PrepU Managing diabetes

Which instruction about insulin administration should a nurse give to a client? -"Always follow the same order when drawing the different insulins into the syringe." -"Shake the vials before withdrawing the insulin." -"Store unopened vials of insulin in the freezer at temperatures well below freezing." -"Discard the intermediate-acting insulin if it appears cloudy."

-"Always follow the same order when drawing the different insulins into the syringe." The nurse should instruct the client to always follow the same order when drawing the different insulins into the syringe. Insulin should never be shaken because the resulting froth prevents withdrawal of an accurate dose and may damage the insulin protein molecules. Insulin should never be frozen because the insulin protein molecules may be damaged. The client doesn't need to discard intermediate-acting insulin if it's cloudy; this finding is normal.

The nurse is educating a patient about the benefits of fruit versus fruit juice in the diabetic diet. The patient states, "What difference does it make if you drink the juice or eat the fruit? It is all the same." What is the best response by the nurse? -"Eating the fruit is more satisfying than drinking the juice. You will get full faster." -"Eating the fruit will give you more vitamins and minerals than the juice will." -"The fruit has less sugar than the juice." -"Eating the fruit instead of drinking juice decreases the glycemic index by slowing absorption."

-"Eating the fruit instead of drinking juice decreases the glycemic index by slowing absorption." Eating whole fruit instead of drinking juice decreases the glycemic index, because fiber in the fruit slows absorption.

When the nurse is caring for a patient with type 1 diabetes, what clinical manifestation would be a priority to closely monitor? -Hypoglycemia -Hyponatremia -Ketonuria -Polyphagia

-Hypoglycemia The therapeutic goal for diabetes management is to achieve normal blood glucose levels (euglycemia) without hypoglycemia while maintaining a high quality of life.

NPH is an example of which type of insulin? -Rapid-acting -Short-acting -Intermediate-acting -Long-acting

-Intermediate-acting NPH is an intermediate-acting insulin.

A client with type 1 diabetes mellitus is being taught about self-injection of insulin. Which fact about site rotation should the nurse include in the teaching? -Avoid the abdomen because absorption there is irregular. -Choose a different site at random for each injection. -Rotate sites from area to area every other day. -Use all available injection sites within one area.

-Use all available injection sites within one area. Systematic rotation of injection sites within an anatomic area is recommended to prevent localized changes in fatty tissue. To promote consistency in insulin absorption, the client should be encouraged to use all available injection sites within one area rather than randomly rotating sites from area to area.

A client has been recently diagnosed with type 2 diabetes, and reports continued weight loss despite increased hunger and food consumption. This condition is called: -polyphagia. -polydipsia. -polyuria. -anorexia.

-polyphagia. While the needed glucose is being wasted, the body's requirement for fuel continues. The person with diabetes feels hungry and eats more (polyphagia). Despite eating more, he or she loses weight as the body uses fat and protein to substitute for glucose.

A nurse is preparing the daily care plan for a client with newly diagnosed diabetes mellitus. The priority nursing concern for this client should be: -monitoring blood glucose every 4 hours and as needed. -checking for the presence of ketones with each void. -providing client education at every opportunity. -administering insulin routinely and as needed via a sliding scale.

-providing client education at every opportunity. The nurse should use routine care responsibilities as teaching opportunities with the intention of preparing the client to understand and eventually manage his disease. Monitoring blood glucose, checking for the presence of ketones, and administering insulin are important when caring for a client with diabetes, but they aren't the priority of care.

After teaching a client with type 1 diabetes who is scheduled to undergo an islet cell transplant, which client statement indicates successful teaching? -"This transplant will provide me with a cure for my diabetes." -"I will receive a whole organ with extra cells to produce insulin." -"They'll need to create a connection from the pancreas to allow enzymes to drain." -"I might need insulin later on but probably not as much or as often."

-"I might need insulin later on but probably not as much or as often." Transplanted islet cells tend to lose their ability to function over time, and approximately 70% of recipients resume insulin administration in 2 years. However, the amount of insulin and the frequency of its administration are reduced because of improved control of blood glucose levels. Thus, this type of transplant doesn't cure diabetes. It requires the use of two human pancreases to obtain sufficient numbers of islet cells for transplantation. A whole organ transplant requires a means for exocrine enzyme drainage and venous absorption of insulin.

A client with type 1 diabetes has a highly elevated glycosylated hemoglobin (Hb) test result. In discussing the result with the client, the nurse is most accurate in stating: -"The test must be repeated following a 12-hour fast." -"It looks like you aren't following the ordered diabetic diet." -"It tells us about your sugar control for the last 3 months." -"Your insulin regimen must be altered significantly."

-"It tells us about your sugar control for the last 3 months." The nurse is providing accurate information to the client when she states that the glycosylated Hb test provides an objective measure of glycemic control over a 3-month period. The test helps identify trends or practices that impair glycemic control, and it doesn't require a fasting period before blood is drawn. The nurse can't conclude that the result occurs from poor dietary management or inadequate insulin coverage.

A nurse is teaching a client recovering from diabetic ketoacidosis (DKA) about management of "sick days." The client asks the nurse why it is important to monitor the urine for ketones. Which statement is the nurse's best response? -"Ketones are formed when insufficient insulin leads to cellular starvation. As cells rupture, they release these acids into the blood." -"When the body does not have enough insulin, hyperglycemia occurs. Excess glucose is broken down by the liver, causing acidic by-products to be released." -"Excess glucose in the blood is metabolized by the liver and turned into ketones, which are an acid." -"Ketones accumulate in the blood and urine when fat breaks down in the absence of insulin. Ketones signal an insulin deficiency that will cause the body to start breaking down stored fat for energy."

-"Ketones accumulate in the blood and urine when fat breaks down in the absence of insulin. Ketones signal an insulin deficiency that will cause the body to start breaking down stored fat for energy." Ketones (or ketone bodies) are by-products of fat breakdown in the absence of insulin, and they accumulate in the blood and urine. Ketones in the urine signal an insulin deficiency and that control of type 1 diabetes is deteriorating. When almost no effective insulin is available, the body starts to break down stored fat for energy.

A client newly diagnosed with diabetes mellitus asks why he needs ketone testing when the disease affects his blood glucose levels. How should the nurse respond? -"The spleen releases ketones when your body can't use glucose." -"Ketones will tell us if your body is using other tissues for energy." -"Ketones can damage your kidneys and eyes." -"Ketones help the physician determine how serious your diabetes is."

-"Ketones will tell us if your body is using other tissues for energy." The nurse should tell the client that ketones are a byproduct of fat metabolism and that ketone testing can determine whether the body is breaking down fat to use for energy. The spleen doesn't release ketones when the body can't use glucose. Although ketones can damage the eyes and kidneys and help the physician evaluate the severity of a client's diabetes, these responses by the nurse are incomplete.

Which instruction should a nurse give to a client with diabetes mellitus when teaching about "sick day rules"? -"Don't take your insulin or oral antidiabetic agent if you don't eat." -"It's okay for your blood glucose to go above 300 mg/dl while you're sick." -"Test your blood glucose every 4 hours." -"Follow your regular meal plan, even if you're nauseous."

-"Test your blood glucose every 4 hours." The nurse should instruct a client with diabetes mellitus to check his blood glucose levels every 3 to 4 hours and take insulin or an oral antidiabetic agent as usual, even when he's sick. If the client's blood glucose level rises above 300 mg/dl, he should call his physician immediately. If the client is unable to follow the regular meal plan because of nausea, he should substitute soft foods, such as gelatin, soup, and custard.

Which instruction should a nurse give to a client with diabetes mellitus when teaching about "sick day rules"? -"Don't take your insulin or oral antidiabetic agent if you don't eat." -"It's okay for your blood glucose to go above 300 mg/dl while you're sick." -"Test your blood glucose every 4 hours." -"Follow your regular meal plan, even if you're nauseous."

-"Test your blood glucose every 4 hours." The nurse should instruct a client with diabetes mellitus to check his blood glucose levels every 3 to 4 hours and take insulin or an oral antidiabetic agent as usual, even when he's sick. If the client's blood glucose level rises above 300 mg/dl, he should call his physician immediately. If the client is unable to follow the regular meal plan because of nausea, he should substitute soft foods, such as gelatin, soup, and custard.

A 16-year-old client newly diagnosed with type 1 diabetes has a very low body weight despite eating regular meals. The client is upset because friends frequently state, "You look anorexic." Which statement by the nurse would be the best response to help this client understand the cause of weight loss due to this condition? -"I will refer you to a dietician who can help you with your weight." -"You may be having undiagnosed infections, causing you to lose extra weight." -"Your body is using protein and fat for energy instead of glucose." -"Don't worry about what your friends think; the carbohydrates you eat are being quickly digested, increasing your metabolism."

-"Your body is using protein and fat for energy instead of glucose." Persons with type 1 diabetes, particularly those in poor control of the condition, tend to be thin because when the body cannot effectively utilize glucose for energy (no insulin supply), it begins to break down protein and fat as an alternate energy source. Patients may be underweight at the onset of type 1 diabetes because of rapid weight loss from severe hyperglycemia. The goal initially may be to provide a higher-calorie diet to regain lost weight and blood glucose control.

A physician orders blood glucose levels every 4 hours for a 4-year-old child with brittle type 1 diabetes. The parents are worried that drawing so much blood will traumatize their child. How can the nurse best reassure the parents? -"Your child will need less blood work as his glucose levels stabilize." -"Your child is young and will soon forget this experience." -"I'll see if the physician can reduce the number of blood draws." -"Our laboratory technicians use tiny needles and they're really good with children."

-"Your child will need less blood work as his glucose levels stabilize." Telling the parents that the number of blood draws will decrease as their child's glucose levels stabilize engages them in the learning process and gives them hope that the present discomfort will end as the child's condition improves. Telling the parents that their child won't remember the experience disregards their concerns and anxiety. The nurse shouldn't offer to ask the physician if he can reduce the number of blood draws; the physician needs the laboratory results to monitor the child's condition properly. Although telling the parents that the laboratory technicians are gentle and use tiny needles may be reassuring, it isn't the most appropriate response.

A client with diabetes mellitus has a blood glucose level of 40 mg/dL. Which rapidly absorbed carbohydrate would be most effective? -1/2 cup fruit juice or regular soft drink -4 oz of skim milk -1/2 tbsp honey or syrup -three to six LifeSavers candies

-1/2 cup fruit juice or regular soft drink In a client with hypoglycemia, the nurse uses the rule of 15: give 15 g of rapidly absorbed carbohydrate, wait 15 minutes, recheck the blood sugar, and administer another 15 g of glucose if the blood sugar is not above 70 mg/dL. One-half cup fruit juice or regular soft drink is equivalent to the recommended 15 g of rapidly absorbed carbohydrate. Eight ounces of skim milk is equivalent to the recommended 15 g of rapidly absorbed carbohydrate. One tablespoon of honey or syrup is equivalent to the recommended 15 g of rapidly absorbed carbohydrate. Six to eight LifeSavers candies is equivalent to the recommended 15 g of rapidly absorbed carbohydrate.

An agitated, confused client arrives in the emergency department. The client's history includes type 1 diabetes, hypertension, and angina pectoris. Assessment reveals pallor, diaphoresis, headache, and intense hunger. A stat blood glucose sample measures 42 mg/dl, and the client is treated for an acute hypoglycemic reaction. After recovery, the nurse teaches the client to treat hypoglycemia by ingesting: -2 to 5 g of a simple carbohydrate. -10 to 15 g of a simple carbohydrate. -18 to 20 g of a simple carbohydrate. -25 to 30 g of a simple carbohydrate.

-10 to 15 g of a simple carbohydrate. To reverse hypoglycemia, the American Diabetes Association recommends ingesting 10 to 15 g of a simple carbohydrate, such as three to five pieces of hard candy, two to three packets of sugar (4 to 6 tsp), or 4 oz of fruit juice. Then the client should check his blood glucose after 15 minutes. If necessary, this treatment may be repeated in 15 minutes. Ingesting only 2 to 5 g of a simple carbohydrate may not raise the blood glucose level sufficiently. Ingesting more than 15 g may raise it above normal, causing hyperglycemia.

Once digested, what percentage of carbohydrates is converted to glucose? -70 -80 -90 -100

-100 Once digested, 100% of carbohydrates are converted to glucose. However, approximately 50% of protein foods are also converted to glucose, but this has minimal effect on blood glucose concentration.

blood glucose level of 800 mg/dl. Which solution is the most appropriate at the beginning of therapy? -100 units of regular insulin in normal saline solution -100 units of neutral protamine Hagedorn (NPH) insulin in normal saline solution -100 units of regular insulin in dextrose 5% in water -100 units of NPH insulin in dextrose 5% in water

-100 units of regular insulin in normal saline solution Continuous insulin infusions use only short-acting regular insulin. Insulin is added to normal saline solution and administered until the client's blood glucose level falls. Further along in the therapy, a dextrose solution is administered to prevent hypoglycemia.

A patient who is 6 months' pregnant was evaluated for gestational diabetes mellitus. The doctor considered prescribing insulin based on the serum glucose result of: -90 mg/dL before meals. -120 mg/dL, 1 hour postprandial. -80 mg/dL, 1 hour postprandial. -138 mg/dL, 2 hours postprandial.

-138 mg/dL, 2 hours postprandial. The goals for a 2-hour, postprandial blood glucose level are less than 120 mg/dL in a patient who might develop gestational diabetes.

A nurse is teaching a client with diabetes mellitus about self-management of his condition. The nurse should instruct the client to administer 1 unit of insulin for every: -10 g of carbohydrates. -15 g of carbohydrates. -20 g of carbohydrates. -25 g of carbohydrates.

-15 g of carbohydrates.

What is the duration of regular insulin? -4 to 6 hours -3 to 5 hours -12 to 16 hours -24 hours

-4 to 6 hours The duration of regular insulin is 4 to 6 hours; 3 to 5 hours is the duration for rapid-acting insulin such as Novolog. The duration of NPH insulin is 12 to 16 hours. The duration of Lantus insulin is 24 hours.

A client with diabetes comes to the clinic for a follow-up visit. The nurse reviews the client's glycosylated hemoglobin test results. Which result would indicate to the nurse that the client's blood glucose level has been well-controlled? -6.5% -7.5 % -8.0% -8.5%

-6.5% Normally the level of glycosylated hemoglobin is less than 7%. Thus a level of 6.5% would indicate that the client's blood glucose level is well-controlled. According to the American Diabetes Association, a glycosylated hemoglobin of 7% is equivalent to an average blood glucose level of 150 mg/dL. Thus, a level of 7.5% would indicate less control. Amount of 8% or greater indicate that control of the client's blood glucose level has been inadequate during the previous 2 to 3 months.

A client is receiving insulin lispro at 7:30 AM. The nurse ensures that the client has breakfast by which time? -7:45 AM -8:00 AM -8:15 AM -8:30 AM

-7:45 AM Insulin lispro has an onset of 5 to 15 minutes. Therefore, the nurse would need to ensure that the client has his breakfast by 7:45 AM at the latest. Otherwise, the client may experience hypoglycemia.

When administering insulin to a client with type 1 diabetes, which of the following would be most important for the nurse to keep in mind? -Duration of the insulin -Accuracy of the dosage -Area for insulin injection -Technique for injecting

-Accuracy of the dosage The measurement of insulin is most important and must be accurate because clients may be sensitive to minute dose changes. The duration, area, and technique for injecting should also to be noted.

A client with type 1 diabetes presents with a decreased level of consciousness and a fingerstick glucose level of 39 mg/dl. His family reports that he has been skipping meals in an effort to lose weight. Which nursing intervention is most appropriate? -Inserting a feeding tube and providing tube feedings -Administering a 500-ml bolus of normal saline solution -Administering 1 ampule of 50% dextrose solution, per physician's order -Observing the client for 1 hour, then rechecking the fingerstick glucose level

-Administering 1 ampule of 50% dextrose solution, per physician's order The nurse should administer 50% dextrose solution to restore the client's physiological integrity. Feeding through a feeding tube isn't appropriate for this client. A bolus of normal saline solution doesn't provide the client with the much-needed glucose. Observing the client for 1 hour delays treatment. The client's blood glucose level could drop further during this time, placing him at risk for irreversible brain damage.

A nurse is caring for a diabetic patient with a diagnosis of nephropathy. What would the nurse expect the urinalysis report to indicate? -Albumin -Bacteria -Red blood cells -White blood cells

-Albumin Albumin is one of the most important blood proteins that leak into the urine. Although small amounts may leak undetected for years, its leakage into the urine is among the earliest signs that can be detected. Clinical nephropathy eventually develops in more than 85% of people with microalbuminuria but in fewer than 5% of people without microalbuminuria. The urine should be checked annually for the presence of microalbumin.

A child is brought into the emergency department with vomiting, drowsiness, and blowing respirations. The father reports that the symptoms have been progressing throughout the day. The nurse suspects diabetic ketoacidosis (DKA). Which action should the nurse take first in the management of DKA? -Give prescribed antiemetics. -Begin fluid replacements. -Administer prescribed dose of insulin. -Administer bicarbonate to correct acidosis.

-Begin fluid replacements. Management of DKA is aimed at correcting dehydration, electrolyte loss, and acidosis before correcting the hypoglycemia with insulin.

A nurse expects to note an elevated serum glucose level in a client with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which other laboratory finding should the nurse anticipate? -Elevated serum acetone level -Serum ketone bodies -Serum alkalosis -Below-normal serum potassium level

-Below-normal serum potassium level A client with HHNS has an overall body deficit of potassium resulting from diuresis, which occurs secondary to the hyperosmolar, hyperglycemic state caused by the relative insulin deficiency. An elevated serum acetone level and serum ketone bodies are characteristic of diabetic ketoacidosis. Metabolic acidosis, not serum alkalosis, may occur in HHNS.

Which clinical characteristic is associated with type 2 diabetes (previously referred to as non-insulin-dependent diabetes mellitus)? -Blood glucose can be controlled through diet and exercise -Client is usually thin at diagnosis -Client is prone to ketosis -Clients demonstrate islet cell antibodies

-Blood glucose can be controlled through diet and exercise Oral hypoglycemic agents may improve blood glucose concentrations if dietary modification and exercise are unsuccessful. Individuals with type 2 diabetes are usually obese at diagnosis. Individuals with type 2 diabetes rarely demonstrate ketosis, except with stress or infection. Individuals with type 2 diabetes do not demonstrate islet cell antibodies.

A client is admitted with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which laboratory finding should the nurse expect in this client? -Arterial pH 7.25 -Plasma bicarbonate 12 mEq/L -Blood glucose level 1,100 mg/dl -Blood urea nitrogen (BUN) 15 mg/dl

-Blood glucose level 1,100 mg/dl HHNS occurs most frequently in older clients. It can occur in clients with either type 1 or type 2 diabetes mellitus but occurs most commonly in those with type 2. The blood glucose level rises to above 600 mg/dl in response to illness or infection. As the blood glucose level rises, the body attempts to rid itself of the excess glucose by producing urine. Initially, the client produces large quantities of urine. If fluid intake isn't increased at this time, the client becomes dehydrated, causing BUN levels to rise. Arterial pH and plasma bicarbonate levels typically remain within normal limits.

Which clinical manifestation of type 2 diabetes occurs if glucose levels are very high? -Hyperactivity -Blurred vision -Oliguria -Increased energy

-Blurred vision Blurred vision occurs when blood glucose levels are very high. The other clinical manifestations are not consistent with type 2 diabetes.

A client's blood glucose level is 45 mg/dl. The nurse should be alert for which signs and symptoms? -Coma, anxiety, confusion, headache, and cool, moist skin -Kussmaul's respirations, dry skin, hypotension, and bradycardia -Polyuria, polydipsia, hypotension, and hypernatremia -Polyuria, polydipsia, polyphagia, and weight loss

-Coma, anxiety, confusion, headache, and cool, moist skin Signs and symptoms of hypoglycemia (indicated by a blood glucose level of 45 mf/dl) include anxiety, restlessness, headache, irritability, confusion, diaphoresis, cool skin, tremors, coma, and seizures. Kussmaul's respirations, dry skin, hypotension, and bradycardia are signs of diabetic ketoacidosis. Excessive thirst, hunger, hypotension, and hypernatremia are symptoms of diabetes insipidus. Polyuria, polydipsia, polyphagia, and weight loss are classic signs and symptoms of diabetes mellitus.

A client is diagnosed with diabetes mellitus. Which assessment finding best supports a nursing diagnosis of Ineffective coping related to diabetes mellitus? -Recent weight gain of 20 lb (9.1 kg) -Failure to monitor blood glucose levels -Skipping insulin doses during illness -Crying whenever diabetes is mentioned

-Crying whenever diabetes is mentioned A client who cries whenever diabetes is mentioned is demonstrating ineffective coping. A recent weight gain and failure to monitor blood glucose levels would support a nursing diagnosis of Noncompliance: Failure to adhere to therapeutic regimen. Skipping insulin doses during illness would support a nursing diagnosis of Deficient knowledge related to treatment of diabetes mellitus.

Which is the best nursing explanation for the symptom of polyuria in a client with diabetes mellitus? -With diabetes, drinking more results in more urine production. -Increased ketones in the urine promote the manufacturing of more urine. -High sugar pulls fluid into the bloodstream, which results in more urine production. -The body's requirement for fuel drives the production of urine.

-High sugar pulls fluid into the bloodstream, which results in more urine production. The hypertonicity from concentrated amounts of glucose in the blood pulls fluid into the vascular system, resulting in polyuria. The urinary frequency triggers the thirst response, which then results in polydipsia. Ketones in the urine and body requirements do not affect the production of urine.

A client with long-standing type 1 diabetes is admitted to the hospital with unstable angina pectoris. After the client's condition stabilizes, the nurse evaluates the diabetes management regimen. The nurse learns that the client sees the physician every 4 weeks, injects insulin after breakfast and dinner, and measures blood glucose before breakfast and at bedtime. Consequently, the nurse should formulate a nursing diagnosis of: -Impaired adjustment. -Defensive coping. -Deficient knowledge (treatment regimen). -Health-seeking behaviors (diabetes control).

-Deficient knowledge (treatment regimen). The client should inject insulin before, not after, breakfast and dinner — 30 minutes before breakfast for the a.m. dose and 30 minutes before dinner for the p.m. dose. Therefore, the client has a knowledge deficit regarding when to administer insulin. By taking insulin, measuring blood glucose levels, and seeing the physician regularly, the client has demonstrated the ability and willingness to modify his lifestyle as needed to manage the disease. This behavior eliminates the nursing diagnoses of Impaired adjustment and Defensive coping. Because the nurse, not the client, questioned the client's health practices related to diabetes management, the nursing diagnosis of Health-seeking behaviors isn't warranted.

An obese Hispanic client, age 65, is diagnosed with type 2 diabetes. Which statement about diabetes mellitus is true? -Nearly two-thirds of clients with diabetes mellitus are older than age 60. -Diabetes mellitus is more common in Hispanics and Blacks than in Whites. -Type 2 diabetes mellitus is less common than type 1 diabetes mellitus. -Approximately one-half of the clients diagnosed with type 2 diabetes are obese.

-Diabetes mellitus is more common in Hispanics and Blacks than in Whites.

An obese Hispanic client, age 65, is diagnosed with type 2 diabetes. Which statement about diabetes mellitus is true? -Nearly two-thirds of clients with diabetes mellitus are older than age 60. -Diabetes mellitus is more common in Hispanics and Blacks than in Whites. -Type 2 diabetes mellitus is less common than type 1 diabetes mellitus. -Approximately one-half of the clients diagnosed with type 2 diabetes are obese.

-Diabetes mellitus is more common in Hispanics and Blacks than in Whites. Diabetes mellitus is more common in Hispanics and Blacks than in Whites. Only about one-third of clients with diabetes mellitus are older than age 60 and 85% to 90% have type 2. At least 80% of clients diagnosed with type 2 diabetes mellitus are obese

A nurse is preparing a client with type 1 diabetes for discharge. The client can care for himself; however, he's had a problem with unstable blood glucose levels in the past. Based on the client's history, he should be referred to which health care worker? -Home health nurse -Dietitian -Psychiatrist -Social worker

-Dietitian The client should be referred to a dietitian, who will help him gain better control of his blood glucose levels. The client can care for himself, so a home health agency isn't necessary. The client shows no signs of needing a psychiatric referral, and referring the client to a psychiatrist isn't in the nurse's scope of practice. Social workers help clients with financial concerns; the scenario doesn't indicate that the client has a financial concern warranting a social worker at this time.

Which of the following is a characteristic of diabetic ketoacidosis (DKA)? Select all that apply. -Elevated blood urea nitrogen (BUN) and creatinine -Rapid onset -More common in type 1 diabetes -Absent ketones -Normal arterial pH level

-Elevated blood urea nitrogen (BUN) and creatinine -Rapid onset -More common in type 1 diabetes DKA is characterized by an elevated BUN and creatinine, rapid onset, and it is more common in type 1 diabetes. Hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is characterized by the absence of urine and serum ketones and a normal arterial pH level.

Which assessment finding is most important in determining nursing care for a client with diabetes mellitus? -Respirations of 12 breaths/minute -Cloudy urine -Blood sugar 170 mg/dL -Fruity breath

-Fruity breath The rising ketones and acetone in the blood can lead to acidosis and be detected as a fruity odor on the breath. Ketoacidosis needs to be treated to prevent further complications such as Kussmaul respirations (fast, labored breathing) and renal shutdown. A blood sugar of 170 mg/dL is not ideal but will not result in glycosuria and/or trigger the classic symptoms of diabetes mellitus. Cloudy urine may indicate a UTI.

Which of the following insulins are used for basal dosage? -Glarginet (Lantus) -NPH (Humulin N) -Lispro (Humalog) -Aspart (Novolog)

-Glarginet (Lantus) Lantus is used for basal dosage. NPH is an intermediate acting insulin, usually taken after food. Humalog and Novolog are rapid-acting insulins.

A nurse is teaching a client with type 1 diabetes how to treat adverse reactions to insulin. To reverse hypoglycemia, the client ideally should ingest an oral carbohydrate. However, this treatment isn't always possible or safe. Therefore, the nurse should advise the client to keep which alternate treatment on hand? -Epinephrine -Glucagon -50% dextrose -Hydrocortisone

-Glucagon During a hypoglycemic reaction, a layperson may administer glucagon, an antihypoglycemic agent, to raise the blood glucose level quickly in a client who can't ingest an oral carbohydrate. Epinephrine isn't a treatment for hypoglycemia. Although 50% dextrose is used to treat hypoglycemia, it must be administered I.V. by a skilled health care professional. Hydrocortisone takes a relatively long time to raise the blood glucose level and therefore isn't effective in reversing hypoglycemia.

Which is the best nursing explanation for the symptom of polyuria in a client with diabetes mellitus? -With diabetes, drinking more results in more urine production. -Increased ketones in the urine promote the manufacturing of more urine. -High sugar pulls fluid into the bloodstream, which results in more urine production. -The body's requirement for fuel drives the production of urine.

-High sugar pulls fluid into the bloodstream, which results in more urine production. The hypertonicity from concentrated amounts of glucose in the blood pulls fluid into the vascular system, resulting in polyuria. The urinary frequency triggers the thirst response, which then results in polydipsia. Ketones in the urine and body requirements do not affect the production of urine.

The nurse is preparing to administer intermediate-acting insulin to a patient with diabetes. Which insulin will the nurse administer? -NPH -Iletin II -Lispro (Humalog) -Glargine (Lantus)

-NPH Intermediate-acting insulins are called NPH insulin (neutral protamine Hagedorn) or Lente insulin. Lispro (Humalog) is rapid acting, Iletin II is short acting, and glargine (Lantus) is very long acting.

A nurse is preparing to discharge a client with coronary artery disease and hypertension who is at risk for type 2 diabetes. Which information is important to include in the discharge teaching? -How to control blood glucose through lifestyle modification with diet and exercise -How to self-inject insulin -How to monitor ketones daily -How to recognize signs of diabetic ketoacidosis

-How to control blood glucose through lifestyle modification with diet and exercise Persons at high risk for type 2 diabetes receive standard lifestyle recommendations plus metformin, standard lifestyle recommendations plus placebo, or an intensive program of lifestyle modifications. The 16-lesson curriculum of the intensive program of lifestyle modifications focuses on reducing weight by more than 7% of initial body weight and moderate-intensity physical activity. It also includes behavior modification strategies designed to help clients achieve the goals of weight reduction and participation in exercise. These findings demonstrate that type 2 diabetes can be prevented or delayed in persons at high risk for the disease.

Which of the following is a risk factor for the development of diabetes mellitus? Select all that apply. -Hypertension -Obesity -Family history -Age greater of 45 years or older -History of gestational diabetes

-Hypertension -Obesity -Family history -Age greater of 45 years or older -History of gestational diabetes

A client with diabetes mellitus is receiving an oral antidiabetic agent. The nurse observes for which symptom when caring for this client? -Polyuria -Hypoglycemia -Blurred vision -Polydipsia

-Hypoglycemia The nurse should observe the client receiving an oral antidiabetic agent for signs of hypoglycemia. The time when the reaction might occur is not predictable and could be from 30 to 60 minutes to several hours after the drug is ingested. Polyuria, polydipsia, and blurred vision are symptoms of diabetes mellitus.

Which combination of adverse effects should a nurse monitor for when administering IV insulin to a client with diabetic ketoacidosis? -Hypokalemia and hypoglycemia -Hypocalcemia and hyperkalemia -Hyperkalemia and hyperglycemia -Hypernatremia and hypercalcemia

-Hypokalemia and hypoglycemia Blood glucose needs to be monitored in clients receiving IV insulin because of the risk of hyperglycemia or hypoglycemia. Hypoglycemia might occur if too much insulin is administered. Hypokalemia, not hyperkalemia, might occur because I.V. insulin forces potassium into cells, thereby lowering the plasma level of potassium. Calcium and sodium levels aren't affected by IV insulin administration.

Which combination of adverse effects should a nurse monitor for when administering IV insulin to a client with diabetic ketoacidosis? -Hypokalemia and hypoglycemia -Hypocalcemia and hyperkalemia -Hyperkalemia and hyperglycemia -Hypernatremia and hypercalcemia

-Hypokalemia and hypoglycemia Blood glucose needs to be monitored in clients receiving IV insulin because of the risk of hyperglycemia or hypoglycemia. Hypoglycemia might occur if too much insulin is administered. Hypokalemia, not hyperkalemia, might occur because I.V. insulin forces potassium into cells, thereby lowering the plasma level of potassium. Calcium and sodium levels aren't affected by IV insulin administration.

The nurse is educating the client with diabetes on setting up a sick plan to manage blood glucose control during times of minor illness such as influenza. Which is the most important teaching item to include? -Increase frequency of glucose self-monitoring. -Decrease food intake until nausea passes. -Do not take insulin if not eating. -Take half the usual dose of insulin until symptoms resolve.

-Increase frequency of glucose self-monitoring. Minor illnesses such as influenza can present a special challenge to a diabetic client. The body's need for insulin increases during illness. Therefore, the client should take the prescribed insulin dose, increase the frequency of glucose monitoring, and maintain adequate fluid intake to counteract the dehydrating effects of hyperglycemia. Clear liquids and juices are encouraged. Taking less than normal dose of insulin may lead to ketoacidosis.

A 60-year-old client comes to the ED reporting weakness, vision problems, increased thirst, increased urination, and frequent infections that do not seem to heal easily. The physician suspects that the client has diabetes. Which classic symptom should the nurse watch for to confirm the diagnosis of diabetes? -Numbness -Increased hunger -Fatigue -Dizziness

-Increased hunger The classic symptoms of diabetes are the three Ps: polyuria (increased urination), polydipsia (increased thirst), and polyphagia (increased hunger). Some of the other symptoms include tingling, numbness, and loss of sensation in the extremities and fatigue.

A 60-year-old client comes to the ED reporting weakness, vision problems, increased thirst, increased urination, and frequent infections that do not seem to heal easily. The physician suspects that the client has diabetes. Which classic symptom should the nurse watch for to confirm the diagnosis of diabetes? -Numbness -Increased hunger -Fatigue -Dizziness

-Increased hunger The classic symptoms of diabetes are the three Ps: polyuria (increased urination), polydipsia (increased thirst), and polyphagia (increased hunger). Some of the other symptoms include tingling, numbness, and loss of sensation in the extremities and fatigue.

A nurse is assessing a client who is receiving total parenteral nutrition (TPN). Which finding suggests that the client has developed hyperglycemia? -Cheyne-Stokes respirations -Increased urine output -Decreased appetite -Diaphoresis

-Increased urine output Glucose supplies most of the calories in TPN; if the glucose infusion rate exceeds the client's rate of glucose metabolism, hyperglycemia arises. When the renal threshold for glucose reabsorption is exceeded, osmotic diuresis occurs, causing an increased urine output. A decreased appetite and diaphoresis suggest hypoglycemia, not hyperglycemia. Cheyne-Stokes respirations are characterized by a period of apnea lasting 10 to 60 seconds, followed by gradually increasing depth and frequency of respirations. Cheyne-Stokes respirations typically occur with cerebral depression or heart failure.

A patient who is diagnosed with type 1 diabetes would be expected to: -Be restricted to an American Diabetic Association diet. -Have no damage to the islet cells of the pancreas. -Need exogenous insulin. -Receive daily doses of a hypoglycemic agent.

-Need exogenous insulin. Type 1 diabetes is characterized by the destruction of pancreatic beta cells that require exogenous insulin.

A patient who is diagnosed with type 1 diabetes would be expected to: -Be restricted to an American Diabetic Association diet. -Have no damage to the islet cells of the pancreas. -Need exogenous insulin. -Receive daily doses of a hypoglycemic agent.

-Need exogenous insulin. Type 1 diabetes is characterized by the destruction of pancreatic beta cells that require exogenous insulin.

The client who is managing diabetes through diet and insulin control asks the nurse why exercise is important. Which is the best response by the nurse to support adding exercise to the daily routine? -Increases ability for glucose to get into the cell and lowers blood sugar -Creates an overall feeling of well-being and lowers risk of depression -Decreases need for pancreas to produce more cells -Decreases risk of developing insulin resistance and hyperglycemia

-Increases ability for glucose to get into the cell and lowers blood sugar Exercise increases trans membrane glucose transporter levels in the skeletal muscles. This allows the glucose to leave the blood and enter into the cells where it can be used as fuel. Exercise can provide an overall feeling of well-being but is not the primary purpose of including in the daily routine of diabetic clients. Exercise does not stimulate the pancreas to produce more cells. Exercise can promote weight loss and decrease risk of insulin resistance but not the primary reason for adding to daily routine.

A nurse explains to a client that she will administer his first insulin dose in his abdomen. How does absorption at the abdominal site compare with absorption at other sites? -Insulin is absorbed more slowly at abdominal injection sites than at other sites. -Insulin is absorbed rapidly regardless of the injection site. -Insulin is absorbed more rapidly at abdominal injection sites than at other sites. -Insulin is absorbed unpredictably at all injection sites.

-Insulin is absorbed more rapidly at abdominal injection sites than at other sites. Subcutaneous insulin is absorbed most rapidly at abdominal injection sites, more slowly at sites on the arms, and slowest at sites on the anterior thigh. Absorption after injection in the buttocks is less predictable.

The nurse is preparing a presentation for a group of adults at a local community center about diabetes. Which of the following would the nurse include as associated with type 2 diabetes? -Onset most common during adolescence -Insulin production insufficient -Less common than type 1 diabetes -Little to relation to pre-diabetes

-Insulin production insufficient Type 2 diabetes is characterized by insulin resistance or insufficient insulin production. It is more common in aging adults, and now accounts for 20% of all newly diagnosed cases. Type 1 diabetes is more likely in childhood and adolescence although it can occur at any age. It accounts for approximately 5% to 10% of all diagnosed cases of diabetes. Pre-diabetes can lead to type 2 diabetes.

The nurse is describing the action of insulin in the body to a client newly diagnosed with type 1 diabetes. Which of the following would the nurse explain as being the primary action? -It carries glucose into body cells. -It aids in the process of gluconeogenesis. -It stimulates the pancreatic beta cells. -It decreases the intestinal absorption of glucose.

-It carries glucose into body cells. Insulin carries glucose into body cells as their preferred source of energy. Besides, it promotes the liver's storage of glucose as glycogen and inhibits the breakdown of glycogen back into glucose. Insulin does not aid in gluconeogenesis but inhibits the breakdown of glycogen back into glucose. Insulin does not have an effect on the intestinal absorption of glucose.

The nurse is describing the action of insulin in the body to a client newly diagnosed with type 1 diabetes. Which of the following would the nurse explain as being the primary action? -It enhances transport of glucose across the cell wall. -It aids in the process of gluconeogenesis. -It stimulates the pancreatic beta cells. -It decreases the intestinal absorption of glucose.

-It enhances transport of glucose across the cell wall. Insulin carries glucose into body cells as their preferred source of energy. Besides, it promotes the liver's storage of glucose as glycogen and inhibits the breakdown of glycogen back into glucose. Insulin does not aid in gluconeogenesis but inhibits the breakdown of glycogen back into glucose.

A patient is diagnosed with type 1 diabetes. What clinical characteristics does the nurse expect to see in this patient? Select all that apply. -Ketosis-prone -Little endogenous insulin -Obesity at diagnoses -Younger than 30 years of age -Older than 65 years of age

-Ketosis-prone -Little endogenous insulin -Younger than 30 years of age

A patient is diagnosed with type 1 diabetes. What clinical characteristics does the nurse expect to see in this patient? Select all that apply. -Ketosis-prone -Little endogenous insulin -Obesity at diagnoses -Younger than 30 years of age -Older than 65 years of age

-Ketosis-prone -Little endogenous insulin -Younger than 30 years of age Type I diabetes mellitus is associated with the following characteristics: onset any age, but usually young (<30 y); usually thin at diagnosis, recent weight loss; etiology includes genetic, immunologic, and environmental factors (e.g., virus); often have islet cell antibodies; often have antibodies to insulin even before insulin treatment; little or no endogenous insulin; need exogenous insulin to preserve life; and ketosis prone when insulin absent.

The nurse is assessing a patient with nonproliferative (background) retinopathy. When examining the retina, what would the nurse expect to assess? Select all that apply. -Leakage of fluid or serum (exudates) -Microaneurysms -Focal capillary single closure -Detachment -Blurred optic discs

-Leakage of fluid or serum (exudates) -Microaneurysms -Focal capillary single closure Almost all patients with type 1 diabetes and the majority of patients with type 2 diabetes have some degree of retinopathy after 20 years (ADA, 2013). Changes in the microvasculature include microaneurysms, intraretinal hemorrhage, hard exudates, and focal capillary closure.

The nurse is caring for a client with an abnormally low blood glucose concentration. What glucose level will the nurse observe when assessing laboratory results? -Lower than 50 to 60 mg/dL (2.77 to 3.33 mmol/L) -Between 60 and 75 mg/dL (3.33 to 4.16 mmol/L) -Between 75 and 90 mg/dL (4.16 to 5.00 mmol/L) -95 mg/dL (5.27 mmol/L)

-Lower than 50 to 60 mg/dL (2.77 to 3.33 mmol/L) Hypoglycemia (low blood glucose) occurs when the blood glucose falls to less than 50 to 60 mg/dL (2.77 to 3.33 mmol/L).

A client with diabetes is receiving an oral antidiabetic agent that acts to help the tissues use available insulin more efficiently. Which of the following agents would the nurse expect to administer? -Metformin -Glyburide -Repaglinide -Glipizide

-Metformin Metformin is a biguanide and along with the thiazolidinediones (rosiglitazone and pioglitazone) are categorized as insulin sensitizers; they help tissues use available insulin more efficiently. Glyburide and glipizide which are sulfonylureas, and repaglinide, a meglitinide, are described as being insulin releasers because they stimulate the pancreas to secrete more insulin.

A nurse expects to find which signs and symptoms in a client experiencing hypoglycemia? -Polyuria, headache, and fatigue -Polyphagia and flushed, dry skin -Polydipsia, pallor, and irritability -Nervousness, diaphoresis, and confusion

-Nervousness, diaphoresis, and confusion Signs and symptoms associated with hypoglycemia include nervousness, diaphoresis, weakness, light-headedness, confusion, paresthesia, irritability, headache, hunger, tachycardia, and changes in speech, hearing, or vision. If untreated, signs and symptoms may progress to unconsciousness, seizures, coma, and death. Polydipsia, polyuria, and polyphagia are symptoms associated with hyperglycemia.

A nurse is teaching a diabetic support group about the causes of type 1 diabetes. The teaching is determined to be effective when the group is able to attribute which factor as a cause of type 1 diabetes? -Presence of autoantibodies against islet cells -Obesity -Rare ketosis -Altered glucose metabolism

-Presence of autoantibodies against islet cells There is evidence of an autoimmune response in type 1 diabetes. This is an abnormal response in which antibodies are directed against normal tissues of the body, responding to these tissues as if they were foreign. Autoantibodies against islet cells and against endogenous (internal) insulin have been detected in people at the time of diagnosis and even several years before the development of clinical signs of type 1 diabetes.

Which clinical characteristic is associated with type 1 diabetes (previously referred to as insulin-dependent diabetes mellitus)? -Presence of islet cell antibodies -Obesity -Rare ketosis -Requirement for oral hypoglycemic agents

-Presence of islet cell antibodies Individuals with type 1 diabetes often have islet cell antibodies and are usually thin or demonstrate recent weight loss at the time of diagnosis. These individuals are prone to experiencing ketosis when insulin is absent and require exogenous insulin to preserve life.

Which clinical characteristic is associated with type 1 diabetes (previously referred to as insulin-dependent diabetes mellitus)? -Presence of islet cell antibodies -Obesity -Rare ketosis -Requirement for oral hypoglycemic agents

-Presence of islet cell antibodies Individuals with type 1 diabetes often have islet cell antibodies and are usually thin or demonstrate recent weight loss at the time of diagnosis. These individuals are prone to experiencing ketosis when insulin is absent and require exogenous insulin to preserve life.

A client who was diagnosed with type 1 diabetes 14 years ago is admitted to the medical-surgical unit with abdominal pain. On admission, the client's blood glucose level is 470 mg/dl. Which finding is most likely to accompany this blood glucose level? -Cool, moist skin -Rapid, thready pulse -Arm and leg trembling -Slow, shallow respirations

-Rapid, thready pulse

Lispro (Humalog) is an example of which type of insulin? -Rapid-acting -Intermediate-acting -Short-acting -Long-acting

-Rapid-acting Humalog is a rapid-acting insulin. NPH is an intermediate-acting insulin. A short-acting insulin is Humulin-R. An example of a long-acting insulin is Glargine (Lantus).

What is the only insulin that can be given intravenously? -Regular -NPH -Lantus -Ultralente

-Regular Insulins other than regular are in suspensions that could be harmful if administered IV.

A patient has been newly diagnosed with type 2 diabetes, and the nurse is assisting with the development of a meal plan. What step should be taken into consideration prior to making the meal plan? -Making sure that the patient is aware that quantity of foods will be limited -Ensuring that the patient understands that some favorite foods may not be allowed on the meal plan and substitutes will need to be found -Determining whether the patient is on insulin or taking oral antidiabetic medication -Reviewing the patient's diet history to identify eating habits and lifestyle and cultural eating patterns

-Reviewing the patient's diet history to identify eating habits and lifestyle and cultural eating patterns The first step in preparing a meal plan is a thorough review of the patient's diet history to identify eating habits and lifestyle and cultural eating patterns.

The diabetic client asks the nurse why shoes and socks are removed at each office visit. Which assessment finding is most significant in determining the protocol for inspection of feet? -Autonomic neuropathy -Retinopathy -Sensory neuropathy -Nephropathy

-Sensory neuropathy Neuropathy results from poor glucose control and decreased circulation to nerve tissues. Neuropathy involving sensory nerves located in the periphery can lead to lack of sensitivity, which increases the potential for soft tissue injury without client awareness. The feet are inspected on each visit to insure no injury or pressure has occurred. Autonomic neuropathy, retinopathy, and nephropathy affect nerves to organs other than feet.

Laboratory studies indicate a client's blood glucose level is 185 mg/dl. Two hours have passed since the client ate breakfast. Which test would yield the most conclusive diagnostic information about the client's glucose use? -Fasting blood glucose test -6-hour glucose tolerance test -Serum glycosylated hemoglobin (Hb A1c) -Urine ketones

-Serum glycosylated hemoglobin (Hb A1c) Hb A1c is the most reliable indicator of glucose use because it reflects blood glucose levels for the prior 3 months. Although a fasting blood glucose test and a 6-hour glucose tolerance test yield information about a client's use of glucose, the results are influenced by such factors as whether the client recently ate breakfast. Presence of ketones in the urine also provides information about glucose use but is limited in its diagnostic significance.

A client with a tentative diagnosis of hyperosmolar hyperglycemic nonketotic syndrome (HHNS) has a history of type 2 diabetes that is being controlled with an oral diabetic agent, tolazamide. Which laboratory test is the most important for confirming this disorder? -Serum potassium level -Serum sodium level -Arterial blood gas (ABG) values -Serum osmolarity

-Serum osmolarity Serum osmolarity is the most important test for confirming HHNS; it's also used to guide treatment strategies and determine evaluation criteria. A client with HHNS typically has a serum osmolarity of more than 350 mOsm/L. Serum potassium, serum sodium, and ABG values are also measured, but they aren't as important as serum osmolarity for confirming a diagnosis of HHNS. A client with HHNS typically has hypernatremia and osmotic diuresis. ABG values reveal acidosis, and the potassium level is variable.

A client with type 2 diabetes asks the nurse why he can't have a pancreatic transplant. Which of the following would the nurse include as a possible reason? -Increased risk for urologic complications -Need for exocrine enzymatic drainage -Underlying problem of insulin resistance -Need for lifelong immunosuppressive therapy

-Underlying problem of insulin resistance

A client with a tentative diagnosis of hyperosmolar hyperglycemic nonketotic syndrome (HHNS) has a history of type 2 diabetes that is being controlled with an oral diabetic agent, tolazamide. Which laboratory test is the most important for confirming this disorder? -Serum potassium level -Serum sodium level -Arterial blood gas (ABG) values -Serum osmolarity

-Serum osmolarity Serum osmolarity is the most important test for confirming HHNS; it's also used to guide treatment strategies and determine evaluation criteria. A client with HHNS typically has a serum osmolarity of more than 350 mOsm/L. Serum potassium, serum sodium, and ABG values are also measured, but they aren't as important as serum osmolarity for confirming a diagnosis of HHNS. A client with HHNS typically has hypernatremia and osmotic diuresis. ABG values reveal acidosis, and the potassium level is variable.

A client with status asthmaticus requires endotracheal intubation and mechanical ventilation. Twenty-four hours after intubation, the client is started on the insulin infusion protocol. The nurse must monitor the client's blood glucose levels hourly and watch for which early signs and symptoms associated with hypoglycemia? -Sweating, tremors, and tachycardia -Dry skin, bradycardia, and somnolence -Bradycardia, thirst, and anxiety -Polyuria, polydipsia, and polyphagia

-Sweating, tremors, and tachycardia Sweating, tremors, and tachycardia, thirst, and anxiety are early signs of hypoglycemia. Dry skin, bradycardia, and somnolence are signs and symptoms associated with hypothyroidism. Polyuria, polydipsia, and polyphagia are signs and symptoms of diabetes mellitus.

Insulin is a hormone secreted by the Islets of Langerhans and is essential for the metabolism of carbohydrates, fats, and protein. The nurse understands the physiologic importance of gluconeogenesis, which refers to the: -Transport of potassium. -Release of glucose. -Synthesis of glucose from noncarbohydrate sources. -Storage of glucose as glycogen in the liver.

-Synthesis of glucose from noncarbohydrate sources. Gluconeogenesis refers to the making of glucose from noncarbohydrates. This occurs mainly in the liver. Its purpose is to maintain the glucose level in the blood to meet the body's demands.

Which of the following factors would a nurse identify as a most likely cause of diabetic ketoacidosis (DKA) in a client with diabetes? -The client continues medication therapy despite adequate food intake. -The client has not consumed sufficient calories. -The client has been exercising more than usual. -The client has eaten and has not taken or received insulin.

-The client has eaten and has not taken or received insulin.

Which of the following factors would a nurse identify as a most likely cause of diabetic ketoacidosis (DKA) in a client with diabetes? -The client continues medication therapy despite adequate food intake. -The client has not consumed sufficient calories. -The client has been exercising more than usual. -The client has eaten and has not taken or received insulin.

-The client has eaten and has not taken or received insulin. If the client has eaten and has not taken or received insulin, DKA is more likely to develop. Hypoglycemia is more likely to develop if the client has not consumed food and continues to take insulin or oral antidiabetic medications, if the client has not consumed sufficient calories, or if client has been exercising more than usual.

Which may be a potential cause of hypoglycemia in the client diagnosed with diabetes mellitus? -The client has not eaten but continues to take insulin or oral antidiabetic medications. -The client has not been exercising. -The client has not complied with the prescribed treatment regimen. -The client has eaten but has not taken or received insulin.

-The client has not eaten but continues to take insulin or oral antidiabetic medications. Hypoglycemia occurs when a client with diabetes is not eating and continues to take insulin or oral antidiabetic medications. Hypoglycemia does not occur when the client has not been compliant with the prescribed treatment regimen. If the client has eaten and has not taken or received insulin, diabetic ketoacidosis is more likely to develop.

The pancreas continues to release a small amount of basal insulin overnight, while a person is sleeping. The nurse knows that if the body needs more sugar: -The pancreatic hormone glucagon will stimulate the liver to release stored glucose. -Insulin will be released to facilitate the transport of sugar. -Glycogenesis will be decreased by the liver. -The process of gluconeogenesis will be inhibited.

-The pancreatic hormone glucagon will stimulate the liver to release stored glucose. When sugar levels are low, glucagon promotes hyperglycemia by stimulating the release of stored glucose. Glycogenolysis and gluconeogenesis will both be increased. Insulin secretion would promote hypoglycemia.

A nurse is preparing to administer two types of insulin to a client with diabetes mellitus. What is the correct procedure for preparing this medication? -The short-acting insulin is withdrawn before the intermediate-acting insulin. -The intermediate-acting insulin is withdrawn before the short-acting insulin. -Different types of insulin are not to be mixed in the same syringe. -If administered immediately, there is no requirement for withdrawing one type of insulin before another.

-The short-acting insulin is withdrawn before the intermediate-acting insulin. When combining two types of insulin in the same syringe, the short-acting regular insulin is withdrawn into the syringe first and the intermediate-acting insulin is added next. This practice is referred to as "clear to cloudy."

A client with diabetes mellitus develops sinusitis and otitis media accompanied by a temperature of 100.8° F (38.2° C). What effect do these findings have on his need for insulin? -They have no effect. -They decrease the need for insulin. -They increase the need for insulin. -They cause wide fluctuations in the need for insulin.

-They increase the need for insulin. Insulin requirements increase in response to growth, pregnancy, increased food intake, stress, surgery, infection, illness, increased insulin antibodies, and some medications. Insulin requirements are decreased by hypothyroidism, decreased food intake, exercise, and some medications.

A client with diabetes mellitus develops sinusitis and otitis media accompanied by a temperature of 100.8° F (38.2° C). What effect do these findings have on his need for insulin? -They have no effect. -They decrease the need for insulin. -They increase the need for insulin. -They cause wide fluctuations in the need for insulin.

-They increase the need for insulin. Insulin requirements increase in response to growth, pregnancy, increased food intake, stress, surgery, infection, illness, increased insulin antibodies, and some medications. Insulin requirements are decreased by hypothyroidism, decreased food intake, exercise, and some medications.

A client with type 2 diabetes asks the nurse why he can't have a pancreatic transplant. Which of the following would the nurse include as a possible reason? -Increased risk for urologic complications -Need for exocrine enzymatic drainage -Underlying problem of insulin resistance -Need for lifelong immunosuppressive therapy

-Underlying problem of insulin resistance Clients with type 2 diabetes are not offered the option of a pancreas transplant because their problem is insulin resistance, which does not improve with a transplant. Urologic complications or the need for exocrine enzymatic drainage are not reasons for not offering pancreas transplant to clients with type 2 diabetes. Any transplant requires lifelong immunosuppressive drug therapy and is not the factor.

The nurse is teaching a client about self-administration of insulin and about mixing regular and neutral protamine Hagedorn (NPH) insulin. Which information is important to include in the teaching plan? -If two different types of insulin are ordered, they need to be given in separate injections. -When mixing insulin, the NPH insulin is drawn up into the syringe first. -When mixing insulin, the regular insulin is drawn up into the syringe first. -There is no need to inject air into the bottle of insulin before withdrawing the insulin.

-When mixing insulin, the regular insulin is drawn up into the syringe first. When rapid-acting or short-acting insulins are to be given simultaneously with longer-acting insulins, they are usually mixed together in the same syringe; the longer-acting insulins must be mixed thoroughly before being drawn into the syringe. The American Diabetic Association recommends that the regular insulin be drawn up first. The most important issues are that patients (1) are consistent in technique, so the wrong dose is not drawn in error or the wrong type of insulin, and (2) do not inject one type of insulin into the bottle containing a different type of insulin. Injecting cloudy insulin into a vial of clear insulin contaminates the entire vial of clear insulin and alters its action.

During a class on exercise for clients with diabetes mellitus, a client asks the nurse educator how often to exercise. To meet the goals of planned exercise, the nurse educator should advise the client to exercise: -at least once per week. -at least three times per week. -at least five times per week. -every day.

-at least three times per week. Clients with diabetes must exercise at least three times per week to meet the goals of planned exercise — lowering the blood glucose level, reducing or maintaining the proper weight, increasing the serum high-density lipoprotein level, decreasing serum triglyceride levels, reducing blood pressure, and minimizing stress. Exercising once per week wouldn't achieve these goals. Exercising more than three times per week, although beneficial, would exceed the minimum requirement.

A nurse is providing dietary instructions to a client with hypoglycemia. To control hypoglycemic episodes, the nurse should recommend: -increasing saturated fat intake and fasting in the afternoon. -increasing intake of vitamins B and D and taking iron supplements. -eating a candy bar if light-headedness occurs. -consuming a low-carbohydrate, high-protein diet and avoiding fasting.

-consuming a low-carbohydrate, high-protein diet and avoiding fasting. To control hypoglycemic episodes, the nurse should instruct the client to consume a low-carbohydrate, high-protein diet, avoid fasting, and avoid simple sugars. Increasing saturated fat intake and increasing vitamin supplementation wouldn't help control hypoglycemia.

A client tells the nurse that she has been working hard for the past 3 months to control her type 2 diabetes with diet and exercise. To determine the effectiveness of the client's efforts, the nurse should check: -urine glucose level. -fasting blood glucose level. -serum fructosamine level. -glycosylated hemoglobin level.

-glycosylated hemoglobin level. Because some of the glucose in the bloodstream attaches to some of the hemoglobin and stays attached during the 120-day life span of red blood cells, glycosylated hemoglobin levels provide information about blood glucose levels during the previous 3 months. Fasting blood glucose and urine glucose levels give information only about glucose levels at the point in time when they were obtained. Serum fructosamine levels provide information about blood glucose control over the past 2 to 3 weeks.

A client with diabetes mellitus is receiving an oral antidiabetic agent. When caring for this client, the nurse should observe for signs of: -hypoglycemia -polyuria -blurred vision -polydipsia

-hypoglycemia The nurse should observe the client receiving an oral antidiabetic agent for the signs of hypoglycemia. The time when the reaction might occur is not predictable and could be from 30 to 60 minutes to several hours after the drug is ingested.

A client with a history of type 1 diabetes is demonstrating fast, deep, labored breathing and has fruity odored breath. What could be the cause of the client's current serious condition? -ketoacidosis -hyperosmolar hyperglycemic nonketotic syndrome -hepatic disorder -All options are correct.

-ketoacidosis Kussmaul respirations (fast, deep, labored breathing) are common in ketoacidosis. Acetone, which is volatile, can be detected on the breath by its characteristic fruity odor. If treatment is not initiated, the outcome of ketoacidosis is circulatory collapse, renal shutdown, and death. Ketoacidosis is more common in people with diabetes who no longer produce insulin, such as those with type 1 diabetes. People with type 2 diabetes are more likely to develop hyperosmolar hyperglycemic nonketotic syndrome because with limited insulin, they can use enough glucose to prevent ketosis but not enough to maintain a normal blood glucose level.

A client with type 1 diabetes has been on a regimen of multiple daily injection therapy. He's being converted to continuous subcutaneous insulin therapy. While teaching the client about continuous subcutaneous insulin therapy, the nurse should tell him that the regimen includes the use of: -intermediate- and long-acting insulins. -short- and long-acting insulins. -rapid-acting insulin only. -short- and intermediate-acting insulins.

-rapid-acting insulin only. A continuous subcutaneous insulin regimen uses a basal rate and boluses of rapid-acting insulin. Multiple daily injection therapy uses a combination of rapid-acting and intermediate- or long-acting insulins.

A nurse is assigned to care for a postoperative client with diabetes mellitus. During the assessment interview, the client reports that he's impotent and says he's concerned about the effect on his marriage. In planning this client's care, the most appropriate intervention would be to: -encourage the client to ask questions about personal sexuality. -provide time for privacy. -provide support for the spouse or significant other. -suggest referral to a sex counselor or other appropriate professional.

-suggest referral to a sex counselor or other appropriate professional. The nurse should refer this client to a sex counselor or other professional. Making appropriate referrals is a valid part of planning the client's care. The nurse doesn't normally provide sex counseling.