slowly breaking down starchy foods in the GI system which helps slowly rise the blood sugar. Therefore, it should be taken with the first bite of food.

.A nurse assesses a client who is being treated for hyperglycemic-hyperosmolar state (HHS). Which clinical manifestation indicates to the nurse that the therapy needs to be adjusted? a. Serum potassium level has increased. b. Blood osmolarity has decreased. c. Glasgow Coma Scale score is unchanged. d. Urine remains negative for ketone bodies.

C A slow but steady improvement in central nervous system functioning is the best indicator of therapy effectiveness for HHS. Lack of improvement in the level of consciousness may indicate inadequate rates of fluid replacement. The Glasgow Coma Scale assesses the clients state of consciousness against criteria of a scale including best eye, verbal, and motor responses. An increase in serum potassium, decreased blood osmolality, and urine negative for ketone bodies do not indicate adequacy of treatment.

A registered nurse is teaching a group of nursing students about the recommendation of the American Diabetes Association (ADA) regarding indications for testing an individual with type 2 diabetes. Which individual suggested by a nursing student for testing indicates a need for further education? a. An individual who has been diagnosed with polycystic ovary syndrome b. An individual who has been diagnosed with gestational diabetes mellitus (GDM) c. An individual who is 45 years old with a body mass index (BMI) less than 25 kg/m2 d. An individual who has impaired fasting glucose and impaired glucose tolerance on testing

C According to the ADA, an individual in the age group of 45 years of age and older with a BMI greater than 25 kg/m2 should be tested for type 2 diabetes. According to the ADA, the following individuals should also be tested for type 2 diabetes: an individual who has been diagnosed with polycystic ovary syndrome; an individual who has been diagnosed with GDM during the pregnancy phase; and an individual who has impaired fasting glucose and impaired glucose tolerance on testing. Test-Taking Tip: Read the question carefully before looking at the answers: (1) Determine what the question is really asking, and look for key words; (2) read each answer thoroughly, and see if it completely covers the material the question asks; and (3) narrow the choices by immediately eliminating answers you know are incorrect.

A nurse assesses a client who has a 15-year history of diabetes and notes decreased tactile sensation in both feet. Which action should the nurse take first? a. Document the finding in the clients chart. b. Assess tactile sensation in the clients hands. c. Examine the clients feet for signs of injury. d. Notify the health care provider.

C Diabetic neuropathy is common when the disease is of long duration. The client is at great risk for injury in any area with decreased sensation because he or she is less able to feel injurious events. Feet are common locations for neuropathy and injury, so the nurse should inspect them for any signs of injury. After assessment, the nurse should document findings in the clients chart. Testing sensory perception in the hands may or may not be needed. The health care provider can be notified after assessment and documentation have been completed.

After teaching a client who is newly diagnosed with type 2 diabetes mellitus, the nurse assesses the clients understanding. Which statement made by the client indicates a need for additional teaching? a. I should increase my intake of vegetables with higher amounts of dietary fiber. b. My intake of saturated fats should be no more than 10% of my total calorie intake. c. I should decrease my intake of protein and eliminate carbohydrates from my diet. d. My intake of water is not restricted by my treatment plan or medication regimen.

C The client should not completely eliminate carbohydrates from the diet, and should reduce protein if microalbuminuria is present. The client should increase dietary intake of complex carbohydrates, including vegetables, and decrease intake of fat. Water does not need to be restricted unless kidney failure is present.

At 4:45 p.m., 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 0630: 95 1130: 70 1630: 47 Intake Breakfast: 10% eaten, client not hungry Lunch: 5% eaten, nauseous, vomits once After reviewing the clients assessment data, which action is appropriate at this time? a. Assess the clients oxygen saturation level and administer oxygen. b. Reorient the client and apply a cool washcloth to the clients forehead. c. Administer dextrose 50% intravenously and reassess the client. d. Provide a glass of orange juice and encourage the client to eat dinner.

C The clients symptoms are related to hypoglycemia. Since the client has not been tolerating food, the nurse should administer dextrose intravenously. The clients oxygen level could be checked, but based on the information provided, this is not the priority. The client will not be reoriented until the glucose level rises.

A nurse assesses a client with diabetes mellitus 3 hours after a surgical procedure and notes the clients breath has a fruity odor. Which action should the nurse take? a. Encourage the client to use an incentive spirometer. b. Increase the clients intravenous fluid flow rate. c. Consult the provider to test for ketoacidosis. d. Perform meticulous pulmonary hygiene care.

C The stress of surgery increases the action of counterregulatory hormones and suppresses the action of insulin, predisposing the client to ketoacidosis and metabolic acidosis. One manifestation of ketoacidosis is a fruity odor to the breath. Documentation should occur after all assessments have been completed. Using an incentive spirometer, increasing IV fluids, and performing pulmonary hygiene will not address this clients problem.

A nurse teaches a client with diabetes mellitus who is experiencing numbness and reduced sensation. Which statement should the nurse include in this clients teaching to prevent injury? a. Examine your feet using a mirror every day. b. Rotate your insulin injection sites every week. c. Check your blood glucose level before each meal. d. Use a bath thermometer to test the water temperature.

D Clients with diminished sensory perception can easily experience a burn injury when bathwater is too hot. Instead of checking the temperature of the water by feeling it, they should use a thermometer. Examining the feet daily does not prevent injury, although daily foot examinations are important to find problems so they can be addressed. Rotating insulin and checking blood glucose levels will not prevent injury.

When providing teaching about nutrition to a patient diagnosed with diabetes, what instruction should the nurse include? a. It is important to avoid snacks. b. Decrease calories when exercising. c. Carbohydrates should be restricted to once a day. d. Eat consistent amounts of food at consistent times.

D It is important to have consistent amounts of food at consistent times. Snacks are OK, calories should not be avoided when exercising, and carbohydrates should not be restricted to once a day.

A patient has a blood glucose of 58 and is sweating, cold, and clammy. The patient is conscious. What is your next nursing intervention? A. Recheck the blood glucose in 5 minutes. B. Give the patient 15 grams of a complex carbohydrate. C. No intervention is needed because this is a normal blood glucose. D. Give the patient 15 grams of a simple carbohydrate.

D Simple carbohydrates work faster than complex. Example of a simple carbohydrate would be 4 oz of fruit juice or soda, glucose tablet or gel, etc.

Which blood glucose level does the operating room nurse recognize as optimal during surgery to prevent hypoglycemia? a. 90 mg/dL b. 120 mg/dL c. 130 mg/dL d. 150 mg/dL

D A blood glucose level of 150 mg/dL is optimal. The Joint Commission's National Patient Safety Goals recommend a blood glucose level between 140 and 180 mg/dL. The values 90, 120, and 130 mg/dL are too low.

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 should the nurse respond? a. I can give your injections to you while you are here in the hospital. b. Everyone gets used to giving themselves injections. It really does not hurt. c. Your disease will not be managed properly if you refuse to administer the shots. d. Tell me what it is about the injections that are concerning you.

D Devote as much teaching time as possible to insulin injection and blood glucose monitoring. Clients with newly diagnosed diabetes are often fearful of giving themselves injections. If the client is worried about giving the injections, it is best to try to find out what specifically is causing the concern, so it can be addressed. Giving the injections for the client does not promote self-care ability. Telling the client that others give themselves injections may cause the client to feel bad. Stating that you dont know another way to manage the disease is dismissive of the clients concerns.

A nurse assesses clients who are at risk for diabetes mellitus. Which client is at greatest risk? NURSINGTB.COM a. A 29-year-old Caucasian b. A 32-year-old African-American c. A 44-year-old Asian d. A 48-year-old American Indian

D Diabetes is a particular problem among African Americans, Hispanics, and American Indians. The incidence of diabetes increases in all races and ethnic groups with age. Being both an American Indian and middle-aged places this client at highest risk.

After teaching a young adult client who is newly diagnosed with type 1 diabetes mellitus, the nurse assesses the clients understanding. Which statement made by the client indicates a correct understanding of the need for eye examinations? a. At my age, I should continue seeing the ophthalmologist as I usually do. b. I will see the eye doctor when I have a vision problem and yearly after age 40. c. My vision will change quickly. I should see the ophthalmologist twice a year. d. Diabetes can cause blindness, so I should see the ophthalmologist yearly.

D Diabetic retinopathy is a leading cause of blindness in North America. All clients with diabetes, regardless of age, should be examined by an ophthalmologist (rather than an optometrist or optician) at diagnosis and at least yearly thereafter.

After teaching a client who has diabetes mellitus and proliferative retinopathy, nephropathy, and peripheral neuropathy, the nurse assesses the clients understanding. Which statement made by the client indicates a correct understanding of the teaching? a. I have so many complications; exercising is not recommended. b. I will exercise more frequently because I have so many complications. c. I used to run for exercise; I will start training for a marathon. d. I should look into swimming or water aerobics to get my exercise.

D Exercise is not contraindicated for this client, although modifications based on existing pathology are necessary to prevent further injury. Swimming or water aerobics will give the client exercise without the worry of having the correct shoes or developing a foot injury. The client should not exercise too vigorously.

A nurse reviews laboratory results for a client with diabetes mellitus who presents with polyuria, lethargy, and a blood glucose of 560 mg/dL. Which laboratory result should the nurse correlate with the clients polyuria? a. Serum sodium: 163 mEq/L b. Serum creatinine: 1.6 mg/dL c. Presence of urine ketone bodies d. Serum osmolarity: 375 mOsm/kg

D Hyperglycemia causes hyperosmolarity of extracellular fluid. This leads to polyuria from an osmotic diuresis. The clients serum osmolarity is high. The clients sodium would be expected to be high owing to dehydration. Serum creatinine and urine ketone bodies are not related to the polyuria.

A nurse reviews the laboratory results of a client who is receiving intravenous insulin. Which should alert the nurse to intervene immediately? a. Serum chloride level of 98 mmol/L b. Serum calcium level of 8.8 mg/dL c. Serum sodium level of 132 mmol/L d. Serum potassium level of 2.5 mmol/L

D Insulin activates the sodium-potassium ATPase pump, increasing the movement of potassium from the extracellular fluid into the intracellular fluid, resulting in hypokalemia. In hyperglycemia, hypokalemia can also result from excessive urine loss of potassium. The chloride level is normal. The calcium and sodium levels are slightly low, but this would not be related to hyperglycemia and insulin administration.

After teaching a client with type 2 diabetes mellitus who is prescribed nateglinide (Starlix), the nurse assesses the clients understanding. Which statement made by the client indicates a correct understanding of the prescribed therapy? a. Ill take this medicine during each of my meals. b. I must take this medicine in the morning when I wake. c. I will take this medicine before I go to bed. d. I will take this medicine immediately before I eat.

D Nateglinide is an insulin secretagogue that is designed to increase meal-related insulin secretion. It should be taken immediately before each meal. The medication should not be taken without eating as it will decrease the clients blood glucose levels. The medication should be taken before meals instead of during meals.

A nurse assesses a client with diabetes mellitus who self-administers subcutaneous insulin. The nurse notes a spongy, swelling area at the site the client uses most frequently for insulin injection. Which action should the nurse take? a. Apply ice to the site to reduce inflammation. b. Consult the provider for a new administration route. c. Assess the client for other signs of cellulitis. d. Instruct the client to rotate sites for insulin injection.

D The clients tissue has been damaged from continuous use of the same site. The client should be educated to rotate sites. The damaged tissue is not caused by cellulitis or any type infection, and applying ice may cause more damage to the tissue. Insulin can only be administered subcutaneously and intravenously. It would not be appropriate or practical to change the administration route.

A nurse cares for a client experiencing diabetic ketoacidosis who presents with Kussmaul respirations. Which action should the nurse take? a. Administration of oxygen via face mask b. Intravenous administration of 10% glucose c. Implementation of seizure precautions d. Administration of intravenous insulin

D The rapid, deep respiratory efforts of Kussmaul respirations are the bodys attempt to reduce the acids produced by using fat rather than glucose for fuel. Only the administration of insulin will reduce this type of respiration by assisting glucose to move into cells and to be used for fuel instead of fat. The client who is in ketoacidosis may not experience any respiratory impairment and therefore does not need additional oxygen. Giving the client glucose would be contraindicated. The client does not require seizure precautions.

.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 should alert the nurse to contact the provider and withhold the prescribed dose? a. Pioglitazone (Actos) b. Glimepiride (Amaryl) c. Glipizide (Glucotrol) d. Metformin (Glucophage)

D Glucophage should not be administered when the kidneys are attempting to excrete IV contrast from the body. This combination would place the client at high risk for kidney failure. The nurse should hold the metformin dose and contact the provider. The other medications are safe to administer after receiving IV contrast.

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 should the nurse respond? a. Drinking any wine or alcohol will increase your insulin requirements. b. Because of poor kidney function, people with diabetes should avoid alcohol. c. You should not drink alcohol because it will make you hungry and overeat. d. One glass of wine is okay with a meal and is counted as two fat exchanges.

D Under normal circumstances, blood glucose levels will not be affected by moderate use of alcohol when diabetes is well controlled. Because alcohol can induce hypoglycemia, it should be ingested with or shortly after a meal. One alcoholic beverage is substituted for two fat exchanges when caloric intake is calculated. Kidney function is not impacted by alcohol intake. Alcohol is not associated with increased hunger or overeating.

The nurse is providing teaching for a patient with diabetic peripheral neuropathy. What exercises are appropriate for this patient? Select all that apply. a. Yoga b. Walking c. Running d. Bicycling e. Swimming

D,E Bicycling and swimming are non-weight-bearing activities that a patient with diabetic peripheral neuropathy can participate in. Walking, running, and yoga are all weight-bearing exercises and are contraindicated for this patient.

Which statements about type 2 diabetes mellitus are MOST characteristic? Select all that apply a. autoimmune process causes beta cell destruction b. cells have decreased ability to respond to insulin c. diagnosis is based on results of 100-g glucose tolerance test. d. most patients diagnosed are obese adults e. usually has abrupt onset of thirst and weight loss f. most patients are not dependent on insulin

b, d, f

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