Unit 5- Chapter 51-Clients with DM

A controlled type 2 diabetic client states, "The doctor said if my blood sugars remain stable, I may not need to take any medication." Which response by the nurse is most appropriate? A) "Diet, exercise, and weight loss can eliminate the need for medication." B) "You will be placed on a strict low-sugar diet for better control." C) "Some doctors do not treat blood sugar elevation until symptoms appear." D) "You misunderstood the doctor. Let's ask for clarification."

A) "Diet, exercise, and weight loss can eliminate the need for medication."

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? A) 6.5% B) 7.5% C) 8.0% D) 8.5%

A) 6.5%

A client with type 1 diabetes mellitus is receiving short-acting insulin to maintain control of blood glucose levels. In providing glucometer instructions, the nurse would instruct the client to use which site for most accurate findings? A) Finger B) Upper arm C) Thigh D) Forearm

A) Finger

Which of the following assessment findings is most important in determining nursing care for a client with hyperosmolar hyperglycemic nonketotic syndrome (HHNKS)? A) Hypotension B) Blood pH 7.38 C) Mental changes D) Fever

A) Hypotension

The nurse is educating the diabetic client 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? A) Increase frequency of glucose self-monitoring. B) Decrease food intake until nausea passes. C) Do not take insulin if not eating. D) Take half the usual dose of insulin until symptoms resolve.

A) Increase frequency of glucose self-monitoring.

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? A) Increases ability for glucose to get into the cell and lowers blood sugar B) Creates an overall feeling of well-being and lowers risk of depression C) Decreases need for pancreas to produce more cells D) Decreases risk of developing insulin resistance and hyperglycemia

A) Increases ability for glucose to get into the cell and lowers blood sugar

Which factor presents the most likely cause for weight gain in a diabetic client who is controlled with insulin? A) Insulin is an anabolic hormone. B) Insulin provides more efficient use of glucose. C) Faulty fat metabolism is shut off. D) Weight gain is attributed to fluid retention.

A) Insulin is an anabolic hormone.

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? A) It carries glucose into body cells. B) It aids in the process of gluconeogenesis. C) It stimulates the pancreatic beta cells. D) It decreases the intestinal absorption of glucose.

A) It carries glucose into body cells.

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? A) Metformin B) Glyburide C) Repaglinide D) Glipizide

A) Metformin

The nurse is teaching an older client how to self-administer insulin. Which of the following would be most helpful to the client who is having difficulty drawing up the correct dosage of insulin in the syringe? A) Syringe magnifier B) Insulin pen C) Jet injector D) Insulin pump

A) Syringe magnifier

A male client, aged 42 years, is diagnosed with diabetes mellitus. He visits the gym regularly and is a vegetarian. Which of the following factors is important when assessing the client? A) The client's consumption of carbohydrates B) History of radiographic contrast studies that used iodine C) The client's mental and emotional status D) The client's exercise routine

A) The client's consumption of carbohydrates

A client asks why pancreas transplantation is not an option offered to all insulin-dependent diabetics. Which is the best response by the nurse? A) Type 1 diabetes can be managed in most clients with insulin. B) Pancreas transplant is becoming more common. C) There is a long waiting list to receive a new pancreas. D) For every transplant, two deceased donors are needed.

A) Type 1 diabetes can be managed in most clients with insulin.

A client reports taking oral medication for control of sugar problems. Which is the best nursing interpretation of this verbal accounting? A) Lack of knowledge of disease process B) Client has type 2 diabetes mellitus. C) Client has prediabetes mellitus. D) Lack of knowledge on medication regime

B) Client has type 2 diabetes mellitus.

A client is admitted with the diagnosis of hyperosmolar hyperglycemic nonketotic syndrome (HHNKS) following steroids therapy. Which of the following symptoms are associated with HHNKS? Select all that apply. A) High blood pressure B) Extreme thirst C) Bradycardia D) Poor skin turgor E) Acidosis F) Hypoglycemia

B) Extreme thirst D) Poor skin turgor

A type 2 diabetic is ordered metformin (Glucophage) as part of the management regime. Which is the best nursing explanation for the action of this drug in controlling glucose levels? A) Delays digestion of carbohydrates B) Helps tissues use insulin more efficiently C) Stimulates insulin release D) Reduces the production of glucose by the liver

B) Helps tissues use insulin more efficiently

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? A) Onset most common during adolescence B) Insufficient insulin production C) Less common than type 1 diabetes D) Little relation to prediabetes

B) Insufficient insulin production

On initial nursing rounds, the diabetic client reports "not feeling well." Later, the nurse finds the client to be diaphoretic and in a stuporous state. Which is the immediate action taken by the nurse? A) Call the physician. B) Obtain a glucometer reading. C) Administer fruit juice. D) Start an IV of dextrose.

B) Obtain a glucometer reading.

Which is the primary reason for encouraging injection site rotation in an insulin dependent diabetic? A) Avoid infection. B) Promote absorption. C) Minimize discomfort. D) Prevent muscle destruction.

B) Promote absorption.

A client is admitted to the unit with diabetic ketoacidosis (DKA). Which insulin would the nurse expect to administer intravenously? A) Glargine B) Regular C) NPH D) Lente

B) Regular

The nurse understands that a client with diabetes mellitus is at greater risk for developing which of the following complications? A) High blood pressure B) Urinary tract infections C) Lifelong obesity D) Elevated triglycerides

B) Urinary tract infections

The nurse is providing information about foot care to a client with diabetes. Which of the following would the nurse include? A) "Wash your feet in hot water every day." B) "Use a razor to remove corns or calluses." C) "Be sure to apply a moisturizer to feet daily." D) "Wear well-fitting comfortable rubber shoes."

C) "Be sure to apply a moisturizer to feet daily."

The client asks the nurse if dipstick of urine can be used for monitoring glucose levels. Which is the best response by the nurse? A) "Yes, it is a cheaper method of monitoring glucose and ketones in the urine." B) "This test can detect ketones but not glucose levels." C) "The most accurate way to monitor glucose levels is by blood testing." D) "Dipstick of urine will only indicate lower levels of glucose and ketones."

C) "The most accurate way to monitor glucose levels is by blood testing."

A recently widowed diabetic comments that blood sugar levels are running higher than usual. Which is the best response from the nurse? A) "People who eat alone tend to eat more." B) "Cooking lower carbohydrate meals for one person is a challenge." C) "This must be a stressful time for you." D) "Quit checking your blood sugars for now."

C) "This must be a stressful time for you."

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 nursing action is most important in the management of DKA? A) Give prescribed antiemetics. B) Begin fluid replacements. C) Administer prescribed dose of insulin. D) Administer bicarbonate to correct acidosis.

C) Administer prescribed dose of insulin.

Which is the primary dietary consideration for a client receiving insulin isophane suspension (NPH) at breakfast? A) Make sure breakfast is not delayed. B) Provide fewest amount of carbohydrates at lunch meal. C) Encourage midday snack. D) Delay dinner meal.

C) Encourage midday snack.

Which of the following would the nurse most likely assess in a client with diabetes who is experiencing autonomic neuropathy? A) Skeletal deformities B) Paresthesias C) Erectile dysfunction D) Soft tissue ulceration

C) Erectile dysfunction

When the nurse inspects the feet of a diabetic, a tack is found sticking in the sole of one foot. The client denies feeling anything unusual in the foot. Which is the best rationale for this finding? A) In diabetes, the autonomic nerves are affected. B) Motor neuropathy causes muscles to weaken and atrophy. C) High blood sugar decreases blood circulation to nerves. D) Nephropathy is a common complication of diabetes mellitus.

C) High blood sugar decreases blood circulation to nerves.

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

C) High sugar pulls fluid into the bloodstream, which results in more urine production.

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? A) Autonomic neuropathy B) Retinopathy C) Sensory neuropathy D) Nephropathy

C) Sensory neuropathy

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? A) Increased risk for urologic complications B) Need for exocrine enzymatic drainage C) Underlying problem of insulin resistance D) Need for lifelong immunosuppressive therapy

C) Underlying problem of insulin resistance

An active type 2 diabetic reports recurrent symptoms of weakness and nervousness. Which is the best response from the nurse? A) "These symptoms are related to added stress." B) "Maybe you should eat simple carbohydrates." C) "Sounds like high blood sugar symptoms." D) "Exercise and activity can lower glucose levels."

D) "Exercise and activity can lower glucose levels."

A diabetic client is having difficulty with blood glucose control even though the client claims to be following a strict diet, exercise, and medication regime. Which of the following conditions would the nurse suspect to be the most likely cause of poor control? A) Hypertension B) Retinopathy C) Peripheral vascular disease D) Emphysema

D) Emphysema

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

D) Fruity breath

A diabetic client maintains glucose control with the use of long-acting and short-acting insulin. Which nursing instruction would be considered a priority teaching issue for this client? A) Mix short-acting and long-acting insulin. B) Monitor blood glucose levels immediately following injection. C) Use stomach for nighttime injections. D) If using Lantus or Levemir, give in separate syringe.

D) If using Lantus or Levemir, give in separate syringe.

The nurse is explaining glycosylated hemoglobin testing to a diabetic client. Which of the following provides the best reason for this order? A) Provides best information on the body's ability to maintain normal blood functioning B) Best indicator for the nutritional state of the client C) Is less costly than performing daily blood sugar test D) Reflects the amount of glucose stored in hemoglobin over past several months

D) Reflects the amount of glucose stored in hemoglobin over past several months