Chapter 51: Assessment and Management of Patients With Diabetes

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." Explanation: 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. Chapter 51: Assessment and Management of Patients With Diabetes - Page 1467-1468

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." Explanation: 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. Chapter 51: Assessment and Management of Patients With Diabetes - Page 1484

The nurse is administering lispro insulin. Based on the onset of action, how long before breakfast should the nurse administer the injection? 10 to 15 minutes 30 to 40 minutes 1 to 2 hours 3 hours

10 to 15 minutes Explanation: The onset of action of rapid-acting lispro insulin is within 10 to 15 minutes. It is used to rapidly reduce the glucose level. Chapter 51: Assessment and Management of Patients With Diabetes - Page 1468

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. Explanation: The goals for a 2-hour, postprandial blood glucose level are less than 120 mg/dL in a patient who might develop gestational diabetes. Chapter 51: Assessment and Management of Patients With Diabetes - Page 1460

A nurse is caring for a client with type 1 diabetes who exhibits confusion, light-headedness, and aberrant behavior. The client is conscious. The nurse should first administer: I.M. or subcutaneous glucagon. I.V. bolus of dextrose 50%. 15 to 20 g of a fast-acting carbohydrate such as orange juice. 10 units of fast-acting insulin.

15 to 20 g of a fast-acting carbohydrate such as orange juice. Explanation: This client is experiencing hypoglycemia. Because the client is conscious, the nurse should first administer a fast-acting carbohydrate, such as orange juice, hard candy, or honey. If the client has lost consciousness, the nurse should administer I.M. or subcutaneous glucagon or an I.V. bolus of dextrose 50%. The nurse shouldn't administer insulin to a client who's hypoglycemic; this action will further compromise the client's condition. Chapter 51: Assessment and Management of Patients With Diabetes - Page 1481

The nurse practitioner worked with a registered dietitian to customize a 1,800-calorie diabetic diet for a 53-year-old man with special dietary needs. Which of the following percent distributions of calories should be provided? Carbohydrates 85%, fat 10%, and protein 5% Carbohydrates 40%, fat 15%, and protein 45% Carbohydrates 45%, fat 20%, and protein 35% Carbohydrates 55%, fat 25%, and protein 20%

Carbohydrates 55%, fat 25%, and protein 20% Explanation: The American Dietetic Association currently recommends the following distribution of caloric intake: 50% to 60% carbohydrates, 20% to 30% fat, and 10% to 20% protein. Chapter 51: Assessment and Management of Patients With Diabetes - Page 1462

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 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 Explanation: 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 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. Chapter 51: Assessment and Management of Patients With Diabetes - Page 1482

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 Explanation: 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. Chapter 51: Assessment and Management of Patients With Diabetes - Page 1497

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 Explanation: 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. Chapter 51: Assessment and Management of Patients With Diabetes - Page 1460

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 Explanation: 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. Chapter 51: Assessment and Management of Patients With Diabetes - Page 1487

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 no relation to pre-diabetes

Insulin production insufficient Explanation: 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. Chapter 51: Assessment and Management of Patients With Diabetes - Page 1459

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

Intermediate-acting Explanation: NPH is an intermediate-acting insulin. Chapter 51: Assessment and Management of Patients With Diabetes - Page 1468

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 Explanation: 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. Chapter 51: Assessment and Management of Patients With Diabetes - Page 1460

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 Explanation: 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. Chapter 51: Assessment and Management of Patients With Diabetes - Page 1468

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 Explanation: 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. Chapter 51: Assessment and Management of Patients With Diabetes - Page 1458

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 Explanation: 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. Chapter 51: Assessment and Management of Patients With Diabetes - Page 1458

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 Explanation: This client's abnormally high blood glucose level indicates hyperglycemia, which typically causes polyuria, polyphagia, and polydipsia. Because polyuria leads to fluid loss, the nurse should expect to assess signs of deficient fluid volume, such as a rapid, thready pulse; decreased blood pressure; and rapid respirations. Cool, moist skin and arm and leg trembling are associated with hypoglycemia. Rapid respirations — not slow, shallow ones — are associated with hyperglycemia. Chapter 51: Assessment and Management of Patients With Diabetes - Page 1484

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 Explanation: 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. Chapter 51: Assessment and Management of Patients With Diabetes - Page 1492

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 Explanation: 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. Chapter 51: Assessment and Management of Patients With Diabetes - Page 1482

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. Explanation: 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. Chapter 51: Assessment and Management of Patients With Diabetes - Page 1483-1484

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? The client's consumption of carbohydrates History of radiographic contrast studies that used iodine The client's mental and emotional status The client's exercise routine

The client's consumption of carbohydrates Explanation: While assessing a client, it is important to note the client's consumption of carbohydrates because he has high blood sugar. Although other factors such as the client's mental and emotional status, history of tests involving iodine, and exercise routine can be part of data collection, they are not as important to information related to the client's to be noted in a client with high blood sugar. Chapter 51: Assessment and Management of Patients With Diabetes - Page 1462

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 Explanation: 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. Chapter 51: Assessment and Management of Patients With Diabetes - Page 1459

A client with type 1 diabetes asks the nurse about taking an oral antidiabetic agent. The nurse explains that these medications are effective only if the client: prefers to take insulin orally. has type 2 diabetes. has type 1 diabetes. is pregnant and has type 2 diabetes.

has type 2 diabetes. Explanation: Oral antidiabetic agents are effective only in adult clients with type 2 diabetes. Oral antidiabetic agents aren't effective in type 1 diabetes. Pregnant and lactating women aren't ordered oral antidiabetic agents because the effect on the fetus or breast-fed infant is uncertain. Chapter 51: Assessment and Management of Patients With Diabetes - Page 1458

A nurse is providing education to a client who is newly diagnosed with diabetes mellitus. What are classic symptoms associated with diabetes? increased thirst, hunger, and urination Increased weight loss, dehydration, and fatigue Loss of appetite, increased urination, and dehydration Increased weight gain, appetite, and thirst

increased thirst, hunger, and urination Explanation: The three classic symptoms of both types of diabetes mellitus are polyuria, polydipsia, and polyphagia. Weight loss, dehydration, and fatigue are additional symptoms. Chapter 51: Assessment and Management of Patients With Diabetes - Page 1460

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." Explanation: 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. Chapter 51: Assessment and Management of Patients With Diabetes - Page 1477-1479

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. Explanation: 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. Chapter 51: Assessment and Management of Patients With Diabetes - Page 1457

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. Explanation: 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. Chapter 51: Assessment and Management of Patients With Diabetes - Page 1465

x 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. Explanation: 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. Chapter 51: Assessment and Management of Patients With Diabetes - Page 1465

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 Explanation: 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. Chapter 51: Assessment and Management of Patients With Diabetes - Page 1468

Which factor is the focus of nutrition intervention for clients with type 2 diabetes? weight loss carbohydrate intake protein metabolism blood glucose level

weight loss Explanation: Weight loss is the focus of nutrition intervention for clients with type 2 diabetes. A low-calorie diet may improve clinical symptoms; even a mild to moderate weight loss such as 10 to 20 lb may lower blood glucose levels and improve insulin action. Chapter 51: Assessment and Management of Patients With Diabetes - Page 1462

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." Explanation: 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. Chapter 51: Assessment and Management of Patients With Diabetes - Page 1467

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." Explanation: 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. Chapter 51: Assessment and Management of Patients With Diabetes - Page 1460

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. Explanation: The nurse should instruct the client to administer 1 unit of insulin for every 15 g of carbohydrates. Chapter 51: Assessment and Management of Patients With Diabetes - Page 1464

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 Explanation: 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. Chapter 51: Assessment and Management of Patients With Diabetes - Page 1468

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 Explanation: Nephropathy, or kidney disease secondary to diabetic microvascular changes in the kidney, is a common complication of diabetes. Consistent elevation of blood glucose levels stresses the kidney's filtration mechanism, allowing blood proteins to leak into the urine and thus increasing the pressure in the blood vessels of the kidney. Albumin is one of the most important blood proteins that leak into the urine, and its leakage 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 proteins, which would include microalbumin. Chapter 51: Assessment and Management of Patients With Diabetes - Page 1492

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 Explanation: 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. Chapter 51: Assessment and Management of Patients With Diabetes - Page 1458

Which information should be included in the teaching plan for a client receiving glargine, a "peakless" basal insulin? Administer the total daily dosage in two doses. Draw up the drug first, then add regular insulin. It is rapidly absorbed and has a fast onset of action. Do not mix with other insulins.

Do not mix with other insulins. Explanation: 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 insulin, it is very important to read the label carefully and to avoid mistaking Lantus insulin for Lente insulin and vice versa. Chapter 51: Assessment and Management of Patients With Diabetes - Page 1468

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 Explanation: 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. Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 51: Assessment and Management of Patients With Diabetes, Management, p. 1482.

Which statement is correct regarding glargine insulin? Its peak action occurs in 2 to 3 hours. It cannot be mixed with any other type of insulin. It is absorbed rapidly. It is given twice daily.

It cannot be mixed with any other type of insulin. Explanation: Because this insulin is in a suspension with a pH of 4, it cannot be mixed with other insulins because this would cause precipitation. There is no peak in action. It is approved to give once daily. Chapter 51: Assessment and Management of Patients With Diabetes - Page 1468

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 or no endogenous insulin Obesity at diagnoses Younger than 30 years of age Older than 65 years of age

Ketosis-prone Little or no endogenous insulin Younger than 30 years of age Explanation: 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. Chapter 51: Assessment and Management of Patients With Diabetes - Page 1458

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 Explanation: 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. Chapter 51: Assessment and Management of Patients With Diabetes - Page 1461-1462

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 Explanation: 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. Chapter 51: Assessment and Management of Patients With Diabetes - Page 1484

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 via an insulin pump. 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. Explanation: 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. Chapter 51: Assessment and Management of Patients With Diabetes - Page 1470