Glucose Regulation EAQ

A client with type 1 diabetes is transported via ambulance to the emergency department of the hospital. The client has dry, hot, flushed skin and a fruity odor to the breath and is having Kussmaul respirations. Which complication does the nurse suspect that the client is experiencing? Correct1 Ketoacidosis 2 Somogyi phenomenon 3 Hypoglycemic reaction 4 Hyperosmolar nonketotic coma

1 Ketoacidosis Ketoacidosis occurs when insulin is lacking and carbohydrates cannot be used for energy; this increases the breakdown of protein and fat causing deep, rapid respirations (Kussmaul respirations), decreased alertness, decreased circulatory volume, metabolic acidosis, and an acetone breath. The Somogyi phenomenon is a rebound hyperglycemia induced by severe hypoglycemia; there are not enough data to determine whether this occurred. Hypoglycemia is manifested by cool, moist skin, not hot, dry skin; Kussmaul respirations do not occur with hypoglycemia. Hyperosmolar nonketotic coma usually occurs in clients with type 2 diabetes because available insulin prevents the breakdown of fat.

A 9-year-old child with type 1 diabetes is hospitalized for insulin dosage regulation. A nurse observes the child sneaking food and trying to talk family members into bringing candy. What action should the nurse take when the child complains of feeling hypoglycemic? 1 Test the urine for ketones Correct2 Obtain a blood glucose level 3 Offer orange juice with sugar 4 Determine when the child ate last

2 Obtain a blood glucose level A check of the blood glucose level will confirm whether the child is hypoglycemic. Ketones are not in the urine during a hypoglycemic episode. Although offering orange juice with sugar might be appropriate to counter hypoglycemia, it does not reveal whether the child is hypoglycemic or is being manipulative. Although the nurse may eventually ask when the child ate last, this is not the priority.

An insulin pump is instituted for a client with type 1 diabetes. The nurse plans discharge instructions. Which short-term goal is the priority for this client? 1 "Adhere to the medical regimen." 2 "Remain normoglycemic for three weeks." Correct3 "Demonstrate correct use of the insulin pump." 4 "List three self-care activities that help control the diabetes."

3 "Demonstrate correct use of the insulin pump." Demonstrating correct use of the insulin pump is the short-term, client-oriented goal necessary for the client to manage the pump and avoid hypo- and hyperglycemia; this outcome can be measured by observing a return demonstration by the client. Adhering to the medical regimen is not a short-term goal. Remaining normoglycemic for three weeks is measurable, but requires the client to manage the insulin pump. Although listing three self-care activities that help control the diabetes is a measurable short-term goal, it is not the priority when the client must master use of the insulin pump.

Which information is most important for a large-for-gestational-age (LGA) infant of a diabetic mother (IDM)? 1 Temperature less than 98° F (36.6° C) 2 Heart rate of 110 beats/min Correct3 Blood glucose level less than 40 mg/dL 4 Increasing bilirubin during the first 24 hours

3 Blood glucose level less than 40 mg/dL At birth, circulating maternal glucose is removed; however, the IDM still has a high level of insulin, and rebound hypoglycemia may develop. The temperature-regulating ability of an IDM is similar to that of a healthy neonate, unless the IDM is preterm. A heart rate of 110 beats/min is within the expected range for a newborn. Pathological jaundice is associated with hemolytic diseases such as Rh and ABO incompatibilities and sepsis, not maternal diabetes.

Which statement made by a 28-year-old client recently diagnosed with type 1 diabetes indicates that further education is necessary regarding the teaching plan? 1 "I will need to have my eyes and vision examined once a year." 2 "I will need to check my blood sugar at home to evaluate my response to my treatment plan." 3 "I can improve metabolic and cardiac risk factors of this disease if I follow a low-calorie diet and lose weight." Correct4 "Once I reach my target weight there is a good chance that I will be able to switch from insulin to an oral medication to control my blood sugar."

4 "Once I reach my target weight there is a good chance that I will be able to switch from insulin to an oral medication to control my blood sugar." Type 1 diabetes mellitus (DM) is an autoimmune disorder in which beta cells are destroyed. No insulin or very little insulin is produced. Therefore, a person with Type 1 DM will need lifelong insulin injections to control blood sugar. Early detection of changes in the eye permits treatment plan adjustments that can slow or halt progression of retinopathy. Blood glucose monitoring should be done at home to evaluate treatment plan. Disease risk factors can be improved with weight loss and a low calorie diet.

The health care provider prescribes daily fasting blood glucose levels for a client with diabetes mellitus. The goal of treatment is that the client will have glucose levels within the range of: 1 40 to 65 mg/dL of blood Correct2 70 to 105 mg/dL of blood 3 110 to 145 mg/dL of blood 4 150 to 175 mg/dL of blood

Correct2 70 to 105 mg/dL of blood The range of 70 to 105 mg/dL of blood is the expected range for blood glucose. The range of 40 to 65 mg/dL of blood is indicative of hypoglycemia. The ranges 110 to 145 mg/dL of blood and 150 to 175 mg/dL of blood are indicative of hyerglycemia.

What should a nurse teach the client to do to avoid lipodystrophy when self-administering insulin therapy? 1 Exercise regularly. Correct2 Rotate injection sites. 3 Use the Z-track technique. 4 Avoid massaging the injection site.

Correct2 Rotate injection sites. Fibrous scar tissue can result from the trauma of repeated injections at the same site. Exercise is unrelated to lipodystrophy, but it reduces blood glucose, which decreases insulin requirements. Insulin is given subcutaneously; the Z-track technique is used with some intramuscular injections. Gentle pressure over the injection site after insulin administration promotes absorption.

When obtaining a health history from a client recently diagnosed with type 1 diabetes, the nurse expects the client to report what clinical manifestations? 1 Irritability, polydipsia, and polyuria Correct2 Polyuria, polydipsia, and polyphagia 3 Nocturia, weight loss, and polydipsia 4 Polyphagia, polyuria, and diaphoresis

2 Polyuria, polydipsia, and polyphagia Excessive thirst (polydipsia), excessive hunger (polyphagia), and frequent urination (polyuria) are caused by the body's inability to metabolize glucose adequately. Although polydipsia and polyuria occur with type 1 diabetes, lethargy occurs because of a lack of metabolized glucose for energy. Although polydipsia and weight loss occur with type 1 diabetes, frequent urination occurs throughout a 24-hour period because glucose in the urine pulls fluid with it. Although polyphagia and polyuria occur with type 1 diabetes, diaphoresis occurs with severe hypoglycemia, not hyperglycemia.

After assessing a client, a nurse concludes that the client may be experiencing hyperglycemia. Which clinical findings commonly associated with hyperglycemia support the nurse's conclusion? (Select all that apply.) Correct1 Polyuria Correct2 Polydipsia Correct3 Polyphagia 4 Polyphrasia 5 Polydysplasia

Correct1 Polyuria Correct2 Polydipsia Correct3 Polyphagia Polyuria is excessive urination associated with osmotic diuresis. Polydipsia is excessive thirst associated with hyperglycemia; thirst is the response to osmotic diuresis and glycosuria. Polyphagia is associated with the catabolic state induced by insulin deficiency. Polyphrasia is excessive talking associated with mental illness, not hyperglycemia. Polydysplasia is related to multiple developmental abnormalities and is unrelated to hyperglycemia.