Chapter 59 DM
A nurse cares for a client who has a family history of diabetes mellitus. The client states, "My father has type 1 diabetes mellitus. Will I develop this disease as well?" How would the nurse respond? "Your risk of diabetes is higher than the general population, but it may not occur." "No genetic risk is associated with the development of type 1 diabetes mellitus." "The risk for becoming a diabetic is 50% because of how it is inherited." "Female children do not inherit diabetes mellitus, but male children will."
A
A nurse teaches a client who is diagnosed with diabetes mellitus. Which statement would the nurse include in this client's plan of care to delay the onset of microvascular and macrovascular complications? "Maintain tight glycemic control and prevent hyperglycemia." "Restrict your fluid intake to no more than 2 L a day." "Prevent hypoglycemia by eating a bedtime snack." "Limit your intake of protein to prevent ketoacidosis."
A
After teaching a client who is recovering from pancreas transplantation, the nurse assesses the client's understanding. Which statement made by the client indicates a need for further teaching? "If I develop an infection, I should stop taking my corticosteroid." "If I have pain over the transplant site, I will call the surgeon immediately." "I should avoid people who are ill or who have an infection." "I should take my cyclosporine exactly the way I was taught."
A
After teaching a client with diabetes mellitus to inject insulin, the nurse assesses the client's understanding. Which statement made by the client indicates a need for further teaching? "The lower abdomen is the best location because it is closest to the pancreas." "I can reach my thigh the best, so I will use the different areas of my thighs." "By rotating the sites in one area, my chance of having a reaction is decreased." "Changing injection sites from the thigh to the arm will change absorption rates."
A
The nurse assesses a client with diabetic ketoacidosis. Which assessment finding would the nurse correlate with this condition? Increased rate and depth of respiration Extremity tremors followed by seizure activity Oral temperature of 102° F (38.9° C) Severe orthostatic hypotension
A
The nurse is planning teaching for a client who is starting acarbose for diabetes mellitus type 2. Which statement will the nurse include in the teaching? "Be sure to take the drug with each meal." "Take the drug every evening before bedtime." "Take the drug on an empty stomach in the morning." "Decide on the best day of the week to take the drug."
A
A nurse provides diabetic education at a public health fair. Which disorders would the nurse include as complications of diabetes mellitus? (Select all that apply.) Stroke Kidney failure Blindness Respiratory failure Cirrhosis
A, B, C
The nurse is caring for a client who has severe hypoglycemia and is experiencing a seizure. What actions will the nurse take at this time? (Select all that apply.) Administer glucagon 1 mg subcutaneously. Be sure the bed side rails are in the up position. Notify the primary health care provider immediately. Monitor the client's blood glucose level. Increase the intravenous infusion rate immediately.
A, B, C, D
A nurse collaborates with the interprofessional team to develop a plan of care for a client who is newly diagnosed with diabetes mellitus. Which team members would the nurse include in this interprofessional team meeting? (Select all that apply.) Registered dietitian nutritionist Clinical pharmacist Occupational therapist Primary health care provider Speech-language pathologist
A, B, D
A nurse teaches a client with diabetes mellitus about foot care. Which statements would the nurse include in this client's teaching? (Select all that apply.) "Do not walk around barefoot." "Soak your feet in a tub each evening." "Trim toenails straight across with a nail clipper." "Treat any blisters or sores with Epsom salts." "Wash your feet every other day."
A, C
A nurse assesses a patient who is experiencing diabetic ketoacidosis (DKA). For which assessment findings would the nurse monitor the client? (Select all that apply.) Deep and fast respirations Decreased urine output Tachycardia Dependent pulmonary crackles Orthostatic hypotension
A, C, E
A nurse assesses a client who has diabetes mellitus. Which arterial blood gas values would the nurse identify as potential ketoacidosis in this client? pH 7.38, HCO3 22 mEq/L (22 mmol/L), PCO2 38 mm Hg, PO2 98 mm Hg pH 7.28, HCO3 18 mEq/L (18 mmol/L), PCO2 28 mm Hg, PO2 98 mm Hg pH 7.48, HCO3 28 mEq/L (28 mmol/L), PCO2 38 mm Hg, PO2 98 mm Hg pH 7.32, HCO3 22 mEq/L (22 mmol/L), PCO2 58 mm Hg, PO2 88 mm H
B
A nurse assesses a client with diabetes mellitus. Which assessment finding would alert the nurse to decreased kidney function in this client? Urine specific gravity of 1.033 Presence of protein in the urine Elevated capillary blood glucose level Presence of ketone bodies in the urine
B
The nurse is caring for a client who has diabetes mellitus. The nurse administers 6 units of regular insulin and 10 units of NPH insulin at 7:00 a.m. (0700). At which time would the nurse assess the client for potential hypoglycemia related to the NPH insulin? 8:00 a.m. (0800) 4:00 p.m. (1600) 8:00 p.m. (2000) 11:00 p.m. (2300)
B
The nurse is caring for a client who has diabetes mellitus type 1 and is experiencing hypoglycemia. Which assessment findings will the nurse expect? (Select all that apply.) Warm, dry skin Nervousness Rapid deep respirations Dehydration Ketoacidosis Blurred vision
B, F
A nurse cares for a client experiencing diabetic ketoacidosis who presents with Kussmaul respirations. What action would the nurse take? Administration of oxygen via facemask Intravenous administration of 10% glucose Implementation of seizure precautions Administration of intravenous insulin
D
A nurse reviews the laboratory results of a client who is receiving intravenous insulin. Which would alert the nurse to intervene immediately? Serum chloride level of 98 mEq/L (98 mmol/L) Serum calcium level of 8.8 mg/dL (2.2 mmol/L) Serum sodium level of 132 mEq (132 mmol/L) Serum potassium level of 2.5 mEq/L (2.5 mmol/L)
D
A nurse teaches a client with diabetes mellitus who is experiencing numbness and reduced sensation. Which statement would the nurse include in this client's teaching to prevent injury? "Examine your feet using a mirror every day." "Rotate your insulin injection sites every week." "Check your blood glucose level before each meal." "Use a bath thermometer to test the water temperature."
D
A nurse teaches a client with type 1 diabetes mellitus. Which statement would the nurse include in this client's teaching to decrease the client's insulin needs? "Limit your fluid intake to 2 L a day." "Animal organ meat is high in insulin." "Limit your carbohydrate intake to 80 g a day." "Walk at a moderate pace for 1 mile daily."
D
After teaching a client who has diabetes mellitus with retinopathy, nephropathy, and peripheral neuropathy, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the teaching? "I have so many complications; exercising is not recommended." "I will exercise more frequently because I have so many complications." "I used to run for exercise; I will start training for a marathon." "I should look into swimming or water aerobics to get my exercise."
D
After teaching a patient with type 2 diabetes mellitus who is prescribed nateglinide, the nurse assesses the client's understanding. Which statement made by the patient indicates a correct understanding of the prescribed therapy? "I'll take this medicine during each of my meals." "I must take this medicine in the morning when I wake." "I will take this medicine before I go to bed." "I will take this medicine immediately before I eat."
D
After teaching a young adult client who is newly diagnosed with type 1 diabetes mellitus, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the need for eye examinations? "At my age, I should continue seeing the ophthalmologist as I usually do." "I will see the eye doctor when I have a vision problem and yearly after age 40." "My vision will change quickly. I should see the ophthalmologist twice a year." "Diabetes can cause blindness, so I should see the ophthalmologist yearly."
D
The nurse is caring for a newly admitted older adult who has a blood glucose of 300 mg/dL (16.7 mmol/L), a urine output of 185 mL in the past 8 hours, and a blood urea nitrogen (BUN) of 44 mg/dL (15.7 mmol/L). What diabetic complication does the nurse suspect? Diabetic ketoacidosis (DKA) Severe hypoglycemia Chronic kidney disease (CKD) Hyperglycemic-hyperosmolar state (HHS)
D
When teaching a client recently diagnosed with type 1 diabetes mellitus, the client states, "I will never be able to stick myself with a needle." How would the nurse respond? "I can give your injections to you while you are here in the hospital." "Everyone gets used to giving themselves injections. It really does not hurt." "Your disease will not be managed properly if you refuse to administer the shots." "Tell me what it is about the injections that are concerning you."
D
A nurse assesses adults at a health fair. Which adults would the nurse counsel to be tested for diabetes? (Select all that apply.) A 56-year-old African-American male A 22-year-old female with a 30-lb (13.6 kg) weight gain during pregnancy A 60-year-old male with a history of liver trauma A 48-year-old female with a sedentary lifestyle A 50-year-old male with a body mass index greater than 25 kg/m2 A 28-year-old female who gave birth to a baby weighing 9.2 lb (4.2 kg)
A, D, E, F
A nurse assesses a client who has diabetes mellitus and notes that the client is awake and alert, but shaky, diaphoretic, and weak. Five minutes after administering a half-cup (120 mL) of orange juice, the client's signs and symptoms have not changed. What action would the nurse take next? Administer another half-cup (120 mL) of orange juice. Administer a half-ampule of dextrose 50% intravenously. Administer 10 units of regular insulin subcutaneously. Administer 1 mg of glucagon intramuscularly.
A
A nurse cares for a patient who is prescribed pioglitazone. After 6 months of therapy, the client reports that he has a new onset of ankle edema. What assessment question would the nurse take? "Have you gained unexpected weight this week?" "Has your urinary output declined recently?" "Have you had fever and achiness this week?" "Have you had abdominal pain recently?"
A
A nurse cares for a client with diabetes mellitus who asks, "Why do I need to administer more than one injection of insulin each day?" How would the nurse respond? "You need to start with multiple injections until you become more proficient at self-injection." "A single dose of insulin each day would not match your blood insulin levels and your food intake patterns." "A regimen of a single dose of insulin injected each day would require that you eat fewer carbohydrates." "A single dose of insulin would be too large to be absorbed, predictably putting you at risk for insulin shock."
B
A nurse develops a dietary plan for a client with diabetes mellitus and new-onset microalbuminuria. Which component of the client's diet would the nurse decrease? Carbohydrates Proteins Fats Total calories
B
A nurse is teaching a client with diabetes mellitus who asks, "Why is it necessary to maintain my blood glucose levels no lower than about 60 mg/dL (3.3 mmol/L)?" How would the nurse respond? "Glucose is the only fuel used by the body to produce the energy that it needs." "Your brain needs a constant supply of glucose because it cannot store it." "Without a minimum level of glucose, your body does not make red blood cells." "Glucose in the blood prevents the formation of lactic acid and prevents acidosis."
B
A nurse reviews laboratory results for a client with diabetes mellitus who is prescribed an intensified insulin regimen:• Fasting blood glucose: 75 mg/dL (4.2 mmol/L)• Postprandial blood glucose: 200 mg/dL (11.1 mmol/L) • Hemoglobin A1C level: 5.5% How would the nurse interpret these laboratory findings? Increased risk for developing ketoacidosis Good control of blood glucose Increased risk for developing hyperglycemia Signs of insulin resistance
B
A nurse teaches a client with diabetes mellitus about sick-day management. Which statement would the nurse include in this client's teaching? "When ill, avoid eating or drinking to reduce vomiting and diarrhea." "Monitor your blood glucose levels at least every 4 hours while sick." "If vomiting, do not use insulin or take your oral antidiabetic agent." "Try to continue your prescribed exercise regimen even if you are sick."
B
A nurse teaches a client with type 2 diabetes mellitus who is prescribed glipizide (Glucotrol). Which statement would the nurse include in this client's teaching? "Change positions slowly when you get out of bed." "Avoid taking nonsteroidal anti-inflammatory drugs (NSAIDs)." "If you miss a dose of this drug, you can double the next dose." "Discontinue the medication if you develop a urinary infection."
B
A nurse teaches a patient about self-monitoring of blood glucose levels. Which statement would the nurse include in this client's teaching to prevent bloodborne infections? "Wash your hands after completing each test." "Do not share your monitoring equipment." "Blot excess blood from the strip with a cotton ball." "Use gloves when monitoring your blood glucose."
B
A nurse assesses a client who has a 15-year history of diabetes and notes decreased tactile sensation in both feet. What action would the nurse take first? Document the finding in the client's chart. Assess tactile sensation in the client's hands. Examine the client's feet for signs of injury. Notify the primary health care provider.
C
After teaching a client who is newly diagnosed with type 2 diabetes mellitus, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching? "I should increase my intake of vegetables with higher amounts of dietary fiber." "My intake of saturated fats should be no more than 10% of my total calorie intake." "I should decrease my intake of protein and eliminate carbohydrates from my diet." "My intake of water is not restricted by my treatment plan or medication regimen."
C
The nurse is assessing a client for risk of developing metabolic syndrome. Which risk factor is associated with this health condition? Hypotension Hyperthyroidism Abdominal obesity Hypoglycemia
C
The nurse is caring for a newly admitted client who is diagnosed with hyperglycemic-hyperosmolar state (HHS). What is the nurse's priority action at this time? Assess the client's blood glucose level. Monitor the client's urinary output every hour. Establish intravenous access to provide fluids. Give regular insulin per agency policy.
C
The nurse is planning teaching for a client who is starting exenatide extended release (ER) for diabetes mellitus type 2. Which statement will the nurse include in the teaching? "Be sure to take the drug once a day before breakfast." "Take the drug every evening before bedtime." "Give your drug injection the same day every week." "Take the drug with dinner at the same time each day."
C
A nurse assesses a client with diabetes mellitus who self-administers subcutaneous insulin. The nurse notes a spongy, swelling area at the site the client uses most frequently for insulin injection. What action would the nurse take? Apply ice to the site to reduce inflammation. Consult the provider for a new administration route. Assess the client for other signs of cellulitis. Instruct the client to rotate sites for insulin injection.
D
A nurse assesses clients who are at risk for diabetes mellitus. Which client is at greatest risk? A 19-year-old Caucasian A 22-year-old African American A 44-year-old Asian American A 58-year-old American Indian
D
A nurse reviews the laboratory test values for a client with a new diagnosis of diabetes mellitus type 2. Which A1C value would the nurse expect? 5.0% 5.7% 6.2% 7.4%
D
