Ch 51 Assessment and Management of Patients with Diabetes Practice Qs

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? a) "Eating the fruit is more satisfying than drinking the juice. You will get full faster." b) "Eating the fruit instead of drinking juice decreases the glycemic index by slowing absorption." c) "The fruit has less sugar than the juice." d) "Eating the fruit will give you more vitamins and minerals than the juice will."

"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.

During a follow-up visit 3 months following a new diagnosis of type 2 diabetes, a patient reports exercising and following a reduced-calorie diet. Assessment reveals that the patient has only lost 1 pound and did not bring the glucose-monitoring record. Which of the following tests will the nurse plan to obtain? a) Oral glucose tolerance test b) Fasting blood glucose level c) Glycosylated hemoglobin level d) Urine dipstick for glucose

Glycosylated hemoglobin level Glycosylated hemoglobin is a blood test that reflects average blood glucose levels over a period of approximately 2 to 3 months. When blood glucose levels are elevated, glucose molecules attach to hemoglobin in red blood cells. The longer the amount of glucose in the blood remains above normal, the more glucose binds to hemoglobin and the higher the glycated hemoglobin level becomes.

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) Little relation to prediabetes b) Onset most common during adolescence c) Less common than type 1 diabetes d) Insufficient insulin production

Insufficient insulin production 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. Prediabetes can lead to type 2 diabetes.

NPH is an example of which type of insulin? a) Rapid-acting b) Long-acting c) Intermediate-acting d) Short-acting

Intermediate-acting NPH is intermediate-acting insulin.

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

"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.

The nurse is administering lispro (Humalog) insulin. Based on the onset of action, how soon should the nurse administer the injection prior to breakfast? a) 30 to 40 minutes b) 1 to 2 hours c) 10 to 15 minutes d) 3 hours

10 to 15 minutes The onset of action of rapid-acting Humalog is within 10 to 15 minutes. It is used for rapid reduction of glucose level.

What is the duration of regular insulin? a) 12 to 16 hours b) 24 hours c) 3 to 5 hours d) 4 to 6 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? a) 7.5 % b) 8.0% c) 8.5% d) 6.5%

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? a) 8:00 AM b) 7:45 AM c) 8:30 AM d) 7:35 AM

7:35 AM Insulin lispro has an onset of 10 to 15 minutes. Therefore, the nurse would need to ensure that the client has his breakfast by 7:35 AM. Otherwise, the client may experience hypoglycemia.

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? a) Administer prescribed dose of insulin. b) Give prescribed antiemetics. c) Administer bicarbonate to correct acidosis. d) Begin fluid replacements.

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

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

Crying whenever diabetes is mentioned A client who cries whenever diabetes is mentioned is demonstrating ineffective coping.

Which of the following is an age-related change that may affect diabetes and its management? a) Increased thirst b) Hypotension c) Decreased renal function d) Increased bowel motility

Decreased renal function Decreased renal function affects the management of diabetes. With decreasing renal function, it takes longer for oral hypoglycemic agents to be excreted by the kidneys and changes in insulin clearance occur with decreased renal function. Other age-related changes that may affect diabetes and its management include hypertension, decreased bowel motility, and decreased thirst.

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

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? a) Social worker b) Psychiatrist c) Home health nurse d) Dietitian

Dietitian The client should be referred to a dietitian, who will help him gain better control of his blood glucose levels.

Which of the following is the most rapid acting insulin? a) Humalog b) Ultralente c) NPH d) Regular

Humalog The onset of action of rapid-acting Humalog is within 10 to 15 minutes.

A 60-year-old patient comes to the ED with complaints of weakness, vision problems, increased thirst, increased urination, and frequent infections that do not seem to heal easily. The physician suspects that the patient has diabetes. Which of the following classic symptoms should the nurse watch for to confirm the diagnosis of diabetes? a) Fatigue b) Dizziness c) Increased hunger d) Numbness

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.

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) Sensory neuropathy b) Nephropathy c) Retinopathy d) Autonomic neuropathy

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.

A client with diabetes mellitus is receiving an oral antidiabetic agent. Which of the following aspects should the nurse observe when caring for this client? a) Polyuria b) Blurred vision c) Polydipsia d) Signs of hypoglycemia

Signs of 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. Observe the client receiving an oral antidiabetic agent for signs of hypoglycemia.

Matt Thompson, a 37-year-old farmer, has been diagnosed with pre diabetes. Following his visit with his primary care provider, you begin your client education session to discuss treatment strategies. What can be the consequences of untreated pre diabetes? a) All options are correct. b) Type 2 diabetes c) CVA d) Cardiac disease

All options are correct. The NIDDK has developed criteria that identify people with prediabetes, which can lead to type 2 diabetes, heart disease, and stroke.

Which of the following should be included in the teaching plan for a patient receiving glargine (Lantus),"peakless" basal insulin? a) Is rapidly absorbed, has a fast onset of action b) Do not mix with other insulins c) Administer the total daily dosage in 2 doses d) Draw up the drug first, then add regular insulin

Do not mix with other insulins Because glargine is in a suspension with a pH of 4, it cannot be mixed with other insulins because this would cause precipitation. When administering glargine (Lantus) insulin it is very important to read the label carefully and to avoid mistaking Lantus insulin for Lente insulin and vice versa. Glargine is absorbed very slowly over a 24-hour period and can be given once a day. Glargine is a "peakless" basal insulin that is absorbed very slowly over a 24-hour period.

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

Finger Even though the fingertips have a higher number of nerve endings, this site provides the most accurate blood sugar reading.

Which combination of adverse effects should a nurse monitor for when administering I.V. insulin to a client with diabetic ketoacidosis? a) Hypokalemia and hypoglycemia b) Hyperkalemia and hyperglycemia c) Hypocalcemia and hyperkalemia d) Hypernatremia and hypercalcemia

Hypokalemia and hypoglycemia Blood glucose needs to be monitored in clients receiving I.V. 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.

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 aids in the process of gluconeogenesis. b) It decreases the intestinal absorption of glucose. c) It carries glucose into body cells. d) It stimulates the pancreatic beta cells.

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.

Which of the following are byproducts of fat breakdown, which accumulate in the blood and urine? a) Cholesterol b) Ketones c) Creatinine d) Hemoglobin

Ketones Ketones are byproducts of fat breakdown, and they accumulate in the blood and urine.

A nurse is teaching a patient recovering from diabetic ketoacidosis (DKA) about management of "sick days." The patient asks the nurse why it is important to monitor the urine for ketones. Which of the following statements is the nurse's best response? a) When the body does not have enough insulin hyperglycemia occurs. Excess glucose is broken down by the liver, causing acidic byproducts to be released. b) Ketones accumulate in the blood and urine when fat breaks down. Ketones signal a deficiency of insulin that will cause the body to start to break down stored fat for energy. c) Ketones are formed when insufficient insulin leads to cellular starvation. As cells rupture, they release these acids into the blood. d) 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. Ketones signal a deficiency of insulin that will cause the body to start to break down stored fat for energy. Ketones (or ketone bodies) are byproducts of fat breakdown, and they accumulate in the blood and urine. Ketones in the urine signal a deficiency of insulin and control of type 1 diabetes is deteriorating. When almost no effective insulin is available, the body starts to break down stored fat for energy.

The nurse is caring for a patient with an abnormally low blood glucose concentration. What glucose level will the nurse observe when assessing laboratory results? a) 95 mg/dL b) Lower than 50-60 mg/dL c) Between 60 and 80 mg/dL d) Between 75 and 90 mg/dL

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

A male client, aged 42, 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 exercise routine b) History of radiographic contrast studies that used iodine c) The client's consumption of carbohydrates d) The client's mental and emotional status

The client's consumption of carbohydrates While assessing a client, it is important to note the client's consumption of carbohydrates because he has high blood sugar

Which of the following may be a potential cause of hypoglycemia in the patient diagnosed with diabetes mellitus? a) The patient has not been exercising. b) The patient has not been compliant with the prescribed treatment regimen. c) The patient has not consumed food and continues to take insulin or oral antidiabetic medications. d) The patient has consumed food and has not taken or received insulin.

The patient has not consumed food and continues to take insulin or oral antidiabetic medications. Hypoglycemia occurs when a patient with diabetes is not eating at all and continues to take insulin or oral antidiabetic medications

A patient is admitted to the health care center with abdominal pain, nausea, and vomiting. The medical reports indicate a history of type 1 diabetes. The nurse suspects the patient's symptoms to be that of diabetic ketoacidosis (DKA). Which of the following actions will help the nurse confirm the diagnosis? a) Assessing for excessive sweating b) Assessing the patient's ability to move all extremities c) Assessing the patient's breath odor d) Assessing the patient's ability to take a deep breath

Assessing the patient's breath odor DKA is commonly preceded by a day or more of polyuria, polydipsia, nausea, vomiting, and fatigue with eventual stupor and coma if not treated. The breath has a characteristic fruity odor due to the presence of ketoacids. Checking the patient's breath will help the nurse confirm the diagnosis

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) Decrease food intake until nausea passes. b) Increase frequency of glucose self-monitoring. c) Do not take insulin if not eating. d) 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 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) Glipizide d) Repaglinide

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.

A client is admitted to the unit with diabetic keto acidosis (DKA). Which insulin would the nurse expect to administer intravenously? a) Regular b) Lente c) NPH d) Glargine

Regular Regular insulin is administered intravenously to treat DKA. It is added to an IV solution and infused continuously.

A client is admitted to the unit with diabetic ketoacidosis (DKA). Which insulin would the nurse expect to administer intravenously? a) Lente b) Glargine c) NPH d) Regular

Regular Regular insulin is administered intravenously to treat DKA. It is added to an IV solution and infused continuously.

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? a) Sweating, tremors, and tachycardia b) Dry skin, bradycardia, and somnolence c) Bradycardia, thirst, and anxiety d) Polyuria, polydipsia, and polyphagia

Sweating, tremors, and tachycardia Sweating, tremors, and tachycardia, thirst, and anxiety are early signs of hypoglycemia.