Diabetes Mellitus

A nurse knows to assess a patient with type 1 diabetes for postprandial hyperglycemia. The nurse knows that glycosuria is present when the serum glucose level exceeds: a. 120 mg/dL b. 140 mg/dL c. 160 mg/dL d. 180 mg/dL

d. 180 mg/dL Glycosuria occurs when the renal threshold for sugar exceeds 180 mg/dL. Glycosuria leads to an excessive loss of water and electrolytes (osmotic diuresis).

Which of the following insulins are used for basal dosage? a. Glargine (Lantus) b. NPH (Humulin N) c. Lispro (Humalog) d. Aspart (Novolog)

a. Glargine (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 client with diabetes mellitus is receiving an oral antidiabetic agent. The nurse observes for which condition when caring for this client? a. Polyuria b. Hypoglycemia c. Blurred vision d. Polydipsia

b. 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.

For a client with hyperglycemia, which assessment finding best supports a nursing diagnosis of Deficient fluid volume? a. Cool, clammy skin b. Jugular vein distention c. Increased urine osmolarity d. Decreased serum sodium level

c. Increased urine osmolarity In hyperglycemia, urine osmolarity (the measurement of dissolved particles in the urine) increases as glucose particles move into the urine. The client experiences glucosuria and polyuria, losing body fluids and experiencing deficient fluid volume. Cool, clammy skin; jugular vein distention; and a decreased serum sodium level are signs of fluid volume excess, the opposite imbalance.

A 30-year-old type 1 diabetic has been admitted to the critical care unit with a diagnosis of diabetic ketoacidosis following a drinking binge over the course of a weekend. The nurse should anticipate that this patient will require what immediate intervention? a. IV administration of calcium gluconate b. Subcutaneous administration of 30 units of insulin glargine (Lantus) c. Oral administration of 2 g of metformin (Glucophage) d. Rapid administration of intravenous normal saline

d. Rapid administration of intravenous normal saline In dehydrated patients with DKA, rehydration is important for maintaining tissue perfusion. Initially, 0.9% sodium chloride (normal saline) solution is administered at a rapid rate. Metformin is insufficient to resolve DKA. Insulin glargine is inappropriate because of its long-acting characteristics. Administration of calcium gluconate is not a relevant intervention.

Lispro (Humalog) is an example of which type of insulin? a. Rapid-acting b. Intermediate-acting c. Short-acting d. Long-acting

a. 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).

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? a. Duration of the insulin b. Accuracy of the dosage c. Area for insulin injection d. Technique for injecting

b. 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 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 Regular insulin is administered intravenously to treat DKA. It is added to an IV solution and infused continuously. Glargine, NPH, and Lente are only administered subcutaneously.

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 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 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 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.

A client is taking glyburide (DiaBeta), 1.25 mg P.O. daily, to treat type 2 diabetes. Which statement indicates the need for further client teaching about managing this disease? a. "I always carry hard candy to eat in case my blood sugar level drops." b. "I avoid exposure to the sun as much as possible." c. "I always wear my medical identification bracelet." d. "I skip lunch when I don't feel hungry."

d. "I skip lunch when I don't feel hungry." The client requires further teaching if he states that he skips meals. A client who is receiving an oral antidiabetic agent should eat meals on a regular schedule because skipping a meal increases the risk of hypoglycemia. Carrying hard candy, avoiding exposure to the sun, and always wearing a medical identification bracelet indicate effective teaching.

A hospital patient has been ordered a sliding scale of Humulin R for the duration of her admission. The patient's medication administration record specifies the first administration time of the day at 08:00 and the nurse knows that breakfast trays typically arrive on the unit between 07:45 and 07:50. When should the nurse administer the patient's insulin? a. 07:30 b. 07:45 c. 08:00 d. 08:15

a. 07:30 Short-acting insulin, called regular insulin and marked "R" on the vial, is an unmodified clear solution that usually is administered 20 to 30 minutes before a meal. Administering the insulin at 07:30 meets this criterion and complies with the common practice of allowing 30 minutes flexibility around medication administration times.

When the dawn phenomenon occurs, the patient has relatively normal blood glucose until approximate what time of day? a. 3 AM b. 5 AM c. 7 AM d. 9 AM

a. 3 AM During the dawn phenomenon, the patient has a relatively normal blood glucose level until about 3 AM, when the level begins to rise.

What is the duration of regular insulin? a. 4 to 6 hours b. 3 to 5 hours c. 12 to 16 hours d. 24 hours

a. 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 diabetic ketoacidosis has been brought into the ED. Which intervention is not a goal in the initial medical treatment of diabetic ketoacidosis? a. Administer glucose. b. Monitor serum electrolytes and blood glucose levels. c. Administer isotonic fluid at a high volume. d. Administer potassium replacements.

a. Administer glucose. Insulin is given intravenously. Insulin reduces the production of ketones by making glucose available for oxidation by the tissues and by restoring the liver's supply of glycogen. As insulin begins to lower the blood glucose level, the IV solution is changed to include one with glucose. Periodic monitoring of serum electrolytes and blood glucose levels is necessary. Isotonic fluid is instilled at a high volume, for example, 250 to 500 mL/hour for several hours. The rate is adjusted once the client becomes rehydrated and diuresis is less acute. Potassium replacements are given despite elevated serum levels to raise intracellular stores.

Which factors will cause hypoglycemia in a client with diabetes? Select all that apply. a. Client has not consumed food and continues to take insulin or oral antidiabetic medications. b. Client has not consumed sufficient calories. c. Client has been exercising more than usual. d. Client has been sleeping excessively. e. Client is experiencing effects of the aging process.

a. Client has not consumed food and continues to take insulin or oral antidiabetic medications. b. Client has not consumed sufficient calories. c. Client has been exercising more than usual. Hypoglycemia can occur when a client with diabetes is not eating at all and continues to take insulin or oral antidiabetic medications, is not eating sufficient calories to compensate for glucose-lowering medications, or is exercising more than usual. Excessive sleep and aging are not factors in the onset of hypoglycemia.

Which of the following is an age-related change that may affect diabetes? Select all that apply. a. Decreased renal function b. Taste changes c. Decreased vision d. Increased bowel motility e. Increased proprioception

a. Decreased renal function b. Taste changes c. Decreased vision Age-related changes include decreased renal function, taste changes, decreased vision, decreased bowel motility, and decreased proprioception.

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

a. Elevated blood urea nitrogen (BUN) and creatinine b. Rapid onset c. 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.

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

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

A client with type 1 diabetes is admitted to an acute care facility with diabetic ketoacidosis. To correct this acute diabetic emergency, which measure should the health care team take first? a. Initiate fluid replacement therapy. b. Administer insulin. c. Correct diabetic ketoacidosis. d. Determine the cause of diabetic ketoacidosis.

a. Initiate fluid replacement therapy. The health care team first initiates fluid replacement therapy to prevent or treat circulatory collapse caused by severe dehydration. Although diabetic ketoacidosis results from insulin deficiency, the client must have an adequate fluid volume before insulin can be administered; otherwise, the drug won't circulate throughout the body effectively. Therefore, insulin administration follows fluid replacement therapy. Determining and correcting the cause of diabetic ketoacidosis are important steps, but the client's condition must first be stabilized to prevent life-threatening complications.

During a period of heavy work and family pressures, an adult male patient with type 1 diabetes has become ill with influenza. This combination of psychological and physiological stress has culminated in ketoacidosis. The nurse who is now providing this patient's care should be aware that the presence of ketones in the blood result from: a. Metabolism of fat b. Increased insulin resistance c. Glycogenolysis d. Hypoglycemia

a. Metabolism of fat Fat metabolism releases ketones, which can accumulated in the type 1 diabetic and result in ketoacidosis. Insulin resistance, glycogenolysis, and hypoglycemia do not directly cause this pathophysiological phenomenon.

A nurse educator been invited to local seniors center to discuss health-maintaining strategies for older adults. The nurse addresses the subject of diabetes mellitus, its symptoms, and consequences. What should the educator teach the participants about type 1 diabetes? a. The participants are unlikely to develop a new onset of type 1 diabetes. b. New cases of diabetes are highly uncommon in older adults. c. New cases of diabetes will be split roughly evenly between type 1 and type 2. d. Type 1 diabetes always develops before the age of 20.

a. The participants are unlikely to develop a new onset of type 1 diabetes. Type 1 diabetes usually (but not always) develops in people younger than 20. In older adults, an onset of type 2 is far more common. A significant number of older adults develops type 2 diabetes.

Which of the following medications is considered a glitazone? a. pioglitazone b. metformin c. metformin with glyburide d. dapagliflozin

a. pioglitazone Pioglitazone and rosiglitazone are classified as a glitazone or thiazolidinedione. Metformin and metformin with glyburide are classified as biguanides. Dapagliflozin is classified as a sodium-glucose co-transporter 2 (SGL-2) inhibitor.

A patient has just been diagnosed with type 2 diabetes. The health care provider has prescribed an oral antidiabetic agent that will inhibit the production of glucose by the liver and thereby aid in the control of blood glucose. What type of oral antidiabetic agent has been prescribed for this patient? a. Sulfonylurea b. Biguanide c. Thiazolidinedione d. Alpha glucosidase inhibitor

b. Biguanide Sulfonylureas exert their primary action by directly stimulating the pancreas to secrete insulin and therefore require a functioning pancreas to be effective. Biguanides inhibit the production of glucose by the liver and are in used in type 2 diabetes to control blood glucose levels. Thiazolidinediones enhance insulin action at the receptor site without increasing insulin secretion from the beta cells of the pancreas. Alpha-glucosidase inhibitors work by delaying the absorption of glucose in the intestinal system, resulting in a lower postprandial blood glucose level.

An older adult patient is in the hospital being treated for sepsis related to a urinary tract infection. The patient has started to have an altered sense of awareness, profound dehydration, and hypotension. What does the nurse suspect the patient is experiencing? a. Systemic inflammatory response syndrome b. Hyperglycemic hyperosmolar syndrome c. Multiple-organ dysfunction syndrome d. Diabetic ketoacidosis

b. Hyperglycemic hyperosmolar syndrome Hyperglycemic hyperosmolar syndrome (HHS) occurs most often in older people (50 to 70 years of age) who have no known history of diabetes or who have type 2 diabetes. The clinical picture of HHS is one of hypotension, profound dehydration (dry mucous membranes, poor skin turgor), tachycardia, and variable neurologic signs (e.g., alteration of consciousness, seizures, hemiparesis).

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. Insulin resistance or insufficient insulin production c. Less common than type 1 diabetes d. Little relation to prediabetes

b. Insulin resistance or 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.

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. Subcutaneous injection sites require rotation to avoid breakdown and/or buildup of subcutaneous fat, either of which can interfere with insulin absorption in the tissue. Infection and discomfort are risks involved with injection site but not the primary reason for rotation of sites. Insulin is not injected into the muscle.

The nurse understands that a client with diabetes mellitus is at greater risk for developing which of the following complications? a. Low blood pressure b. Urinary tract infections c. Lifelong obesity d. Elevated triglycerides

b. Urinary tract infections Elevated levels of blood glucose and glycosuria supports bacterial growth and places the diabetic at greater risk for urinary tract, skin, and vaginal infections. Obesity, elevated triglycerides, and high blood pressure are considered symptoms of metabolic syndrome, which can result in type 2 diabetes mellitus.

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

c. "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.

Health teaching for a patient with diabetes who is prescribed Humulin N, an intermediate NPH insulin, would include which of the following advice? a. "Your insulin will begin to act in 15 minutes." b. "You should expect your insulin to reach its peak effectiveness by 9:00 AM if you take it at 8:00 AM." c. "You should take your insulin after breakfast and after dinner." d. "Your insulin will last 8 hours, and you will need to take it three times a day."

c. "You should take your insulin after breakfast and after dinner." NPH (Humulin N) insulin is an intermediate-acting insulin that has an onset of 2 to 4 hours, a peak effectiveness of 4 to 12 hours, and a duration of 16 to 20 hours.

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. Because NPH is an intermediate-acting insulin that peaks in approximately 4 to 12 hours, a midday snack should be included in daily calorie intake to avoid hypoglycemia. NPH insulin has no immediate effects. Carbohydrates are distributed throughout the meal plan of diabetics to avoid highs and lows. Delaying dinner meal is not indicated with NPH insulin use.

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

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

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? a. Fasting blood glucose test b. 6-hour glucose tolerance test c. Serum glycosylated hemoglobin (Hb A1c) d. Urine ketones

c. 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.

Which factor is the focus of nutrition intervention for clients with type 2 diabetes? a. Protein metabolism b. Blood glucose level c. Weight loss d. Carbohydrate intake

c. Weight loss Weight loss is the focus of nutrition intervention for clients with type 2 diabetes. A low-calorie diet may improve clinical symptoms, and even a mild to moderate weight loss, such as 10 to 20 pounds, may lower blood glucose levels and improve insulin action. Consistency in the total amount of carbohydrates consumed is considered an important factor that influences blood glucose level. Protein metabolism is not the focus of nutrition intervention for clients with type 2 diabetes.

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? a. "Ketones are formed when insufficient insulin leads to cellular starvation. As cells rupture, they release these acids into the blood." b. "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." c. "Excess glucose in the blood is metabolized by the liver and turned into ketones, which are an acid." d. "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."

d. "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 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? a. Elevated serum acetone level b. Serum ketone bodies c. Serum alkalosis d. Below-normal serum potassium level

d. 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 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 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.

A 44-year-old woman was diagnosed with type 2 diabetes 4 months ago and has presented for a follow-up appointment. Together with the patient, the nurse is reviewing her diet, meal planning, and nutrition. It is becoming apparent that the patient's eating habits are not conducive to preventing fluctuations in blood glucose levels. The patient acknowledges this fact, stating, "I went over all of this with the dietitian, and I know that it's important, but no one seems to realize how hard it is to put it all into practice." The nurse should identify what nursing diagnosis in the planning of this patient's subsequent care? a. Ineffective denial related to dietary modifications for diabetes management b. Anxiety related to the management of an appropriate diet c. Altered nutrition, more than body requirements related to ineffective dietary management d. Hopelessness related to inability to implement an appropriate diet

d. Hopelessness related to inability to implement an appropriate diet This patient's statement suggests that she knows what her diet should be but that she despairs of her ability to put this knowledge into practice. There is no evidence of altered nutrition, more than body requirements in this scenario, however. Similarly, denial and anxiety are not evident in the woman's statement.

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? a. Serum potassium level b. Serum sodium level c. Arterial blood gas (ABG) values d. Serum osmolarity

d. 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.

Which category of oral antidiabetic agents exerts the primary action by directly stimulating the pancreas to secrete insulin? a. Thiazolidinediones b. Biguanides c. Alpha-glucosidase inhibitors d. Sulfonylureas

d. Sulfonylureas A functioning pancreas is necessary for sulfonylureas to be effective. Thiazolidinediones enhance insulin action at the receptor site without increasing insulin secretion from the beta cells of the pancreas. Biguanides facilitate the action of insulin on peripheral receptor sites. Alpha-glucosidase inhibitors delay the absorption of glucose in the intestinal system, resulting in a lower postprandial blood glucose level.

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: a. encourage the client to ask questions about personal sexuality. b. provide time for privacy. c. provide support for the spouse or significant other. d. suggest referral to a sex counselor or other appropriate professional.

d. 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.

A health care provider prescribes short-acting insulin for a patient, instructing the patient to take the insulin 20 to 30 minutes before a meal. The nurse explains to the patient that Humulin-R taken at 6:30 AM will reach peak effectiveness by: a. 8:30 AM. b. 10:30 AM. c. 12:30 PM. d. 2:30 PM.

a. 8:30 AM. Short-acting insulin reaches its peak effectiveness 2 to 3 hours after administration.

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

a. "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.

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? a. "Your child will need less blood work as his glucose levels stabilize." b. "Your child is young and will soon forget this experience." c. "I'll see if the physician can reduce the number of blood draws." d. "Our laboratory technicians use tiny needles and they're really good with children."

a. "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 nurse is preparing a continuous insulin infusion for a child with diabetic ketoacidosis and a blood glucose level of 800 mg/dl. Which solution is the most appropriate at the beginning of therapy? a. 100 units of regular insulin in normal saline solution b. 100 units of neutral protamine Hagedorn (NPH) insulin in normal saline solution c. 100 units of regular insulin in dextrose 5% in water d. 100 units of NPH insulin in dextrose 5% in water

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

a. 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.

A 61-year-old man who has achieved great success in the areas of business and community influence is frustrated that he has received a diagnosis of type 2 diabetes. The man tells the nurse, "I'm not at all obese, so I don't see how this could have developed." When discussing the risk factors for diabetes, which of the following factors should the nurse identify? Select all that apply. a. Age greater than 45 years b. History of angina or myocardial infarction c. High-stress lifestyle d. Hypertension e. Family history

a. Age greater than 45 years d. Hypertension e. Family history Family history, hypertension, and age ≥ 45 years are risk factors for diabetes. Stress and acute coronary syndrome are not identified as direct etiologic factors for diabetes.

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

a. Albumin 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.

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

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

a. Coma, anxiety, confusion, headache, and cool, moist skin Signs and symptoms of hypoglycemia (indicated by a blood glucose level of 45 mg/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.

A nurse educates a group of clients with diabetes mellitus on the prevention of diabetic nephropathy. Which of the following suggestions would be most important? a. Control blood glucose levels. b. Drink plenty of fluids. c. Take the antidiabetic drugs regularly. d. Eat a high-fiber diet.

a. Control blood glucose levels. Controlling blood glucose levels and any hypertension can prevent or delay the development of diabetic nephropathy. Drinking plenty of fluids does not prevent diabetic nephropathy. Taking antidiabetic drugs regularly may help to control blood glucose levels, but it is the control of these levels that is most important. A high-fiber diet is unrelated to the development of diabetic nephropathy.

The diabetic nurse educator is teaching a class for newly diagnosed diabetics and their families. In this class, the educator is teaching about "sick day rules." What guideline applies to periods of illness in a diabetic patient? a. Do not eliminate insulin when nauseated and vomiting. b. Seek care for glucose levels >150 mg/dL. c. Eat three meals a day. d. If nauseated, do not eat solid foods.

a. Do not eliminate insulin when nauseated and vomiting. The most important issue to teach patients with diabetes who become ill is not to eliminate insulin doses when nausea and vomiting occur. Rather, they should take their usual insulin or oral hypoglycemic agent dose, and then attempt to consume frequent small portions of food. In general, blood sugar levels will rise but should be reported if they are >300 mg/dL.

The nurse is preparing to administer a patient's scheduled dose of Novolin 70/30. When administering this dose of insulin, the nurse should: a. Ensure that the insulin is not given near a previous injection site b. Aspirate before injecting the insulin into the patient's subcutaneous tissue c. Massage the injection site gently for 10 to 15 seconds after administration d. Use a 3 mL syringe with a 24 gauge needle

a. Ensure that the insulin is not given near a previous injection site Systematic rotation of injection sites within an anatomic area is recommended to prevent localized changes in fatty tissue. Aspiration and massage are not recommended. The largest syringe that is used for insulin administration is 1 mL.

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

a. Hypertension b. Obesity c. Family history d. Age greater of 45 years or older e. History of gestational diabetes Risk factors for the development of diabetes mellitus include hypertension, obesity, family history, age of 45 years or older, and a history of gestational diabetes.

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

a. 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? 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. 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.

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 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.

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. 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? a. It enhances the transport of glucose across the cell membrane. 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 enhances the transport of glucose across the cell membrane. 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. a. Ketosis-prone b. Little or no endogenous insulin c. Obesity at diagnoses d. Younger than 30 years of age e. Older than 65 years of age

a. Ketosis-prone b. Little or no endogenous insulin d. 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.

A nurse is caring for a client with an abnormally low blood glucose concentration. What glucose level should the nurse observe when assessing laboratory results? a. Less than 70 mg/dL (3.7 mmol/L) b. Between 70 and 75 mg/dL (3.9 to 4.16 mmol/L) c. Between 75 and 90 mg/dL (4.16 to 5.00 mmol/L) d. 95 mg/dL (5.27 mmol/L)

a. Less than 70 mg/dL (3.7 mmol/L) Hypoglycemia means low (hypo) sugar in the blood (glycemia), and occurs when the blood glucose level falls to less than 70 mg/dL (3.7 mmol/L). Severe hypoglycemia is when glucose levels are less the 40 mg/dL (2.5 mmol/L).

A client with diabetes is receiving an oral anti diabetic 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 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.

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

a. 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 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? a. Presence of autoantibodies against islet cells b. Obesity c. Rare ketosis d. Altered glucose metabolism

a. 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)? a. Presence of islet cell antibodies b. Obesity c. Rare ketosis d. Requirement for oral hypoglycemic agents

a. 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 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

a. 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.

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 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.

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: a. The pancreatic hormone glucagon will stimulate the liver to release stored glucose. b. Insulin will be released to facilitate the transport of sugar. c. Glycogenesis will be decreased by the liver. d. The process of gluconeogenesis will be inhibited.

a. 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? a. The short-acting insulin is withdrawn before the intermediate-acting insulin. b. The intermediate-acting insulin is withdrawn before the short-acting insulin. c. Different types of insulin are not to be mixed in the same syringe. d. If administered immediately, there is no requirement for withdrawing one type of insulin before another.

a. 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 15-year-old boy is brought to the emergency department with symptoms of hyperglycemia. Following diagnostic testing, a diagnosis of diabetes mellitus is made. What classification will be used to describe a 15-year-old with diabetes who requires daily insulin injections? a. Type 1 diabetes b. Type 2 diabetes c. Juvenile diabetes d. Prediabetes

a. Type 1 diabetes Once classified as juvenile diabetes or juvenile-onset diabetes, the current classification for children with diabetes is type 1 diabetes. Type 2 diabetes is characterized by onset of the condition during adulthood, and insulin may or may not be required. Prediabetes is characterized by normal glucose metabolism, but a previous history of hyperglycemia during illness or pregnancy may exist.

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

a. increased thirst, hunger, and urination The three classic symptoms of both types of diabetes mellitus are polyuria, polydipsia, and polyphagia. Weight loss, dehydration, and fatigue are additional symptoms.

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: a. polyphagia. b. polydipsia. c. polyuria. d. anorexia.

a. 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 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? a. "The spleen releases ketones when your body can't use glucose." b. "Ketones will tell us if your body is using other tissues for energy." c. "Ketones can damage your kidneys and eyes." d. "Ketones help the physician determine how serious your diabetes is."

b. "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.

A client with diabetes mellitus must learn how to self-administer insulin. The physician has ordered 10 units of U-100 regular insulin and 35 units of U-100 isophane insulin suspension (NPH) to be taken before breakfast. When teaching the client how to select and rotate insulin injection sites, the nurse should provide which instruction? a. "Inject insulin into healthy tissue with large blood vessels and nerves." b. "Rotate injection sites within the same anatomic region, not among different regions." c. "Administer insulin into areas of scar tissue or hypertrophy whenever possible." d. "Administer insulin into sites above muscles that you plan to exercise heavily later that day."

b. "Rotate injection sites within the same anatomic region, not among different regions." The nurse should instruct the client to rotate injection sites within the same anatomic region. Rotating sites among different regions may cause excessive day-to-day variations in the blood glucose level; also, insulin absorption differs from one region to the next. Insulin should be injected only into healthy tissue lacking large blood vessels, nerves, or scar tissue or other deviations. Injecting insulin into areas of hypertrophy may delay absorption. The client shouldn't inject insulin into areas of lipodystrophy (such as hypertrophy or atrophy); to prevent lipodystrophy, the client should rotate injection sites systematically. Exercise speeds drug absorption, so the client shouldn't inject insulin into sites above muscles that will be exercised heavily.

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: a. 10 g of carbohydrates. b. 15 g of carbohydrates. c. 20 g of carbohydrates. d. 25 g of carbohydrates.

b. 15 g of carbohydrates. The nurse should instruct the client to administer 1 unit of insulin for every 15 g of carbohydrates.

Glycosylated hemoglobin reflects blood glucose concentrations over which period of time? a. 1 month b. 3 months c. 6 months d. 9 months

b. 3 months Glycosylated hemoglobin is a blood test that reflects average blood glucose concentrations over a period of 3 months.

An elderly patient has come to the clinic with his daughter. The patient is a diabetic and is concerned about foot care. The nurse goes over foot care with the patient and his daughter as the nurse realizes that foot care is extremely important. Why would the nurse believe that foot care is so important to this patient? a. An elderly patient with foot ulcers experiences severe foot pain due to diabetic polyneuropathy. b. Avoiding the complications associated with foot ulcers may mean the difference between institutionalization and continued independent living. c. Hypoglycemia is a dangerous situation, and it may lead to unsteadiness and falls. d. Drugs that patients are required to take for their diabetic condition often decrease circulation to the lower extremities.

b. Avoiding the complications associated with foot ulcers may mean the difference between institutionalization and continued independent living. The nurse recognizes that providing information on long-term complications, especially foot and eye problems, associated with diabetes is important. Avoiding amputation through early detection of foot ulcers may mean the difference between institutionalization and continued independent living for the elderly person with diabetes. While the nurse recognizes that hypoglycemia is a dangerous situation and may lead to falls, hypoglycemia is not directly connected to the importance of foot care. Patients with foot ulcers may not realize that they have a foot ulcer because the patient has diminished sensation due to diabetic polyneuropathy, and pain is generally absent. The nurse is correct to recognize that patients with diabetes are at risk for decreased circulation to the lower extremities, but she should understand that the decrease in circulation is related to vascular changes and is not associated with drugs administered for the condition.

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

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

A patient with a recent diagnosis of type 2 diabetes has been prescribed metformin (Glucophage) 500 mg PO t.i.d. The nurse who is providing this patient's care should recognize that this medication helps the patient achieve stable blood glucose levels by: a. Stimulating insulin release from the pancreatic beta cells. b. Facilitating the action of insulin on peripheral receptor sites c. Stimulating insulin synthesis by the pancreatic beta cells d. Delaying the absorption of glucose in the intestinal system

b. Facilitating the action of insulin on peripheral receptor sites Metformin (Glucophage), the most commonly used biguanide, produces its antidiabetic effects by decreasing hepatic production of glucose and facilitating the action of insulin on peripheral receptor sites. Biguanides have no effect on pancreatic beta cells. Alpha-glucosidase inhibitors work by delaying the absorption of glucose in the intestinal system.

A nurse practitioner ordered blood work for a 65-year-old man who is hypertensive and obese. Which of the following results is consistent with a diagnosis of prediabetes? a. Fasting plasma glucose of 116 mg/dL b. Fasting plasma glucose of 128 mg/dL c. Casual plasma glucose concentration of 140 mg/dL d. Two-hour postload glucose equal to 160 mg/dL

b. Fasting plasma glucose of 128 mg/dL A fasting plasma glucose greater than 126 mg/dL is considered diagnostic for prediabetes.

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? a. Epinephrine b. Glucagon c. 50% dextrose d. Hydrocortisone

b. 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.

A client with diabetes mellitus is receiving an oral antidiabetic agent. The nurse observes for which condition when caring for this client? a. Polyuria b. Hypoglycemia c. Blurred vision d. Polydipsia

b. 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.

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? a. Numbness b. Increased hunger c. Fatigue d. Dizziness

b. 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? a. Cheyne-Stokes respirations b. Increased urine output c. Decreased appetite d. Diaphoresis

b. 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.

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. Insulin production insufficient c. Less common than type 1 diabetes d. Little to no relation to pre-diabetes

b. 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.

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

b. It cannot be mixed with any other type of insulin. 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.

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? a. Cool, moist skin b. Rapid, thready pulse c. Arm and leg trembling d. Slow, shallow respirations

b. Rapid, thready pulse 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.

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 Regular insulin is administered intravenously to treat DKA. It is added to an IV solution and infused continuously. Glargine, NPH, and Lente are only administered subcutaneously.

Health teaching for a patient with diabetes who is prescribed Humulin N, an intermediate NPH insulin, would include which of the following advice? a. "Your insulin will begin to act in 15 minutes." b. "You should expect your insulin to reach its peak effectiveness by 12 noon if you take it at 8:00 AM." c. "You should take your insulin after you eat breakfast and dinner." d. "Your insulin will last 8 hours, and you will need to take it three times a day."

c. "You should take your insulin after you eat breakfast and dinner." NPH (Humulin N) insulin is an intermediate-acting insulin that has an onset of 2 to 4 hours, a peak effectiveness of 6 to 8 hours, and a duration of 12 to 16 hours.

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? a. "I will refer you to a dietician who can help you with your weight." b. "You may be having undiagnosed infections, causing you to lose extra weight." c. "Your body is using protein and fat for energy instead of glucose." d. "Don't worry about what your friends think; the carbohydrates you eat are being quickly digested, increasing your metabolism."

c. "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 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: a. I.M. or subcutaneous glucagon. b. I.V. bolus of dextrose 50%. c. 15 to 20 g of a fast-acting carbohydrate such as orange juice. d. 10 units of fast-acting insulin.

c. 15 to 20 g of a fast-acting carbohydrate such as orange juice. 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.

Which statement is true regarding gestational diabetes? a. It occurs in most pregnancies. b. Onset usually occurs in the first trimester. c. A glucose challenge test should be performed between 24 and 28 weeks. d. There is a low risk for perinatal complications.

c. A glucose challenge test should be performed between 24 and 28 weeks. A glucose challenge test should be performed between 24 and 28 weeks in women at average risk. It occurs in less than 10% of all pregnancies. Onset usually occurs in the second or third trimester. There is an above-normal risk for perinatal complications.

The nurse has cared for four patients with type 1 diabetes over the past few shifts. Based upon components of managing diabetes, which patient will likely have the greatest success in maintaining tight glucose control of his or her type 1 diabetes? a. A patient who skips breakfast when her morning glucose reading is greater than 220 mg/dL. b. A patient who never deviates from his prescribed dose of insulin. c. A patient who adheres to a meal plan and meal schedule. d. A patient who eliminates carbohydrates from her daily intake.

c. A patient who adheres to a meal plan and meal schedule. The therapeutic goal for diabetes management is to achieve normal blood glucose levels without hypoglycemia. Therefore, diabetes management involves constant assessment and modification of the treatment plan by health professionals and daily adjustments in therapy (possibly including insulin) by patients. For patients who require insulin to help control blood glucose levels, maintaining consistency in the amount of calories and carbohydrates ingested at meals is essential. In addition, consistency in the approximate time intervals between meals and snacks helps maintain overall glucose control. Skipping meals is never advisable for an insulin-dependent diabetic.

A client 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 client's symptoms to be those of diabetic ketoacidosis (DKA). Which action will help the nurse confirm the diagnosis? a. Assess the client's ability to take a deep breath b. Assess the client's ability to move all extremities c. Assess the client's breath odor d. Assess for excessive sweating

c. Assess the client'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 client's breath will help the nurse confirm the diagnosis.

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

c. 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.

A patient newly diagnosed with type 2 diabetes is attending a nutrition class specifically designed for type 2 diabetics. What general guideline would it be important to teach the patients at this class? a. A low fat food generally contains low sugar. b. Protein should be exclusively from animal sources. c. Calorie intake should support a reasonable body weight. d. Dietary fat should be eliminated from the diet.

c. Calorie intake should support a reasonable body weight. In general, the calorie distribution recommended is higher in carbohydrates than in fats and protein, and all carbohydrates should be eaten in moderation to avoid high postprandial blood glucose levels. The most important objective in the dietary management of diabetes is control of total calorie intake to attain or maintain reasonable body weight. Low-fat does not automatically mean low-sugar. Dietary fat does not need to be eliminated from the diet. Nonanimal protein sources should be included in the diet.

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: a. Impaired adjustment. b. Defensive coping. c. Deficient knowledge (treatment regimen). d. Health-seeking behaviors (diabetes control).

c. 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.

During a follow-up visit 3 months after a new diagnosis of type 2 diabetes, a client reports exercising and following a reduced-calorie diet. Assessment reveals that the client has only lost 1 pound and did not bring the glucose-monitoring record. Which value should the nurse measure? a. Fasting blood glucose level b. Glucose via a urine dipstick test c. Glycosylated hemoglobin level d. Glucose via an oral glucose tolerance test

c. Glycosylated hemoglobin level Glycosylated hemoglobin is a blood test that reflects the average blood glucose concentration over a period of approximately 2 to 3 months. When blood glucose is 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 glycosylated hemoglobin level becomes.

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? a. Insulin is absorbed more slowly at abdominal injection sites than at other sites. b. Insulin is absorbed rapidly regardless of the injection site. c. Insulin is absorbed more rapidly at abdominal injection sites than at other sites. d. Insulin is absorbed unpredictably at all injection sites.

c. 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.

Which type of insulin acts most quickly? a. Regular b. NPH c. Lispro d. Glargine

c. Lispro The onset of action of rapid-acting lispro is within 10 to 15 minutes. The onset of action of short-acting regular insulin is 30 minutes to 1 hour. The onset of action of intermediate-acting NPH insulin is 3 to 4 hours. The onset of action of very long-acting glargine is ~6 hours.

A patient with a diagnosis of type 2 diabetes has been vigilant about glycemic control since being diagnosed and has committed to increasing her knowledge about the disease. To reduce her risk of developing diabetic nephropathy in the future, this patient should combine glycemic control with what other preventative measure? a. Vigorous physical activity at least three times weekly b. Maintenance of a low-sodium, low-protein diet c. Maintenance of healthy blood pressure and prompt treatment of hypertension d. Subcutaneous injection of 5,000 units of heparin twice daily

c. Maintenance of healthy blood pressure and prompt treatment of hypertension Hypertension significantly increases a diabetic patient's risk of nephropathy. A low-sodium, low-protein diet does not appreciably reduce this risk. Exercise is of benefit, but hypertension is a greater risk than inactivity. Heparin is not a relevant intervention.

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

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

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: a. Transport of potassium. b. Release of glucose. c. Synthesis of glucose from noncarbohydrate sources. d. Storage of glucose as glycogen in the liver.

c. 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.

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? a. They have no effect. b. They decrease the need for insulin. c. They increase the need for insulin. d. They cause wide fluctuations in the need for insulin.

c. 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.

Which intervention is essential when performing dressing changes on a client with a diabetic foot ulcer? a. Applying a heating pad b. Debriding the wound three times per day c. Using sterile technique during the dressing change d. Cleaning the wound with a povidone-iodine solution

c. Using sterile technique during the dressing change The nurse should perform the dressing changes using sterile technique to prevent infection. Applying heat should be avoided in a client with diabetes mellitus because of the risk of injury. Cleaning the wound with povidone-iodine solution and debriding the wound with each dressing change prevents the development of granulation tissue, which is essential in the wound healing process.

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

d. 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.

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

d. 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 78-year-old patient with type 2 diabetes is brought to the emergency department by his daughter. The patient is found to have a blood glucose level of 623 mg/dL. The patient's daughter reports that the patient recently had a gastrointestinal virus and has been confused for the last 3 hours. A diagnosis of hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is made. What nursing action would be the priority? a. Administering antihypertensive medications b. Administering sodium bicarbonate intravenously for low bicarbonate levels c. Reversing acidosis by administering insulin d. Replacing fluids and electrolytes

d. Replacing fluids and electrolytes The overall approach to HHNS includes fluid replacement, correction of electrolyte imbalances, and insulin administration. Insulin administration plays a less important role in the treatment of HHNS because it is not needed for reversal of acidosis, as in diabetic ketoacidosis (DKA). Sodium bicarbonate is not administered to patients with HHNS, as their plasma bicarbonate level is usually normal. Also, antihypertensive medications are not indicated, as hypotension generally accompanies HHNS, due to dehydration.

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? a. Making sure that the patient is aware that quantity of foods will be limited b. Ensuring that the patient understands that some favorite foods may not be allowed on the meal plan and substitutes will need to be found c. Determining whether the patient is on insulin or taking oral antidiabetic medication d. Reviewing the patient's diet history to identify eating habits and lifestyle and cultural eating patterns

d. 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.

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

d. 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.