Diabetes Prep U chapter 51
Lispro (Humalog) is an example of which type of insulin?
rapid-acting
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?
The short-acting insulin is withdrawn before the intermediate-acting insulin.
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:
Deficient knowledge (treatment regimen).
A client with type 1 diabetes has been on a regimen of multiple daily injection therapy. He's being converted to continuous subcutaneous insulin therapy. While teaching the client about continuous subcutaneous insulin therapy, the nurse should tell him that the regimen includes the use of:
rapid-acting insulin only.
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?
Administer glucose.
A client with type 1 diabetes presents with a decreased level of consciousness and a fingerstick glucose level of 39 mg/dl. His family reports that he has been skipping meals in an effort to lose weight. Which nursing intervention is most appropriate?
Administering 1 ampule of 50% dextrose solution, per physician's order
A client receives a daily injection of glargine insulin at 7:00 a.m. When should the nurse monitor this client for a hypoglycemic reaction?
This insulin has no peak action and does not cause a hypoglycemic reaction.
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?
It carries glucose into body cells.
Which would not be observed in a client with diabetic peripheral neuropathy?
hyperconduction of electrical stimulation along nerves
A client with type 1 diabetes has a highly elevated glycosylated hemoglobin (Hb) test result. In discussing the result with the client, the nurse is most accurate in stating:
"It tells us about your sugar control for the last 3 months."
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?
"Ketones will tell us if your body is using other tissues for energy."
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:
15 g of carbohydrates.
When the dawn phenomenon occurs, the patient has relatively normal blood glucose until approximate what time of day?
3 am
Glycosylated hemoglobin reflects blood glucose concentrations over which period of time?
3 months
What is the duration of regular insulin?
4-6 hours
Every morning, a client with type 1 diabetes receives 15 units of Humulin 70/30. What does this type of insulin contain?
70% NPH insulin and 30% regular insulin
A client is receiving insulin lispro at 7:30 AM. The nurse ensures that the client has breakfast by which time?
7:45 am
A nurse educator has been invited to a local senior center to discuss health-maintaining strategies for older adults. During a session on nutrition, the nurse discusses diabetes mellitus, its symptoms, and consequences. In the United States, diabetes mellitus is the _______ leading cause of death.
7th
Which statement is true regarding gestational diabetes?
A glucose challenge test should be performed between 24 to 28 weeks.
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?
Accuracy of the dosage
A client is admitted with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which laboratory finding should the nurse expect in this client?
Blood glucose level 1,100 mg/dl
The nurse is reviewing the initial laboratory test results of a client diagnosed with DKA. Which of the following would the nurse expect to find?
Blood pH of 6.9
An obese Hispanic client, age 65, is diagnosed with type 2 diabetes. Which statement about diabetes mellitus is true?
Diabetes mellitus is more common in Hispanics and Blacks than in Whites.
Which of the following is a characteristic of diabetic ketoacidosis (DKA)? Select all that apply
Elevated blood urea nitrogen (BUN) and creatinine Rapid onset More common in type 1 diabetes
Which is the primary dietary consideration for a client receiving insulin isophane suspension (NPH) at breakfast?
Encourage midday snack.
A type 2 diabetic is ordered metformin (Glucophage) as part of the management regime. Which is the best nursing explanation for the action of this drug in controlling glucose levels
Helps tissues use insulin more efficiently
A patient with diabetic ketoacidosis (DKA) has had a large volume of fluid infused for rehydration. What potential complication from rehydration should the nurse monitor for?
Hypokalemia
A client is admitted with diabetic ketoacidosis (DKA). Which order from the physician should the nurse implement first?
Infuse 0.9% normal saline solution 1 L/hr for 2 hours.
Which of the following insulins are used for basal dosage?
Lantus
Which type of insulin acts most quickly?
Lispro
A client with type 1 diabetes is experiencing polyphagia. The nurse knows to assess for which additional clinical manifestation(s) associated with this classic symptom?
Muscle wasting and tissue loss
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?
Serum osmolarity
Which category of oral antidiabetic agents exerts the primary action by directly stimulating the pancreas to secrete insulin?
Sulfonylureas
After taking glipizide (Glucotrol) for 9 months, a client experiences secondary failure. What should the nurse expect the physician to do?
Switch the client to a different oral antidiabetic agent.
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:
Synthesis of glucose from noncarbohydrate sources.
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?
The participants are unlikely to develop a new onset of type 1 diabetes.
Which of the following medications is considered a glitazone?
actos
A nurse is providing dietary instructions to a client with hypoglycemia. To control hypoglycemic episodes, the nurse should recommend:
consuming a low-carbohydrate, high-protein diet and avoiding fasting.
Which of the following would be considered a "free" item from the exchange list?
diet soda
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?
increased hunger
A nurse is preparing the daily care plan for a client with newly diagnosed diabetes mellitus. The priority nursing concern for this client should be:
providing client education at every opportunity.
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:
180 mg/dL
Which is the best nursing explanation for the symptom of polyuria in a client with diabetes mellitus?
High sugar pulls fluid into the bloodstream, which results in more urine production.
For a client with hyperglycemia, which assessment finding best supports a nursing diagnosis of Deficient fluid volume?
Increased urine osmolarity
Which factor is the focus of nutrition intervention for clients with type 2 diabetes?
Weight loss
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?
Serum glycosylated hemoglobin (Hb A1c)
The nurse practitioner worked with a registered dietitian to customize a 1,800-calorie diabetic diet for a 53-year-old man with special dietary needs. Which of the following percent distribution of calories should be provided?
Carbohydrates 50%, fat 25%, and protein 20%
A client with diabetic ketoacidosis was admitted to the intensive care unit 4 hours ago and has these laboratory results: blood glucose level 450 mg/dl, serum potassium level 2.5 mEq/L, serum sodium level 140 mEq/L, and urine specific gravity 1.025. The client has two IV lines in place with normal saline solution infusing through both. Over the past 4 hours, his total urine output has been 50 ml. Which physician order should the nurse question?
Change the second IV solution to dextrose 5% in water.
Which of the following is a risk factor for the development of diabetes mellitus? Select all that apply.
Hypertension Obesity Family history Age greater of 45 years or older History of gestational diabetes
A client with diabetes mellitus is prescribed to switch from animal to synthesized human insulin. Which factor should the nurse monitor when caring for the client?
Low blood glucose concentration
Which instruction about insulin administration should a nurse give to a client?
"Always follow the same order when drawing the different insulins into the syringe."
The nurse is providing information about foot care to a client with diabetes. Which of the following would the nurse include?
"Be sure to apply a moisturizer to feet daily."
A nurse is assigned to care for a patient who is suspected of having type 2 diabetes. Select all the clinical manifestations that the nurse knows could be consistent with this diagnosis.
- Blurred or deteriorating vision - Fatigue and irritability - Polyuria and polydipsia - Wounds that heal slowly or respond poorly to treatment
The nurse is educating a patient about the benefits of fruit versus fruit juice in the diabetic diet. The patient states, "What difference does it make if you drink the juice or eat the fruit? It is all the same." What is the best response by the nurse?
"Eating the fruit instead of drinking juice decreases the glycemic index by slowing absorption."
A client with type 2 diabetes has recently been prescribed acarbose, and the nurse is explaining how to take this medication. The teaching is determined to be effective based on which statement by the client?
"I will take this medication in the morning, with my first bite of breakfast."
A nurse is teaching a client recovering from diabetic ketoacidosis (DKA) about management of "sick days." The client asks the nurse why it is important to monitor the urine for ketones. Which statement is the nurse's best response?
"Ketones 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."
Which instruction should a nurse give to a client with diabetes mellitus when teaching about "sick day rules"?
"Test your blood glucose every 4 hours."
A client has just been diagnosed with type 1 diabetes. When teaching the client and family how diet and exercise affect insulin requirements, the nurse should include which guideline?
"You'll need less insulin when you exercise or reduce your food intake."
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?
"Your child will need less blood work as his glucose levels stabilize."
Which factors will cause hypoglycemia in a client with diabetes? Select all that apply.
- Client has not consumed food and continues to take insulin or oral antidiabetic medications. - Client has not consumed sufficient calories. - Client has been exercising more than usual.
Which of the following is an age-related change that may affect diabetes? Select all that apply.
- Decreased renal function - Taste changes - Decreased vision
Which of the following is a characteristic of diabetic ketoacidosis (DKA)? Select all that apply.
- Elevated blood urea nitrogen (BUN) and creatinine - Rapid onset - More common in type 1 diabetes
Once digested, what percentage of carbohydrates is converted to glucose?
100
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?
100 units of regular insulin in normal saline solution
A patient is prescribed Glucophage, an oral antidiabetic agent classified as a biguanide. The nurse knows that a primary action of this drug is its ability to:
Inhibit the production of glucose by the liver.
The nurse expects that a type 1 diabetic patient may receive what percentage of his or her usual morning dose of insulin preoperatively?
50% to 60%
A client with diabetes comes to the clinic for a follow-up visit. The nurse reviews the client's glycosylated hemoglobin test results. Which result would indicate to the nurse that the client's blood glucose level has been well controlled?
6.5%
A client newly diagnosed with type 1 diabetes has an unusual increase in blood glucose from bedtime to morning. The physician suspects the client is experiencing insulin waning. Based on this diagnosis, the nurse expects which change to the client's medication regimen?
Administering a dose of intermediate-acting insulin before the evening meal
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?
Begin fluid replacements
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?
Below-normal serum potassium level
A nurse is teaching a client about insulin infusion pump use. What intervention should the nurse include to prevent infection at the injection site?
Change the needle every 3 days.
A client is diagnosed with diabetes mellitus. Which assessment finding best supports a nursing diagnosis of Ineffective coping related to diabetes mellitus?
Crying whenever diabetes is mentioned
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?
Initiate fluid replacement therapy.
Which clinical characteristic is associated with type 1 diabetes (previously referred to as insulin-dependent diabetes mellitus)?
Presence of islet cell antibodies
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?
It enhances transport of glucose across the cell wall.
The nurse suspects that a patient with diabetes has developed proliferative retinopathy. The nurse confirms this by the presence of which of the following diagnostic signs?
Neovascularization into the vitreous humor
A nurse obtains a fingerstick glucose level of 45 mg/dl on a client newly diagnosed with diabetes mellitus. The client is alert and oriented, and the client's skin is warm and dry. How should the nurse intervene?
Obtain a repeat fingerstick glucose level.
Which of the following factors should the nurse take into consideration when planning meals and selecting the type and dosage of insulin or oral hypoglycemic agent for an elderly patient with diabetes mellitus?
Patient's eating and sleeping habits
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?
Rapid, thready pulse
A client with status asthmaticus requires endotracheal intubation and mechanical ventilation. Twenty-four hours after intubation, the client is started on the insulin infusion protocol. The nurse must monitor the client's blood glucose levels hourly and watch for which early signs and symptoms associated with hypoglycemia?
Sweating, tremors, and tachycardia
Which of the following factors would a nurse identify as a most likely cause of diabetic ketoacidosis (DKA) in a client with diabetes?
The client has eaten and has not taken or received insulin.
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?
They increase the need for insulin.
Insulin is secreted by which of the following types of cells?
beta cells
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:
suggest referral to a sex counselor or other appropriate professional.
A nurse is assessing a client who is receiving total parenteral nutrition (TPN). Which finding suggests that the client has developed hyperglycemia?
increased urine output
A nurse understands that a major concern with type 2 diabetes is:
insulin resistance
Which term refers to the progressive increase in blood glucose from bedtime to morning?
insulin waning
Which is the primary reason for encouraging injection site rotation in an insulin dependent diabetic?
promote absorption
The diabetic client asks the nurse why shoes and socks are removed at each office visit. Which assessment finding is most significant in determining the protocol for inspection of feet?
sensory neuropathy
A controlled type 2 diabetic client states, "The doctor said if my blood sugars remain stable, I may not need to take any medication." Which response by the nurse is most appropriate?
"Diet, exercise, and weight loss can eliminate the need for medication."
A patient is diagnosed with type 1 diabetes. What clinical characteristics does the nurse expect to see in this patient? Select all that apply.
- Ketosis-prone - Little endogenous insulin - Younger than 30 years of age
A client has gained 55 lb in the last 3 years and is concerned about developing type 2 diabetes mellitus. Additionally, the client's healthcare provider has diagnosed metabolic syndrome. What are the conditions which contribute to developing metabolic syndrome? Select all that apply.
- abdominal obesity - elevated blood glucose levels
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?
Hyperglycemic hyperosmolar syndrome
When the nurse inspects the feet of a diabetic, a tack is found sticking in the sole of one foot. The client denies feeling anything unusual in the foot. Which is the best rationale for this finding?
High blood sugar decreases blood circulation to nerves.
During a class on exercise for clients with diabetes mellitus, a client asks the nurse educator how often to exercise. To meet the goals of planned exercise, the nurse educator should advise the client to exercise:
at least three times per week.
Which assessment finding is most important in determining nursing care for a client with diabetes mellitus?
fruit breath
A client with a 30-year history of type 2 diabetes is having an annual physical and blood work. Which test result would the physician be most concerned with when monitoring the client's treatment compliance?
glycosylated hemoglobin
A client with diabetes mellitus is receiving an oral antidiabetic agent. The nurse observes for which symptom when caring for this client?
hypoglycemia
When the nurse is caring for a patient with type 1 diabetes, what clinical manifestation would be a priority to closely monitor?
hypoglycemia