Diabetes - Prep-U/Test Bank

A nurse is conducting a class on how to self-manage insulin regimens. A client asks how long a vial of insulin can be stored at room temperature before it "goes bad." What would be the nurse's best answer? A. "If you are going to use up the vial within 1 month, it can be kept at room temperature." B. "If a vial of insulin will be used up within 21 days, it may be kept at room temperature." C. "If a vial of insulin will be used up within 2 weeks, it may be kept at room temperature." D. "If a vial of insulin will be used up within 1 week, it may be kept at room temperature."

A. "If you are going to use up the vial within 1 month, it can be kept at room temperature." Rationale: If a vial of insulin will be used up within 1 month, it may be kept at room temperature.

Which of the following would be considered a "free" item from the exchange list? A. Diet soda B. Green salad C. Medium apple D. 1 tsp olive oil

A. Diet soda Rationale: Free items include unsweetened iced tea, diet soda, and ice water with lemon. A green salad is exchanged for 1 vegetable. A medium apple is 1 fruit; 1 tsp of olive oil is 1 fat.

A client presents to the clinic reporting symptoms that suggest diabetes. What criteria would support checking blood levels for the diagnosis of diabetes? A. Fasting plasma glucose greater than or equal to 126 mg/dL (7.0 mmol/L) B. Random plasma glucose greater than 150 mg/dL (8.3 mmol/L) C. Fasting plasma glucose greater than 116 mg/dL (6.4 mmol/L) on two separate occasions D. Random plasma glucose greater than 126 mg/dL (7.0 mmol/L)

A. Fasting plasma glucose greater than or equal to 126 mg/dL (7.0 mmol/L) Rationale: Criteria for the diagnosis of diabetes include symptoms of diabetes plus random plasma glucose greater than or equal to 200 mg/dL (11.1 mmol/L), or a fasting plasma glucose greater than or equal to 126 mg/dL (7.0 mmol/L).

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

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." Rationale: 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.

A nurse is providing health education to a teenage client newly diagnosed with type 1 diabetes mellitus, as well as the client's family. The nurse teaches the client and family nonpharmacologic measures that will decrease the body's need for insulin. What measure provides the greatest impact on glucose reduction? A. Adequate sleep B. Low stimulation C. Exercise D. Low-fat diet

C. Exercise Rationale: Exercise lowers blood glucose, increases levels of HDLs, and decreases total cholesterol and triglyceride levels. Low-fat intake and low levels of stimulation do not reduce a client's need for insulin. Adequate sleep is beneficial in reducing stress, but does not have an effect that is as pronounced as that of exercise.

A child presents to the primary care setting with enuresis, nocturia, increased hunger, weight loss, and increased thirst. What does the nurse suspect? A. Syndrome of inappropriate diuretic hormone B. Diabetes insipidus C. Type 1 diabetes mellitus D. Hypothyroidism

C. Type 1 diabetes mellitus Rationale: Signs and symptoms of type 1 diabetes mellitus include polyuria, polydipsia, polyphagia, enuresis, and weight loss.

A nurse is assessing a client who has diabetes for the presence of peripheral neuropathy. The nurse should question the client about what sign or symptom that would suggest the possible development of peripheral neuropathy? A. Persistently cold feet B. Pain that does not respond to analgesia C. Acute pain, unrelieved by rest D. The presence of a tingling sensation

D. The presence of a tingling sensation Rationale: Although approximately half of clients with diabetic neuropathy do not have symptoms, initial symptoms may include paresthesias (prickling, tingling, or heightened sensation) and burning sensations (especially at night). Cold and intense pain are atypical early signs of this complication.

The nurse is caring for a 5-year-old child recently diagnosed with type 1 diabetes. When discussing the care and management of the disorder with the child's parents, which statement(s) indicates understanding? Select all that apply. A. "Regular exercise will help in the regulation of my child's blood sugar levels." B. "If my child's blood glucose remains stable for a few months, my child can move from injections to pills." C. "When my child is ill and unable to eat, we will need to hold the insulin until the child is able to tolerate fluids." D. "The insulin dosages will be directly associated to my child's carbohydrate ingestion." E. "We need to rotate insulin injection sites to prevent complications."

A. "Regular exercise will help in the regulation of my child's blood sugar levels." D. "The insulin dosages will be directly associated to my child's carbohydrate ingestion." E. "We need to rotate insulin injection sites to prevent complications." Rationale: When a child has type 1 diabetes, there is an absence of insulin to manage the metabolism of serum glucose. Regular exercise is helpful in the maintenance of stable serum glucose levels. Carbohydrate ingestion is linked to the amount of insulin that will be needed in the body. Carbohydrates break down and the body needs insulin to metabolize the resulting glucose. The rotation of insulin injection sites is important. Failing to rotate injection sites can cause a complication, lipohypertrophy. Type 1 diabetes means that the body does not have insulin, so injected insulin is needed to manage it. Oral medications are only an option for those having type 2 diabetes. When the child is ill, it is still important that the child with diabetes take the prescribed medications.

The nurse is preparing to administer the child's ordered lispro (Humalog) insulin at 0800. When will the child's blood glucose level begin to decline? A. 0815 B. 0845 C. 0900 D. 0930

A. 0815 Rationale: The onset of rapid-acting insulins like lispro (Humalog) is within 15 minutes. The onset of short-acting insulin is 30 to 60 minutes. The onset of intermediate-acting insulin is 1-3 hours, and long-acting insulin's onset is 1-2 hours.

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 Rationale: 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 10-year-old child is newly diagnosed with type 1 diabetes. The child's hemoglobin A1C level is being monitored. The nurse determines that additional intervention is needed with the child based on which result? A. 8.5% B. 6.5% C. 7.5 % D. 7.0%

A. 8.5% Rationale: The goal for hemoglobin A1C in children between the ages of 6 and 12 years is less than 8%. Therefore, a result of 8.5% would indicate that additional intervention is needed to achieve the recommended goal.

A nurse is working for the summer at a camp for adolescents with diabetes. When providing information on the prevention and management of hypoglycemia, what action should the nurse promote? A. Always carry a form of fast-acting sugar. B. Perform exercise prior to eating whenever possible. C. Eat a meal or snack every 8 hours. D. Check blood sugar at least every 24 hours.

A. Always carry a form of fast-acting sugar. Rationale: The following teaching points should be included in information provided to the client on how to prevent hypoglycemia: Always carry a form of fast-acting sugar, increase food prior to exercise, eat a meal or snack every 4 to 5 hours, and check blood sugar regularly.

A nurse is caring for a client newly diagnosed with type 1 diabetes. The nurse is educating the client about self-administration of insulin in the home setting. The nurse should teach the client to do what action? A. Avoid using the same injection site more than once in 2 to 3 weeks. B. Avoid mixing more than one type of insulin in a syringe. C. Cleanse the injection site thoroughly with alcohol prior to injecting. D. Inject at a 45-degree angle.

A. Avoid using the same injection site more than once in 2 to 3 weeks. Rationale: To prevent lipodystrophy, the client should try not to use the same site more than once in 2 to 3 weeks. Mixing different types of insulin in a syringe is acceptable, within specific guidelines, and the needle is usually inserted at a 90-degree angle. Cleansing the injection site with alcohol is optional.

The nurse is developing a plan of care for a 7-year-old boy with diabetes insipidus. What is the priority nursing diagnosis? A. Deficient fluid volume related to dehydration B. Excess fluid volume related to edema C. Deficient knowledge related to fluid intake regimen D. Imbalanced nutrition, more than body requirements related to excess weight

A. Deficient fluid volume related to dehydration Rationale: The priority nursing diagnosis most likely would be deficient fluid volume related to dehydration, due to a deficiency in the secretion of antidiuretic hormone (ADH). Excess fluid would result from a disorder that leads to water retention, such as syndrome of inappropriate antidiuretic hormone (SIADH). Deficient knowledge related to fluid intake regimen is a nursing diagnosis for this child, but a secondary one. Imbalanced nutrition, more than body requirements related to excess weight would be inappropriate for this child since he probably has lost weight secondary to the fluid loss.

The nurse is preparing a teaching plan for the family and their 6-year-old son who has just been diagnosed with diabetes mellitus. What would the nurse identify as the initial goal for the teaching plan? A. Developing management and decision-making skills B. Educating the parents about diabetes mellitus type 1 C. Developing a nutritionally sound, 30-day meal plan D. Promoting independence with self-administration of insulin

A. Developing management and decision-making skills Rationale: Developing basic management and decision-making skills related to the diabetes is the initial goal of the teaching plan for this child and family. The nurse would have provided a basic description of the disorder after it was diagnosed. Development of a detailed monthly meal plan would come later, perhaps after consulting with a nutritionist. It is too soon to expect the boy to administer his own insulin.

A diabetes nurse educator is teaching a group of clients with type 1 diabetes about "sick day rules." What guideline applies to periods of illness in a diabetic client? A. Do not eliminate insulin when nauseated and vomiting. B. Report elevated glucose levels greater than 150 mg/dL (8.3 mmol/L). C. Eat three substantial meals a day, if possible. D. Reduce food intake and insulin doses in times of illness.

A. Do not eliminate insulin when nauseated and vomiting. Rationale: The most important issue to teach clients 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 carbohydrates. In general, blood sugar levels will rise but should be reported if they are greater than 300 mg/dL (16.6 mmol/L).

A client has been brought to the emergency department by paramedics after being found unconscious. The client's MedicAlert bracelet indicates that the client has type 1 diabetes and the client's blood glucose is 22 mg/dL (1.2 mmol/L). The nurse should anticipate what intervention? A. IV administration of 50% dextrose in water B. Subcutaneous administration of 10 units of Humalog C. Subcutaneous administration of 12 to 15 units of regular insulin D. IV bolus of 5% dextrose in 0.45% NaCl

A. IV administration of 50% dextrose in water Rationale: In hospitals and emergency departments, for clients who are unconscious or cannot swallow, 25 to 50 mL of 50% dextrose in water (D50W) may be administered IV for the treatment of hypoglycemia. Five percent dextrose would be inadequate, and insulin would exacerbate the client's condition.

A client with diabetes is receiving an oral antidiabetic agent that acts to help the tissues use available insulin more efficiently. Which of the following agents would the nurse expect to administer? A. Metformin B. Glyburide C. Repaglinide D. Glipizide

A. Metformin Rationale: 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 Rationale: 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 client has been living with type 2 diabetes for several years, and the nurse realizes that the client is likely to have minimal contact with the health care system. In order to ensure that the client maintains adequate blood sugar control over the long term, what should the nurse recommend? A. Participation in a support group for persons with diabetes B. Regular consultation of websites that address diabetes management C. Weekly telephone "check-ins" with an endocrinologist D. Participation in clinical trials relating to antihyperglycemics

A. Participation in a support group for persons with diabetes Rationale: Participation in support groups is encouraged for clients who have had diabetes for many years as well as for those who are newly diagnosed. This is more interactive and instructive than simply consulting websites. Weekly telephone contact with an endocrinologist is not realistic in most cases. Participation in research trials may or may not be beneficial and appropriate, depending on clients' circumstances.

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 Rationale: 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.

After being sick for 3 days, a client with a history of diabetes mellitus is admitted to the hospital with diabetic ketoacidosis (DKA). The nurse should evaluate which diagnostic test results to prevent dysrhythmias? A. Serum potassium level B. Serum calcium level C. Serum sodium level D. Serum chloride level

A. Serum potassium level Rationale: The nurse should monitor the client's potassium level because during periods of acidosis, potassium leaves the cell, causing hyperkalemia. As blood glucose levels normalize with treatment, potassium reenters the cell, causing hypokalemia if levels aren't monitored closely. Hypokalemia places the client at risk for cardiac arrhythmias such as ventricular tachycardia. DKA has a lesser affect on serum calcium, sodium, and chloride levels. Changes in these levels don't typically cause cardiac arrhythmias.

A child with diabetes insipidus is being treated with vasopressin. The nurse would assess the child closely for signs and symptoms of which condition? A. Syndrome of inappropriate antidiuretic hormone (SIADH) B. Thyroid storm C. Cushing syndrome D. Vitamin D toxicity

A. Syndrome of inappropriate antidiuretic hormone (SIADH) Rationale: SIADH, although rare in children, is a potential complication of excessive administration of vasopressin. Thyroid storm may result from overadministration of levothyroxine (thyroid hormone replacement). Cushing syndrome is associated with corticosteroid use. Vitamin D toxicity may result from the use of vitamin D as treatment of hypoparathyroidism.

The most recent blood work of a client with a long-standing diagnosis of type 1 diabetes has shown the presence of microalbuminuria. What is the nurse's most appropriate action? A. Teach the client about actions to slow the progression of nephropathy. B. Ensure that the client receives a comprehensive assessment of liver function. C. Determine whether the client has been using expired insulin. D. Administer a fluid challenge and have the test repeated.

A. Teach the client about actions to slow the progression of nephropathy. Rationale: Clinical nephropathy eventually develops in more than 85% of people with microalbuminuria. As such, educational interventions addressing this microvascular complication are warranted. Expired insulin does not cause nephropathy, and the client's liver function is not likely affected. There is no indication for the use of a fluid challenge.

A teenage client is brought to the emergency department with symptoms of hyperglycemia. Based on the fact that the pancreatic beta cells are being destroyed, the client would be diagnosed with what type of diabetes? A. Type 1 diabetes B. Type 2 diabetes C. Non-insulin-dependent diabetes D. Prediabetes

A. Type 1 diabetes Rationale: Beta cell destruction is the hallmark of type 1 diabetes. Non- insulin-dependent diabetes is synonymous with type 2 diabetes, which involves insulin resistance and impaired insulin secretion, but not beta cell destruction. Prediabetes is characterized by normal glucose metabolism, but a previous history of hyperglycemia, often during illness or pregnancy.

A child with type 1 diabetes is brought to the emergency department. The nurse suspects diabetic ketoacidosis (DKA) based on which assessment findings? Select all that apply. A. fruity odor on the breath B. decreased level of consciousness C. poor skin turgor D. increased urine output E. quick capillary refill

A. fruity odor on the breath B. decreased level of consciousness C. poor skin turgor Rationale: If insulin deficiency persists and ketone bodies continue to be excreted, the child begins to experience stomach pains, vomiting, and continued weight loss. Dehydration quickly develops as DKA progresses. The degree of dehydration is assessed while the child is weighed and examined. Assessment includes examining the mucous membranes for moistness, the eyeballs for degree of depression, the skin for turgor, and the anterior fontanel (fontanelle), if present, for depression. The child may also show signs of impending shock: tachypnea, decreased output, decreased level of consciousness, slowed capillary refill, and tachycardia. A late sign of shock in children is hypotension. DKA is most commonly present in new-onset T1DM or during crises in children with known type 1 diabetes, but it may also be found in newly diagnosed type 2 diabetes in the adolescent age group. Kussmaul respirations and changes in mental status may ensue. The breath develops a fruity odor in all children with DKA. If the child becomes somnolent and advances into a coma, these are ominous signs of cerebral edema.

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." Rationale: 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 child and her parents are being seen in the office after discharge from the hospital with a new diagnosis of type 2 diabetes. Which statement by the nurse is true? A. "You are lucky that you did not have to learn how to give yourself a shot." B. "Kids can usually be managed with an oral agent, meal planning, and exercise." C. "This will rectify itself if you follow all of the doctor's directions." D. "A weight-loss program should be implemented and maintained."

B. "Kids can usually be managed with an oral agent, meal planning, and exercise." Rationale: Treating type 2 diabetes in children may require insulin at the outset if the child is acidotic and acutely ill. More commonly, the child can be managed initially with oral agents, meal planning, and increased activity. Telling the child that she is lucky she did not have to learn how to give a shot might scare her, so it will inhibit her from seeking future health care. The condition will not rectify itself if all orders are followed. A weight-loss program might need to be implemented but that is not always the case.

An occupational health nurse is screening a group of workers for diabetes. What statement should the nurse interpret as being suggestive of diabetes? A. "I've always been a fan of sweet foods, but lately I'm turned off by them." B. "Lately, I drink and drink and can't seem to quench my thirst." C. "No matter how much sleep I get, it seems to take me hours to wake up." D. "When I went to the washroom the last few days, my urine smelled odd."

B. "Lately, I drink and drink and can't seem to quench my thirst." Rationale: Classic clinical manifestations of diabetes include the "three Ps": polyuria, polydipsia, and polyphagia. Lack of interest in sweet foods, fatigue, and foul-smelling urine are not suggestive of diabetes.

The nurse is teaching a group of caregivers of children diagnosed with diabetes. The nurse is explaining insulin shock and the caregivers make the following statements. Which statement indicates the best understanding of a reason an insulin reaction might occur? A. "If my child eats as much as their older brother eats they could have an insulin reaction." B. "My child measures their own medication but sometimes doesn't administer the correct amount." C. "My child monitors their glucose levels to keep them from going too high." D. "On the weekends we encourage our child to participate in lots of sports activities and stay busy so they don't have an insulin reaction."

B. "My child measures their own medication but sometimes doesn't administer the correct amount." Rationale: Insulin reaction (insulin shock, hypoglycemia) is caused by insulin overload, resulting in too-rapid metabolism of the body's glucose. This may be attributable to a change in the body's requirement, carelessness in diet (such as failure to eat proper amounts of food), an error in insulin measurement, or excessive exercise.

A diabetic educator is discussing "sick day rules" with a newly diagnosed type 1 diabetic. The educator is aware that the client will require further teaching when the client states what? A. "I will not take my insulin on the days when I am sick, but I will certainly check my blood sugar every 2 hours." B. "If I cannot eat a meal, I will eat a soft food such as soup, gelatin, or pudding six to eight times a day." C. "I will call the doctor if I am not able to keep liquids in my body due to vomiting or diarrhea." D. "I will call the doctor if my blood sugar is over 300 mg/dL (16.6 mmol/L) or if I have ketones in my urine."

A. "I will not take my insulin on the days when I am sick, but I will certainly check my blood sugar every 2 hours." Rationale: The nurse must explain the "sick day rules" again to the client who plans to stop taking insulin when sick. The nurse should emphasize that the client should take insulin agents as usual and test the blood sugar and urine ketones every 3 to 4 hours. In fact, insulin-requiring clients may need supplemental doses of regular insulin every 3 to 4 hours. The client should report elevated glucose levels (greater than 300 mg/dL or 16.6 mmol/L, or as otherwise instructed) or urine ketones to the health care provider. If the client is not able to eat normally, the client should be instructed to substitute with soft foods such a gelatin, soup, and pudding. If vomiting, diarrhea, or fever persists, the client should have an intake of liquids every 30 to 60 minutes to prevent dehydration.

The nurse is talking with a parent of an adolescent who is newly diagnosed with type 2 diabetes and asks, "How could this happen? No one in our family has diabetes." What response would be appropriate? A. "This is caused by the pancreas not making enough insulin." B. "This disorder usually occurs when inadequate calories are ingested on a regular basis." C. "Because this disorder is genetic, someone in the family will eventually develop the illness." D. "This is caused by insulin resistance from previous pancreatic injury or generalized infection."

D. "This is caused by insulin resistance from previous pancreatic injury or generalized infection." Rationale: Type 2 diabetes is now seen in overweight adolescents as well as those who eat a diet high in fats and carbohydrates and do not exercise regularly. Pancreatic malfunction is not a cause of type 2 diabetes. This disorder is not linked to inadequate ingestion of daily calories. This disorder may have a genetic link, but environmental factors such as obesity, diet, and exercise can influence its development. Type 2 diabetes is a result of insulin resistance in the metabolism of glucose to maintain normal blood glucose levels, but it is not associated with infection or a previous pancreatic injury.

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 Rationale: 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.

An older adult client with type 2 diabetes is brought to the emergency department by the client's daughter. The client is found to have a blood glucose level of 600 mg/dL (33.3 mmol/L). The client's daughter reports that the client recently had a gastrointestinal virus and has been confused for the last 3 hours. The diagnosis of hyperglycemic hyperosmolar syndrome (HHS) is made. What nursing action would be a priority? A. Administration of antihypertensive medications B. Administering sodium bicarbonate intravenously C. Reversing acidosis by administering insulin D. Fluid and electrolyte replacement

D. Fluid and electrolyte replacement Rationale: The overall approach to HHS includes fluid replacement, correction of electrolyte imbalances, and insulin administration. Antihypertensive medications are not indicated, as hypotension generally accompanies HHS due to dehydration. Sodium bicarbonate is not given to clients with HHS, as their plasma bicarbonate level is usually normal. Insulin administration plays a less important role in the treatment of HHS because it is not needed for reversal of acidosis, as in diabetic ketoacidosis (DKA).

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 Rationale: 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 school nurse is teaching a group of high school students about risk factors for diabetes. What action has the greatest potential to reduce an individual's risk for developing diabetes? A. Have blood glucose levels checked annually. B. Stop using tobacco in any form. C. Undergo eye examinations regularly. D. Lose weight, if obese

D. Lose weight, if obese Rationale: Obesity is a major modifiable risk factor for diabetes. Smoking is not a direct risk factor for the disease. Eye examinations are necessary for persons who have been diagnosed with diabetes, but they do not screen for the disease or prevent it. Similarly, blood glucose checks do not prevent diabetes.

A medical nurse is aware of the need to screen specific clients for their risk of hyperglycemic hyperosmolar syndrome (HHS). In what client population does this syndrome most often occur? A. Clients who are obese and who have no known history of diabetes B. Clients with type 1 diabetes and poor dietary control C. Adolescents with type 2 diabetes and sporadic use of antihyperglycemics D. Middle-aged or older people with either type 2 diabetes or no known history of diabetes

D. Middle-aged or older people with either type 2 diabetes or no known history of diabetes Rationale: HHS occurs most often in older clients (50 to 70 years of age) who have no known history of diabetes or who have type 2 diabetes. HHS is a serious metabolic disorder resulting from a relative insulin deficiency initiated by an illness that raises the demand for insulin. Obesity does play a role in HHS but clients usually have a history of type 2 diabetes. Clients with type 1 diabetes usually present with DKA (diabetic ketoacidosis). Adolescents with type 2 have a low incidence of this condition.

A nurse is teaching basic "survival skills" to a client newly diagnosed with type 1 diabetes. What topic should the nurse address? A. Signs and symptoms of diabetic nephropathy B. Management of diabetic ketoacidosis C. Effects of surgery and pregnancy on blood sugar levels D. Recognition of hypoglycemia and hyperglycemia

D. Recognition of hypoglycemia and hyperglycemia Rationale: It is imperative that newly diagnosed clients know the signs and symptoms and management of hypo- and hyperglycemia. The other listed topics are valid points for education, but are not components of the client's immediate "survival skills" following a new diagnosis.

A client with type 2 diabetes has been managing his blood glucose levels using diet and metformin. Following an ordered increase in the client's daily dose of metformin, the nurse should prioritize which of the following assessments? A. Monitoring the client's neutrophil levels B. Assessing the client for signs of impaired liver function C. Monitoring the client's level of consciousness and behavior D. Reviewing the client's creatinine and BUN levels

D. Reviewing the client's creatinine and BUN levels Rationale: Metformin has the potential to be nephrotoxic; consequently, the nurse should monitor the client's kidney function. This drug does not typically affect clients' neutrophils, liver function, or cognition.

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 Rationale: 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.

A client newly diagnosed with type 2 diabetes has been told by their family that they can no longer consume alcohol. The client asks the nurse if abstaining from all alcohol is necessary. What is the nurse's best response? A. "You should stop all alcohol intake. Alcohol is absorbed by your body before other important nutrients and may lead to very high blood glucose levels." B. "You do not need to give up alcohol entirely but there are potential side effects specific to clients with diabetes that you should consider." C. "You should no longer consume alcohol since it causes immediate low blood glucose levels in diabetic clients." D. "You can still consume alcohol, but limit your consumption to no more than 3 glasses of wine or beer daily because of the high sugar content of alcohol."

B. "You do not need to give up alcohol entirely but there are potential side effects specific to clients with diabetes that you should consider." Rationale: Clients with diabetes do not need to give up alcoholic beverages entirely. Moderation is the key. Moderate intake is no more than 1 alcoholic beverage (light beer, wine) for women and 2 drinks for men daily. Recommendations include avoiding mixed drinks and liqueurs because of the possibility of excessive weight gain, elevated glucose levels, and hyperlipidemia. Clients should be aware of potential side effects of alcohol consumption. These include diabetic ketoacidosis and hypoglycemia To combat possible hypoglycemia, clients with diabetes should not consume alcohol on an empty stomach.

A nurse is caring for a client with type 1 diabetes. The client's medication administration record includes the administration of regular insulin three times daily. Knowing that the client's lunch tray will arrive at 11:45 AM, when should the nurse administer the client's insulin? A. 10:45 AM B. 11:30 AM C. 11:45 AM D. 11:50 AM

B. 11:30 AM Rationale: Short-acting insulin is called regular insulin. It is in a clear solution and is usually given 15 minutes before a meal or in combination with a longer-acting insulin. Earlier administration creates a risk for hypoglycemia; later administration creates a risk for hyperglycemia.

A 5-year-old child with type 1 diabetes is brought to the clinic by his mother for a follow-up visit after having his hemoglobin A1C level drawn. Which result would indicate to the nurse that the child is achieving long-term glucose control? A. 9.0% B. 8.2% C. 7.3% D. 6.9%

B. 8.2% Rationale: For a child 6 years of age and younger, the target HbA1C level should be less than 8.5% but greater than 7.5%. For children between the ages of 6 and 12 years, the target HbA1C level is less than 8%. For children and adolescents between 13 and 19 years of age, the target HbA1C level would be less than 7.5%.

The nurse reviews foot care with an older adult client. Why would the nurse feel that foot care is so important to this client? A. An older adult client with foot ulcers experiences severe foot pain due to the diabetic polyneuropathy. B. Avoiding foot ulcers may mean the difference between institutionalization and continued independent living. C. Hypoglycemia is linked with a risk for falls; this risk is elevated in older adults with diabetes. D. Oral antihyperglycemics have the possible adverse effect of decreased circulation to the lower extremities.

B. Avoiding foot ulcers may mean the difference between institutionalization and continued independent living. Rationale: The nurse recognizes that providing information on the 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 older adult 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. Decrease in circulation is related to vascular changes and is not associated with drugs given for diabetes.

A child is brought into the emergency department with vomiting, drowsiness, and blowing respirations. The child's parent 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. Rationale: Management of DKA is aimed at correcting dehydration, electrolyte loss, and acidosis before correcting the hyperglycemia with insulin.

A child with diabetes reports that he is feeling a little shaky. Further assessment reveals that the child is coherent but with some slight tremors and sweating. A fingerstick blood glucose level is 70 mg/dL. What would the nurse do next? A. Administer a sliding-scale dose of insulin. B. Give 10 to 15 g of a simple carbohydrate. C. Offer a complex carbohydrate snack. D. Administer glucagon intramuscularly.

B. Give 10 to 15 g of a simple carbohydrate. Rationale: The child is experiencing hypoglycemia as evidenced by the assessment findings and blood glucose level. Since the child is coherent, offering the child 10 to 15 g of a simple carbohydrate would be appropriate. Insulin is not used because the child is hypoglycemic. A complex carbohydrate snack would be used after offering the simple carbohydrate to maintain the glucose level. Intramuscular glucagons would be used if the child was not coherent.

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 Rationale: The classic symptoms of diabetes are the three Ps: polyuria (increased urination), polydipsia (increased thirst), and polyphagia (increased hunger). Some of the other symptoms include tingling, numbness, and loss of sensation in the extremities and fatigue.

The 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 Rationale: 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.

A client with a history of type 1 diabetes has just been admitted to the critical care unit (CCU) for diabetic ketoacidosis. The CCU nurse should prioritize what assessment during the client's initial phase of treatment? A. Monitoring the client for dysrhythmias B. Maintaining and monitoring the client's fluid balance C. Assessing the client's level of consciousness D. Assessing the client for signs and symptoms of venous thromboembolism

B. Maintaining and monitoring the client's fluid balance Rationale: In addition to treating hyperglycemia, management of DKA is aimed at correcting dehydration, electrolyte loss, and acidosis before correcting the hyperglycemia with insulin. The nurse should monitor the client for dysrhythmias, decreased LOC and VTE, but restoration and maintenance of fluid balance is the highest

A nurse is caring for a client with type 1 diabetes who is being discharged home tomorrow. What is the best way to assess the client's ability to prepare and self-administer insulin? A. Ask the client to describe the process in detail. B. Observe the client drawing up and administering the insulin. C. Provide a health education session reviewing the main points of insulin delivery. D. Review the client's first hemoglobin A1C result after discharge.

B. Observe the client drawing up and administering the insulin. Rationale: Nurses should assess the client's ability to perform diabetes-related self-care as soon as possible during the hospitalization or office visit to determine whether the client requires further diabetes teaching. While consulting a home care nurse is beneficial, an initial assessment should be performed during the hospitalization or office visit. Nurses should directly observe the client performing the skills such as insulin preparation and infection, blood glucose monitoring, and foot care. Simply questioning the client about these skills without actually observing performance of the skill is not sufficient. Further education does not guarantee learning.

A client with type 2 diabetes normally achieves adequate glycemic control through diet and exercise. Upon being admitted to the hospital for a cholecystectomy, however, the client has required insulin injections on two occasions. The nurse would identify what factor most likely caused this short-term change in treatment? A. Alterations in bile metabolism and release have likely caused hyperglycemia. B. Stress has likely caused an increase in the client's blood sugar levels. C. The client's efforts did not control the diabetes using nonpharmacologic measures. D. The client's volatile fluid balance surrounding surgery has likely caused unstable blood sugars.

B. Stress has likely caused an increase in the client's blood sugar levels. Rationale: During periods of physiologic stress, such as surgery, blood glucose levels tend to increase because levels of stress hormones (epinephrine, norepinephrine, glucagon, cortisol, and growth hormone) increase. The client's need for insulin is unrelated to the action of bile. The client's normal routine of nonpharmacological strategies of diet and exercise have been changed due to the client's admission to the hospital. Therefore, the client cannot overestimate what they cannot control. Electrolyte/ fluid balances may have some bearing on glucose levels, but stress is the most impactful cause of the change happening to this client.

The nurse is discussing macrovascular complications of diabetes with a client. The nurse would address what topic during this dialogue? A. The need for frequent eye examinations for clients with diabetes B. The fact that clients with diabetes have an elevated risk of myocardial infarction C. The relationship between kidney function and blood glucose levels D. The need to monitor urine for the presence of albumin

B. The fact that clients with diabetes have an elevated risk of myocardial infarction Rationale: Myocardial infarction and stroke are considered macrovascular complications of diabetes, while the effects on vision and kidney function are considered to be microvascular.

A diabetes educator is teaching a client about type 2 diabetes. The educator recognizes that the client understands the primary treatment for type 2 diabetes when the client states: A. "I read that a pancreas transplant will provide a cure for my diabetes." B. "I will take my oral antidiabetic agents when my morning blood sugar is high." C. "I will make sure to follow the weight loss plan designed by the dietitian." D. "I will make sure I call the diabetes educator when I have questions about my insulin."

C. "I will make sure to follow the weight loss plan designed by the dietitian." Rationale: Insulin resistance is associated with obesity; thus the primary treatment of type 2 diabetes is weight loss. Oral antidiabetic agents may be added if diet and exercise are not successful in controlling blood glucose levels. If maximum doses of a single category of oral agents fail to reduce glucose levels to satisfactory levels, additional oral agents may be used. Some clients may require insulin on an ongoing basis, or on a temporary basis during times of acute psychological stress, but it is not the central component of type 2 treatment. Pancreas transplantation is associated with type 1 diabetes.

The health care provider has explained to a client that the client has developed diabetic neuropathy in the right foot. Later that day, the client asks the nurse what causes diabetic neuropathy. What would be the nurse's best response? A. "Research has shown that diabetic neuropathy is caused by fluctuations in blood sugar that have gone on for years." B. "The cause is not known for sure but it is thought to have something to do with ketoacidosis." C. "The cause is not known for sure but it is thought to involve elevated blood glucose levels over a period of years." D. "Research has shown that diabetic neuropathy is caused by a combination of elevated glucose and ketone levels."

C. "The cause is not known for sure but it is thought to involve elevated blood glucose levels over a period of years." Rationale: The etiology of neuropathy may involve elevated blood glucose levels over a period of years. High blood sugar (rather than fluctuations or variations in blood sugars) is thought to be responsible. Ketones and ketoacidosis are not direct causes of neuropathies.

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." Rationale: 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. See Table 30-3 in the text.

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." Rationale: 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.

Which of the following clients with type 1 diabetes is most likely to experience adequate glucose control? A. A client who skips breakfast when the glucose reading is greater than 220 mg/dL (12.3 mmol/L) B. A client who never deviates from the prescribed dose of insulin C. A client who adheres closely to a meal plan and meal schedule D. A client who eliminates carbohydrates from the daily intake

C. A client who adheres closely to a meal plan and meal schedule Rationale: 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 clients. For clients 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 the snacks, helps maintain overall glucose control. Skipping meals is never advisable for person with type 1 diabetes.

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. Rationale: 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.

A nurse is preparing a presentation for a group of parents of adolescents diagnosed with type 1 diabetes. What issues would the nurse need to address? Select all that apply. A. Self-monitoring of blood glucose levels B. Feelings of being different C. Deficient decision-making skills D. Body image conflicts E. Struggle for independence

C. Deficient decision-making skills D. Body image conflicts E. Struggle for independence Rationale: Adolescents are undergoing rapid physical, emotional, and cognitive growth. Working toward a separate identity from parents and the demands of diabetic care can hinder this. This struggle for independence can lead to nonadherence of the diabetic care regimen. Conflicts develop with self-management, body image, and peer group acceptance. Teens may acquire the skills to perform tasks related to diabetic care but may lack decision-making skills needed to adjust treatment plan. Teens do not always foresee the consequences of their activities. Self-monitoring of blood glucose levels and feelings of being different are issues common to school- age children.

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). Rationale: 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.

The nurse is taking the history of a client with diabetes who is experiencing autonomic neuropathy. Which would the nurse expect the client to report? A. Skeletal deformities B. Paresthesias C. Erectile dysfunction D. Soft tissue ulceration

C. Erectile dysfunction Rationale: Autonomic neuropathy affects organ functioning. According the American Diabetes Association, up to 50% of men with diabetes develop erectile dysfunction when nerves that promote erection become impaired. Skeletal deformities and soft tissue ulcers may occur with motor neuropathy. Paresthesias are associated with sensory neuropathy.

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 Rationale: 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 student with diabetes reports feeling nervous and hungry. The school nurse assesses the student and finds the child has tachycardia and is diaphoretic with a blood glucose level of 50 mg/dL (2.8 mmol/L). What should the school nurse administer? A. A combination of protein and carbohydrates, such as a small cup of yogurt B. Two teaspoons of sugar dissolved in a cup of apple juice C. Half of a cup of juice, followed by cheese and crackers D. Half a sandwich with a protein-based filling

C. Half of a cup of juice, followed by cheese and crackers Rationale: Initial treatment for hypoglycemia is 15 g concentrated carbohydrate, such as two or three glucose tablets, 1 tube glucose gel, or 0.5 cup juice. Initial treatment should be followed with a snack including starch and protein, such as cheese and crackers, milk and crackers, or half of a sandwich. It is unnecessary to add sugar to juice, even it if is labeled as unsweetened juice, because the fruit sugar in juice contains enough simple carbohydrate to raise the blood glucose level and the additional sugar may result in a sharp rise in blood sugar that will last for several hours.

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) Rationale: 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.

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. Rationale: 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 type 1 diabetes has told the nurse that the client's most recent urine test for ketones was positive. What is the nurse's most plausible conclusion based on this assessment finding? A. The client should withhold the next scheduled dose of insulin. B. The client should promptly eat some protein and carbohydrates. C. The client's insulin levels are inadequate. D. The client would benefit from a dose of metformin.

C. The client's insulin levels are inadequate. Rationale: Ketones in the urine signal that there is a deficiency of insulin and that control of type 1 diabetes is deteriorating. Withholding insulin or eating food would exacerbate the client's ketonuria. Metformin will not cause short-term resolution of hyperglycemia.

A pregnant client has been diagnosed with gestational diabetes. The client is shocked by the diagnosis, stating that they are conscientious about their health, and asks the nurse what causes gestational diabetes. The nurse should explain that gestational diabetes is a result of what etiologic factor? A. Increased caloric intake during the first trimester B. Changes in osmolality and fluid balance C. The effects of hormonal changes during pregnancy D. Overconsumption of carbohydrates during the first two trimesters

C. The effects of hormonal changes during pregnancy Rationale: Hyperglycemia and eventual gestational diabetes develop during pregnancy because of the secretion of placental hormones, which causes insulin resistance. The disease is not the result of food intake or changes in osmolality.

The nurse is assessing a 13-year-old boy with type 2 diabetes mellitus. What would the nurse correlate with disorder? A. The parents report that their child had "a cold or flu" recently. B. Blood pressure is decreased when checking vital signs. C. The parents report that their son "can't drink enough water." D. Auscultation reveals Kussmaul breathing.

C. The parents report that their son "can't drink enough water." Rationale: Unquenchable thirst (polydipsia) is a common finding associated with diabetes mellitus, type 1 and 2. However, reports of flu-like illness and Kussmaul breathing are more commonly associated with type 1 diabetes. Blood pressure is normal with type 1 diabetes and elevated with type 2 diabetes.

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 Rationale: 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.

The nurse is interpreting the negative feedback system that controls endocrine function. What secretion will the nurse correlate as decreasing while blood glucose levels decrease? A. glucagon B. adrenocorticotropic hormone C. insulin D. glycogen

C. insulin Rationale: Feedback is seen in endocrine systems that regulate concentrations of blood components such as glucose. Glucose from the ingested lactose or sucrose is absorbed in the intestine and the level of glucose in blood rises. Elevation of blood glucose concentration stimulates endocrine cells in the pancreas to release insulin. Insulin has the major effect of facilitating entry of glucose into many cells of the body; as a result, blood glucose levels fall. When the level of blood glucose falls sufficiently, the stimulus for insulin release disappears and insulin is no longer secreted. Glycogen is stored in the liver and muscles. It is released to provide energy when the blood glucose levels fall. Glucagon is also produced by the pancreas. Its job is to force the liver to release stored insulin when the body has a need for more insulin. The adrenocorticotropic hormone is produced by the anterior pituitary. Its function is to regulate cortisol. This is needed so the adrenal glands can function properly. It also helps the body respond to stress.

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." Rationale: 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.

When would a child diagnosed with type 1 diabetes mellitus most likely demonstrate a decreased need for insulin? A. During the "honeymoon" phase B. During adolescence C. During growth spurts D. During minor illnesses

A. During the "honeymoon" phase Rationale: During the honeymoon phase, which may last from a few weeks to a year or longer, the child is likely to need less insulin

The nurse is caring for a 9-year-old client newly diagnosed with diabetes. The client has polyuria, polydipsia, and weight loss. Which nursing diagnoses will the nurse include in the care plan? Select all that apply. A. Imbalanced nutrition: less than body requirements B. Deficient fluid volume C. Deficient knowledge regarding disease process D. Noncompliance E. Delayed growth and development

A. Imbalanced nutrition: less than body requirements B. Deficient fluid volume C. Deficient knowledge regarding disease process Rationale: Polyuria (excessive urination), polydipsia (excessive thirst), and weight loss support the diagnoses of deficient fluid volume and imbalanced nutrition: less than body requirements. Being newly diagnosed with the disease at the age of 9 supports the diagnosis of deficient knowledge regarding disease process. There is no data to support noncompliance or delayed growth and development.

What is the primary concern for a 7-year-old child with type 1 diabetes mellitus who asks his mother not to tell anyone at school that he has diabetes? A. The child's safety B. The privacy of the child C. Development of a sense of industry D. Peer group acceptance

A. The child's safety Rationale: Safety is the primary issue. School personnel need to be aware of the signs and symptoms of hypoglycemia and hyperglycemia and the appropriate interventions.

What is the best time for the nurse to assess the peak effectiveness of subcutaneously administered Regular insulin? A. Two hours after administration B. Four hours after administration C. Immediately after administration D. Thirty minutes after administration

A. Two hours after administration Rationale: The peak action of regular (short-acting) insulin is 2-3 hours after subcutaneous administration.

Diabetes insipidus is a disorder of the A. Anterior pituitary B. Posterior pituitary C. Adrenal cortex D. Adrenal medulla

B. Posterior pituitary Rationale: The principal disorder of the posterior pituitary hypo function is diabetes insipidus

What should a nurse advise the parents of a child with type 1 diabetes mellitus who is not eating as a result of a minor illness? A. Give the child half his regular morning dose of insulin B. Substitute simple carbs or calorie-containing liquids for solid foods C. Give the child plenty of unsweetened, clear liquids to prevent dehydration D. Take the child directly to the ED

B. Substitute simple carbs or calorie-containing liquids for solid foods Rationale: A sick-day diet of simple carbs or calorie-containing liquids will maintain normal serum glucose levels and decrease the risk of hypoglycemia

A parents asks the nurse why self-monitoring of blood glucose is being recommended for her child with diabetes. The nurse should base the explanation on the knowledge that A. It is a less expensive method of testing B. It is not as accurate as laboratory testing C. Children are better able to manage the diabetes D. The parents are better able to manage the disease

C. Children are better able to manage the diabetes Rationale: Blood glucose self-management has improved diabetes management and can be successfully by children from the time of diagnosis. Insulin dosages can be adjusted based on blood sugar results. The ability to self-test allows the child to balance, diet, exercise, and insulin. The parents are partners in the process, but the child should be taught how to manage the disease. Blood glucose monitoring is more expensive but provides improved management. It is as accurate as lab testing.

What is the best nursing action when a child with type 1 diabetes mellitus is sweating, trembling, and pale? A. Offer the child a glass of water B. Give the child 5 units of regular insulin subcutaneously C. Give the child a glass of orange juice D. Give the child glucagon subcutaneously

C. Give the child a glass of orange juice Rationale: An easily digested carbohydrate is indicated when a child exhibits symptoms of hypoglycemia. Four ounces of orange juice is an appropriate treatment for the conscious child who is exhibiting signs of hypoglycemia. Subcutaneous injection of glucagon is used to treat hypoglycemia when the child is unconscious.

Which comment by a 12-year-old with type 1 diabetes indicates deficient knowledge. A. I rotate my insulin injection sites every time I give myself an injection B. I keep records of my glucose levels and insulin sites and amounts C. Ill be glad when I can take a pill for my diabetes like my uncle does D. I keep lifesavers in my school bag in case I have a low-sugar reaction

C. Ill be glad when I can take a pill for my diabetes like my uncle does Rationale: Children with type 1 diabetes will require life-long insulin therapy

Which sign, when exhibited by a hospitalized child, should the nurse recognize as a characteristic of diabetes insipidus? A. Weight gain B. Increased urine specific gravity C. Increased urination D. Serum sodium level of 130 mEq/L

C. Increased urination Rationale: The deficiency of antidiuretic hormone associated with diabetes insipidus causes the body to excrete large volumes of dilute urine

Which sign is the nurse most likely to assess in a child with hypoglycemia? A. Urine positive for ketones and serum glucose greater than 300 mg/dL B. Normal sensorium and serum glucose greater than 160 mg/dL C. Irritability and serum glucose less than 60 mg/dL D. Increased urination and serum glucose less than 120 mg/dL

C. Irritability and serum glucose less than 60 mg/dL Rationale: Irritability and serum glucose less than 60 mg/dL are neuroglycopenic manifestations of hypoglycemia

What should the nurse include in the teaching plan for parents of a child with diabetes insipidus who is receiving DDAVP? A. Increase the dosage of DDAVP as the urine specific gravity (SG) increases B. Give DDAVP only if urine output decreases C. The child should have free access to water and toilet facilities at school D. Cleanse skin before administering the transdermal patch

C. The child should have free access to water and toilet facilities at school Rationale: The childs teachers should be aware of the diagnosis and the child should have access to free water and toilet facilities at school. DDAVP needs to be given as ordered by the physician. If the parents are monitoring urine SG at home, they would not increase the medication dose for increased SG; the physician may order an increased dosage for very dilute urine with decreased SG. DDAVP needs to be given continuously as ordered by the physician. DDAVP is typically given intranasally or by sub cut injection. For nocturnal enuresis, it may be given orally.

Which is the nurse's best response to the parents of a 10-year-old child newly diagnosed with type 1 diabetes mellitus who are concerned about the child's continued participation in soccer? A. "Consider the swim team as an alternative to soccer." B. "Encourage intellectual activity rather than participation in sports." C. "It is okay to play sports such as soccer unless the weather is too hot." D. "Give the child an extra 15 to 30 g of carbohydrate snack before soccer practice."

D. "Give the child an extra 15 to 30 g of carbohydrate snack before soccer practice." Rationale: Exercise lowers blood glucose levels. A snack with 15-30 g of carbs before exercise will decrease the risk of hypoglycemia.

Type 1 diabetes mellitus is suspected in an adolescent. Which clinical manifestation may be present? A. Moist skin B. Weight gain C. Fluid overload D. Blurred vision

D. Blurred vision Rationale: Dry skin, weight loss, dehydration, fatigue, and blurred vision are clinical manifestations of type 1 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 Rationale: 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.

The nurse is explaining glycosylated hemoglobin testing to a diabetic client. Which of the following provides the best reason for this order? A. Provides best information on the body's ability to maintain normal blood functioning B. Best indicator for the nutritional state of the client C. Is less costly than performing daily blood sugar test D. Reflects the amount of glucose stored in hemoglobin over past several months.

D. Reflects the amount of glucose stored in hemoglobin over past several months. Rationale: Hemoglobin A1c tests reflect the amount of glucose that is stored in the hemoglobin molecule during its life span of 120 days. This test provides a more accurate picture of overall glucose control in a client. Glycosylated hemoglobin test does not indicate normal blood functioning or nutritional state of the client. Self-monitoring with a glucometer is still encouraged in clients who are taking insulin or have unstable blood glucose levels.

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 Rationale: 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 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. Rationale: Short-acting insulin reaches its peak effectiveness 2 to 3 hours after administration. See Table 30-3 in the text.

A client with diabetes mellitus has a blood glucose level of 40 mg/dL. Which rapidly absorbed carbohydrate would be most effective? A. 1/2 cup fruit juice or regular soft drink B. 4 oz of skim milk C. 1/2 tbsp honey or syrup D. three to five LifeSavers candies

A. 1/2 cup fruit juice or regular soft drink Rationale: In a client with hypoglycemia, the nurse uses the rule of 15: give 15 g of rapidly absorbed carbohydrate, wait 15 minutes, recheck the blood sugar, and administer another 15 g of glucose if the blood sugar is not above 70 mg/dL. One-half cup fruit juice or regular soft drink is equivalent to the recommended 15 g of rapidly absorbed carbohydrate. Eight ounces of skim milk is equivalent to the recommended 15 g of rapidly absorbed carbohydrate. One tablespoon of honey or syrup is equivalent to the recommended 15 g of rapidly absorbed carbohydrate. Six to eight LifeSavers candies is equivalent to the recommended 15 g of rapidly absorbed carbohydrate.

After teaching a group of students about endocrine disorders, the instructor determines that the teaching was successful when the students identify insulin deficiency, increased levels of counterregulatory hormones, and dehydration as the primary cause of which condition? A. diabetic ketoacidosis B. ketone bodies C. ketonuria D. glucosuria

A. diabetic ketoacidosis Rationale: Insulin deficiency, in association with increased levels of counterregulatory hormones (glucagon, growth hormone, cortisol, catecholamines) and dehydration, is the primary cause of diabetic ketoacidosis, a life-threatening form of metabolic acidosis that is a frequent complication of diabetes. The liver converts triglycerides (lipolysis) to fatty acids, which in turn change to ketone bodies. The accumulation and excretion of ketone bodies by the kidneys is called ketonuria. Glucosuria is glucose that is spilled into the urine.

A client with diabetes mellitus is receiving an oral antidiabetic agent. When caring for this client, the nurse should observe for signs of: A. hypoglycemia B. polyuria C. blurred vision D. polydipsia

A. hypoglycemia Rationale: The nurse should observe the client receiving an oral antidiabetic agent for the signs of hypoglycemia. The time when the reaction might occur is not predictable and could be from 30 to 60 minutes to several hours after the drug is ingested.

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. Rationale: 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.

Which type of insulin acts most quickly? A. Regular B. NPH C. Lispro D. Glargine

C. Lispro Rationale: 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.

Which findings should the nurse expect to assess when completing the health history of a child admitted for possible type 2 diabetes? Select all that apply. A. Abrupt onset of symptoms B. Marked weight loss C. Polyuria D. Polydipsia E. Polyphagia

C. Polyuria D. Polydipsia E. Polyphagia Rationale: Type 2 diabetes mellitus is characterized by a gradual onset and is most often associated with obesity and not marked weight loss. Type 1 diabetes is most often abrupt and associated with marked weight loss. Polyuria, polydipsia, and polyphagia are frequent assessment findings in both types of diabetes mellitus.

A client with diabetes is asking the nurse what causes diabetic ketoacidosis (DKA). Which of the following is a correct statement by the nurse? A. "DKA can be caused by taking too much insulin." B. "DKA can be caused by taking too little insulin." C. "DKA can happen without a cause." D. "DKA will not happen with type 1 diabetes."

B. "DKA can be caused by taking too little insulin." Rationale: Three main causes of DKA are decreased or missed dose of insulin, illness or infection, and undiagnosed and untreated diabetes. DKA may be the initial manifestation of type 1 diabetes. For prevention of DKA related to illness, the client should attempt to consume frequent small portions of carbohydrates. Drinking fluid every hour is important to prevent dehydration. Blood glucose and urine ketones must be assessed every 3 to 4 hours, and the client should take the usual dose of insulin.

A client is brought to the emergency department. The client is a type 2 diabetic and is experiencing hyperglycemic hyperosmolar syndrome (HHS). The nurse should identify what components of HHS? Select all that apply. A. Leukocytosis B. Glycosuria C. Dehydration D. Hypernatremia E. Hyperglycemia

B. Glycosuria C. Dehydration E. Hyperglycemia Rationale: In HHS, persistent hyperglycemia causes osmotic diuresis, which results in losses of water and electrolytes. To maintain osmotic equilibrium, water shifts from the intracellular fluid space to the extracellular fluid space. With glycosuria and dehydration, hyponatremia and increased osmolarity occur. Leukocytosis does not take place.

The nurse is administering 10 units of NPH insulin to a child at 8 AM. The nurse would expect this insulin to begin acting at which time? A. By 8:15 AM B. Between 8:30 and 9 AM C. Between 9 and 11 AM D. Around 12 noon

C) Between 9 and 11 AM Rationale: NPH insulin has an onset of action of 1 to 3 hours, so the drug would begin to act between 9 and 11 AM. A rapid-acting insulin would begin to act by 8:15 AM; regular insulin would begin to act between 8:30 and 9 AM. No type of insulin would begin acting around 12 noon.

A client newly diagnosed with type 2 diabetes is attending a nutrition class. What general guideline should the nurse teach the clients at this class? A. Low fat generally indicates low sugar. B. Protein should constitute 30% to 40% of caloric intake. C. Most calories should be derived from carbohydrates. D. Animal fats should be eliminated from the diet.

C. Most calories should be derived from carbohydrates. Rationale: For all levels of caloric intake, 50% to 60% of calories should be derived from carbohydrates, 20% to 30% from fat, and the remaining 10% to 20% from protein. Low fat does not automatically mean low sugar. Dietary animal fat does not need to be eliminated from the diet.

A newly admitted client with a diagnosis of type 1 diabetes asks the nurse what caused their diabetes. When the nurse is explaining to the client the etiology of type 1 diabetes, what process should the nurse describe? A. "The tissues in your body are resistant to the action of insulin, making the glucose levels in your blood increase." B. "Damage to your pancreas causes an increase in the amount of glucose that it releases, and there is not enough insulin to control it." C. "The amount of glucose that your body makes overwhelms your pancreas and decreases your production of insulin." D. "Destruction of special cells in the pancreas causes a decrease in insulin production. Glucose levels rise because insulin normally breaks it down."

D. "Destruction of special cells in the pancreas causes a decrease in insulin production. Glucose levels rise because insulin normally breaks it down." Rationale: Type 1 diabetes is characterized by the destruction of pancreatic beta cells, resulting in decreased insulin production, unchecked glucose production by the liver, and fasting hyperglycemia. Also, glucose derived from food cannot be stored in the liver and remains circulating in the blood, which leads to postprandial hyperglycemia. Type 2 diabetes involves insulin resistance and impaired insulin secretion. The body does not "make" glucose.

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. Rationale: 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.

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

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." Rationale: 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 child who has type 1 diabetes mellitus is brought to the emergency department and diagnosed with diabetic ketoacidosis. What treatment would the nurse expect to administer? A. Regular insulin B. Lispro C. NPH D. Detemir

A. Regular insulin Rationale: Insulin for diabetic ketoacidosis is given intravenously. Only regular insulin can be administered by this route.

A client with a long-standing diagnosis of type 1 diabetes has a history of poor glycemic control. The nurse recognizes the need to assess the client for signs and symptoms of peripheral neuropathy. Peripheral neuropathy constitutes a risk for what nursing diagnosis? A. Infection B. Acute pain C. Acute confusion D. Impaired urinary elimination

A. Infection Rationale: Decreased sensations of pain and temperature place clients with neuropathy at increased risk for injury and undetected foot infections. The neurologic changes associated with peripheral neuropathy do not normally result in pain, confusion, or impairments in urinary function.

A client 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 did the health care provider prescribe for this client? A. A sulfonylurea B. A biguanide C. A thiazolidinedione D. An alpha-glucosidase inhibitor

B. A biguanide Rationale: 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.

A client with type 1 diabetes mellitus is seeing the nurse to review foot care. What would be a priority instruction for the nurse to give the client? A. Examine feet weekly for redness, blisters, and abrasions. B. Avoid the use of moisturizing lotions. C. Avoid hot-water bottles and heating pads. D. Dry feet vigorously after each bath.

C. Avoid hot-water bottles and heating pads. Rationale: High-risk behaviors, such as walking barefoot, using heating pads on the feet, wearing open-toed shoes, soaking the feet, and shaving calluses, should be avoided. Socks should be worn for warmth. Feet should be examined each day for cuts, blisters, swelling, redness, tenderness, and abrasions. Lotion should be applied to dry feet but never between the toes. After a bath, the client should gently, not vigorously, pat feet dry to avoid injury.

The nurse suspects that a 4-year-old with type 1 diabetes is experiencing hypoglycemia based on what findings? Select all that apply. A. Blurred vision B. Dry, flushed skin C. Diaphoresis D. Slurred speech E. Fruity breath odor F. Tachycardia

C. Diaphoresis D. Slurred speech F. Tachycardia Rationale: Manifestations of hypoglycemia include behavioral changes, confusion, slurred speech, belligerence, diaphoresis, tremors, palpitation, and tachycardia. Blurred vision; dry, flushed skin; and fruity breath odor suggest hyperglycemia.

The nurse has told the 14-year-old adolescent with diabetes that the doctor would like to have a hemoglobin A1C test performed. Which comment by the client indicates that she understands what this test is for? A. "That is the test that I take after I have fasted for at least 8 hours." B. "The normal level for my hemoglobin A1C is between 60 to 100 mg/dl." C. "I monitor my own blood glucose every day at home. I don't see why the doctor would want this done." D. "This will tell my doctor what my average blood glucose level has been over the last 2 to 3 months."

D. "This will tell my doctor what my average blood glucose level has been over the last 2 to 3 months." Rationale: Hemoglobin A1C (HgbA1C) provides the physician or nurse practitioner with information regarding the long-term control of glucose levels, as it provides an average of what the blood glucose levels are over a 2 to 3-month period. No fasting is required. Desired levels for children and adolescents 13 to 19 years are less than 7.5%.

A diabetes nurse educator is presenting current recommendations for levels of caloric intake. What are the current recommendations that the nurse would describe? A. 10% of calories from carbohydrates, 50% from fat, and the remaining 40% from protein B. 10% to 20% of calories from carbohydrates, 20% to 30% from fat, and the remaining 50% to 60% from protein C. 20% to 30% of calories from carbohydrates, 50% to 60% from fat, and the remaining 10% to 20% from protein D. 50% to 60% of calories from carbohydrates, 20% to 30% from fat, and the remaining 10% to 20% from protein

D. 50% to 60% of calories from carbohydrates, 20% to 30% from fat, and the remaining 10% to 20% from protein Rationale: Currently, the ADA and the Academy of Nutrition and Dietetics (formerly the American Dietetic Association) recommend that for all levels of caloric intake, 50% to 60% of calories come from carbohydrates, 20% to 30% from fat, and the remaining 10% to 20% from protein. Low fat does not automatically mean low sugar. Dietary animal fat does not need to be eliminated from the diet.

A client has received a diagnosis of type 2 diabetes. The diabetes nurse has made contact with the client and will implement a program of health education. What is the nurse's priority action? A. Ensure that the client understands the basic pathophysiology of diabetes. B. Identify the client's body mass index. C. Teach the client "survival skills" for diabetes. D. Assess the client's readiness to learn.

D. Assess the client's readiness to learn. Rationale: Before initiating diabetes education, the nurse assesses the client's (and family's) readiness to learn. This must precede other physiologic assessments (such as BMI) and providing health education.

A group of students are reviewing information about the various types of insulin used to treat type 1 diabetes. The students demonstrate understanding of the information when they identify which of these insulins as having the longest duration? A. Lispro B. Regular C. NPH D. Glargine

D. Glargine Rationale: Of the insulins listed, glargine (Lantus) has the longest duration of action, that is, 12 to 24 hours. Lispro lasts approximately 3 to 5 hours; regular lasts 5 to 8 hours; and NPH lasts approximately 10 to 16 hours.