glucose regulation EAQ

Which nursing intervention is the priority when a client is first admitted with hyperglycemic hyperosmolar nonketotic syndrome (HHNS)?

Administering fluid replacement

A client with type 1 diabetes requests information about the differences between penlike insulin delivery devices and syringes. Which information would the nurse provide about the penlike devices?

"Penlike devices provide a more accurate dose delivery." because they are easy to use. promote adherence because they can be administered discreetly. disadvantage is the injection time will be longer, device must remain in place several seconds after injected to make sure insulin doesn't leak out

Which finding would lead the nurse to recheck the blood glucose level of a diabetic client before administering a mealtime insulin dose? **Select all that apply - Confusion - Drowsiness - Diaphoresis - Nervousness - Heart rate 110 beats/min

- Confusion - Drowsiness - Diaphoresis - Heart rate 110 beats/min

Which finding would lead the nurse to recheck the blood glucose level of a diabetic client before administering a mealtime insulin dose? ***Select all that apply - Confusion - Drowsiness - Diaphoresis - Nervousness - Heart rate 110 beats/min

- Confusion - Drowsiness - Diaphoresis - Nervousness - Heart rate 110 beats/min

Which advice will the nurse provide to a client who is taking an oral hypoglycemic daily for type 2 diabetes who develops an infection with anorexia? **Select all that apply - Avoid solid food - Continue to take the oral medication - Drink fluids throughout the day - Monitor capillary glucose levels - Do not take medication until tolerating food

- Continue to take the oral medication - Drink fluids throughout the day - Monitor capillary glucose levels

Which response indicates that the client receiving total parenteral nutrition is experiencing hyperglycemia? **Select all that apply - Polyuria - Polydipsia - Paralytic ileus - Respiratory rate of 26 breaths/min - Serum glucose of 105 mg/dL (5.8 mmol/L)

- Polyuria - Polydipsia - Respiratory rate of 26 breaths/min

which descriptors for maturity-onset diabetes of the young (MODY) would the nurse identify as accurate?

-autosomal dominant -characterized by young age of onset (typically before 25) not associated with obesity or htn like DMII. its a single gene mutation that leads to a beta cell dysfunction with an inability of the pancreas to produce sufficient amounts of insulin, which makes insulin necessary

Glucose transportation into the cells through cell membranes take place in which order?

1. Secretion of proinsulin by beta cells 2. Storage of proinsulin in the pancreas 3. Transformation of proinsulin into active insulin 4. Attachment of insulin to cell receptors

Which client is at risk for developing type 2 diabetes mellitus (DM)? Select all that apply.

15-year-old male who plays video games 6 hours per day o 36-year-old female with a history of gestational diabetes o 47-year-old male who weighs 250 pounds and is 5' 9" tall o 28-year-old female with polycystic ovarian syndrome (POS) o 60-year-old male of Native American descent who abuses alcohol POS can affect insulin resistance 15 y/o is too sedentary and can lead to obesity

A client's breath has a sweet, fruity odor. Which condition is likely affecting this client? A. Gum disease B. Uremic acidosis C. Diabetic acidosis D. Infection inside a cast

C. Diabetic acidosis

The risk for which pregnancy complication is increased in the client with type 1 diabetes mellitus? A. Hypertensive disorders of pregnancy B. Placenta accreta C. Increased appetite D. Oligohydramnios in the third trimester

A. Hypertensive disorders of pregnancy

a child with type 1 diabetes is exhibiting deep rapid respirations; flushed, dry cheeks; abdominal pain with nausea; and increased thirst. which blood pH and glucose level would the nurse expect the laboratory tests to reveal?

7.20 and 460 mg/dL

Which blood glucose levels would the nurse identify as hypoglycemia? A. 68 mg/dL (3.8 mmol/L) B. 78 mg/dL (4.3 mmol/L) C. 88 mg/dL (4.9 mmol/L) D. 98 mg/dL (5.4 mmol/L)

A. 68 mg/dL (3.8 mmol/L)

Which information would the nurse include in a teaching plan about what causes diabetic acidosis? A. A breakdown of fat stores for energy B. Ingestion of too many highly acidic foods C. Excessive secretion of endogenous insulin D. Increased amounts of cholesterol in the extracellular compartment

A. A breakdown of fat stores for energy

Why is blood glucose self-monitoring preferred over urine glucose testing? A. Blood glucose monitoring is more accurate B. Blood glucose monitoring is easier to perform C. Blood glucose monitoring is done by the client D. Blood glucose monitoring is not influenced by medications

A. Blood glucose monitoring is more accurate

Which action would the nurse take after contacting the primary health care provider of a post-surgical client complaining of nausea, fatigue, and a headache during the fourth hour of the infusion of total parenteral nutrition (TPN) instituted via a central venous infusion who has an hourly urine output that is twice the amount of the previous hour? A. Check the serum glucose level B. Obtain an oxygen saturation level C. Administer a prescribed analgesic D. Elevate the head of the bed

A. Check the serum glucose level

Which information would the nurse base a response on to a parent who asks for guidance regarding who to tell of the diagnosis of diabetes of their child who plays on the soccer team? A. Children with diabetes who participate in active sports can have episodes of hypoglycemia B. Children may have to leave athletic teams if school authorities learn that they have diabetes C. The school nurse will treat the child if clinical findings of hypoglycemia are recognized early D. The coach might violate confidentiality by discussing the child's condition with other faculty members

A. Children with diabetes who participate in active sports can have episodes of hypoglycemia

Which information is important is for the nurse to include concerning insulin administration when discussing insulin needs with an adolescent with recently diagnosed type 1 diabetes? A. Insulin will be required throughout life B. Insulin may be taken orally until adulthood C. Insulin needs increase with strenuous exercise D. Insulin needs decrease in the presence of an infection

A. Insulin will be required throughout life

An increase in which blood component is responsible for the acidosis related to untreated diabetic mellitus? A. Ketones B. Glucose C. Lactic acid D. Glutamic acid

A. Ketones

The nurse is teaching a client newly diagnosed with type 1 diabetes about self-care. Which is the primary long-term goal? A. Maintaining normoglycemia B. Complying with the diabetic diet C. Adhering to an exercise program D. Developing a nonstressful lifestyle

A. Maintaining normoglycemia

The nurse provides education about signs and symptoms of hypoglycemia to a client with newly diagnosed type 1 diabetes. The nurse concludes that the teaching was effective when the client acknowledges the need to drink orange juice when experiencing which symptoms? A. Nervous and weak B. Thirsty with a headache C. Flushed and short of breath D. Nausea and abdominal cramps

A. Nervous and weak

Which formula is most preferable for an infant hat has lactose intolerance? A. Soy-based formula B. Whey hydrolysate formula C. Cow's milk-based formula D. Amino acid-based formula

A. Soy-based formula

Which mechanism of action explains how glyburide decreases serum glucose levels? A. Stimulates the pancreas to produce insulin B. Accelerates the liver's release of stored glycogen C. Increases glucose transport across the cell membrane D. Decreases absorption of glucose from the gastrointestinal system

A. Stimulates the pancreas to produce insulin

Which response would a nurse give to a client who asks "Why can't I take the insulin in pills instead of taking shots?" during a teaching session about insulin injections? A. "Insulin cannot be manufactured in pill form" B. "Insulin is destroyed by gastric juices, rendering it ineffective" C. "Your health care provider decides the route of administration D. "Your health care provider will prescribe pills when you are ready"

B. "Insulin is destroyed by gastric juices, rendering it ineffective"

Which mineral deficiency would a nurse suspect in a client who reports tingling in the fingers and around the mouth and exhibits carpopedal spasm and tremors after a surgical thyroidectomy? A. Potassium B. Calcium C. Magnesium D. Sodium

B. Calcium

An unconscious adolescent with type 1 diabetes is brought to the ED. The blood glucose level is 742 mg/dL (41.2 mmol/L). Which finding would the nurse expect during the initial assessment? A. Pyrexia B. Hyperpnea C. Bradycardia D. Hypertension

B. Hyperpnea

Which type of insulin would the nurse recognize as compatible with IV solutions when caring for a client with diabetes mellitus who is scheduled to recieve an intravenous (IV) administration of 25 units of insulin in 250 mL normal saline? A. NPH insulin B. Insulin lispro C. Insulin detemir D. Insulin glargine

B. Insulin lispro

Which initial response would the nurse make to a 67-year-old man with type 2 diabetes who sadly confides in the nurse that he has been unable to have an erection for several years? A. 'At your age, sex isn't that important' B. 'That is a natural occurrence at your age' C. 'You sound upset about not being able to have an errection' D. 'Maybe it's time for you to speak to your primary health care provider about this'

C. 'You sound upset about not being able to have an errection'

Between which weeks of gestation would a client with type 1 diabetes expect to increase her insulin dosage? A. 10th and 12th week of gestation B. 18th and 22nd weeks of gestation C. 24th and 28th weeks of gestation D. 36th and 40th weeks of gestation

C. 24th and 28th weeks of gestation

Between which weeks of gestation would a client with type 1 diabetes expect to increase her insulin dosage? A. 10th and 12th weeks of gestation B. 18th and 22nd weeks of gestation C. 24th and 28th weeks of gestation D. 36th and 40th weeks of gestation

C. 24th and 28th weeks of gestation end of second trimester, and beginning of 3rd due to increase in maternal resistance to insulin

Which intervention would the nurse implement for a client who has type 1 diabetes and has an elevate blood glucose? A. Administer an oral hypoglycemic B. Institute urine glucose monitoring C. Give supplemental doses of regular insulin D. Decrease the rate of intravenous fusion

C. Give supplemental doses of regular insulin

Which condition would the nurse identify as the likely cause of profound weakness and nervousness in a client that became confused shortly after self-administering the morning dose of 10 units of regular insulin and 25 units of NPH insulin after a light breakfast with no additional intake in the 3 hours since that time? A. Hyperglycemia B. Hyperinsulinemia C. Hypoglycemia D. Hypoinsulinemia

C. Hypoglycemia

A client is diagnosed with hyperthyroidism and is treated with 131I. Before discharge the nurse teaches the client to observe for signs and symptoms of therapy-induced hypothyroidism. Which signs and symptoms should be included in the teaching?

Fatigue, dry skin, progressive weight gain

When teaching a client with type 2 diabetes, which statement by the nurse reflects accurate information about preparing for a serum glucose test? A. "Eat your usual breakfast B. "Have clear liquids for breakfast" C. "Take your medication before the test" D. "Do not ingest anything before the test"

D. "Do not ingest anything before the test"

Which response would the nurse give to a client with type 1 diabetes who asks what causes several brown spots on the skin? A. "The brown spots reflect the accumulation of blood fats in the skin; they should disappear" B. "Those spots indicate a high glucose content in the skin that may get infected if left untreated" C. "They are the result of diseased small vessels in the shins and may spread if not treated soon" D. "Those brown spots result from small blood vessel damage; the blood contains iron, which leaves a brown spot"

D. "Those brown spots result from small blood vessel damage; the blood contains iron, which leaves a brown spot"

A client with diabetes mellitus who shows decreased glucose tolerance is at risk for which complication? A. Cystitis B. Thin and dry skin C. Decreased bone density D. Frequent yeast infections

D. Frequent yeast infections

Which test is considered the most accurate in the evaluation of the effectiveness of diet and insulin therapy over time? A. Blood pH B. Serum protein level C. Serum glucose level D. Glycosylated hemoglobin

D. Glycosylated hemoglobin

Which response would be given by the nurse of an adolescent who has just been found to have type 1 diabetes and asks about exercise?

Extra snacks are needed before exercise

The laboratory findings of an obese hypertensive adolescent reveal hyperinsulinemia and dyslipidemia. Which condition would the nurse anticipate incorporating into the plan of care?

Insulin resistance syndrome, aka metabolic syndrome

Which fluid shift will the nurse take into consideration when assessing a client with type 1 diabetes who is experiencing a fluid imbalance?

Intracellular to intravascular as a result of hyperosmolarity osmotic effect of hyperglycemia pulls fluid from the cells, resulting in cellular dehydration

which condition would cause a nontender 5-cm indurated region on the upper arm of a client with type 1 diabetes who says to the nurse, "that is where i give myself insulin shots"

Lipodystrophy a non inflammatory reaction causing localized atrophy or hypertrophy and a localized increase in collagen deposits. Injections will not cause a horny growth such as a wart or callus

Which nursing action is important when a client with type 1 diabetes develops heart failure and digoxin is prescribed

Monitor the client for cardiac dysrhythmias speed of conduction is decreased when digoxin is given, and this can result in a variety of cardiac dysrhythmias. administration times do not have to be coordinated.

While hospitalized, a client with diabetes is observed picking at calluses on the feet. Which intervention should the nurse implement immediately?

Teach the client the importance of effective foot care.

A client has been placing used insulin needles in a container sealed with heavy-duty tape. Where would the nurse tell the client to dispose of the container?

The local hazardous waste collection site

A client with adrenal insufficiency reports feeling weak and dizzy, especially in the morning. What should the nurse determine is the most probable cause of these symptoms?

a hypoglycemic reaction deficiency of glucocorticoids causes hypoglycemia in clients with addison's disease (adrenal insufficiency)

which clinical finding supports the conclusion by a nurse that a client has had a hypoglycemic reaction to insulin?

irritability heart palpitations

for which condition is an oral hypoglycemic agent indicated

reduced insulin production oral hypoglycemics may be helpful when some functioning of the beta cells exists, as in type 2 diabetes.

Which instruction would the nurse provide to a 6'0", 160-pound client newly diagnosed with type 1 diabetes who wants to self-administer injections with an insulin pen? **Select all that apply - Prime the needle with two units - Use a 29-gauge insulin needle - Give the injection at 45-degree angle - Refrain from recapping the needle - Dial the pen to deliver the unit dose

- Prime the needle with two units - Use a 29-gauge insulin needle - Give the injection at 45-degree angle - Refrain from recapping the needle - Dial the pen to deliver the unit dose

Which condition is likely being experienced by a client receiving NPH insulin every morning who reports feeling nervous at 4:30 PM and has skin that is moist and cool? A. Hyperosmolar hyperglycemic nonketotic state B. Ketoacidosis C. Glycogenesis D. Hypoglycemia

D. Hypoglycemia

which is the reason a nurse would monitor a client with a diagnosis of cushing syndrome for symptoms for diabetes mellitus?

Glucocorticoids accelerate the process of gluconeogenesis

Which hormone would the nurse identify as inhibiting insulin and glucagon secretion? A. Amylin B. Somatostatin C. Triiodothyronine (T3) D. Pancreatic polypeptide

B. Somatostatin it's a hormone that inhibits insulin and glucagon secretion, as well as growth hormone, tsh, and cholecystokinin.

Which complication associated with type 1 diabetes should the nurse include in the teaching plan for the parent of a newly diagnosed child? A. Obesity B. Ketoacidosis C. Resistance to treatment D. Hypersensitivity to other medications

B. Ketoacidosis

Which medication is responsible for neonatal hypoglycemia? A. Warfarin B. Simvastatin C. Tolbutamide D. Methimazole

C. Tolbutamide an oral hypoglycemic agent used for DMII. known to have effects such as neonatal hypoglycemia

Which is a risk factor of necrotizing enterocolitis in the preterm infant? A. Polycythemia B. Hypoglycemia C. Ventilatory support D. Antibiotic administration

A. Polycythemia

Which chemical buffers excessive acetoacetic acid? A. Potassium B. Sodium bicarbonate C. Carbon dioxide D. Sodium chloride

B. Sodium bicarbonate

Which response will the nurse provide to a client with type 2 diabetes taking one glyburide tablet daily who asks whether an extra table should be taken before exercise? A. "You will need to decrease how much you are exercising" B. "An extra pill will help your body use glucose when exercising" C. "The amount of medication you need to take is not related to exercising" D. "Do not take an extra pill because you may become hypoglycemic when exercising"

D. "Do not take an extra pill because you may become hypoglycemic when exercising"

A full-term infant who is large for gestational age (LGA) should be monitored for which risk? A. Hypotension B. Hypothermia C. Hypocalcemia D. Hypoglycemia

D. Hypoglycemia

With which condition would the nurse associate the response of diaphoresis, weakness, and pallor at 3:00 PM in a client with type 1 diabetes who receives 30 units of neutral protamine Hagedorn (NPH) insulin at 7:00 AM? A. Diabetic coma B. Hyperosmolar hyperglycemic nonketotic syndrome C. Diabetic ketoacidosis D. Hypoglycemic reaction

D. Hypoglycemic reaction

With which condition would the nurse associate the response of diaphoresis, weakness, and pallor at 3:30 PM in a client with type 1 diabetes who receives 30 units of protamine Hagedorn (NPH) insulin at 7:00AM? A. Diabetic coma B. Hyperosmolar hyperglycemic nonketotic syndrome C. Diabetic ketoacidosis D. Hypoglycemic reaction

D. Hypoglycemic reaction

In which parts of the kidney are glucose and amino acids reabsorbed? A. Distal tubule B. Loop of Henle C. Collecting duct D. Proximal tubule

D. Proximal tubule

Before having surgery, a client with type 1 diabetes insulin requirements are elevated but well controlled. Which insulin requirements would the nurse anticipate for this client postoperatively? A. Decrease B. Fluctuate C. Increase sharply D. Remain elevated

D. Remain elevated

which indicator of client status is important for the nurse to assess in a client receiving total parenteral nutrition?

blood glucose if it exceeds the renal threshold for glucose reabsorption in the kidney tubules (approximately 160-180) will cause cellular osmotic diuresis, resulting in dehydration.

Which molecule excessively accumulate in the blood to precipitate the signs and symptoms associated with diabetic coma? A. Sodium bicarbonate, causing alkalosis B. Ketones as a result of rapid fat breakdown, causing acidosis C. Nitrogen from protein catabolism, causing ammonia intoxication D. Glucose from rapid carbohydrate metabolism, causing drowsiness

B. Ketones as a result of rapid fat breakdown, causing acidosis

When obtaining a health history from a client recently diagnosed with type 1 diabetes, the nurse would expect the client to report which clinical manifestation? A. Nervousness B. Polyuria C. Nocturia D. Diaphoresis

B. Polyuria

Which advice will the nurse give the client to avoid lipodystrophy when self-administering insulin therapy? A. Exercise regularly B. Rotate injection sites C. Use the Z-track technique D. Vigorously massage the injection site

B. Rotate injection sites

Which nursing assessment finding would indicate that a client receiving total parenteral nutrition has hyperglycemia? A. Paralytic ileus B. Respiratory rate below 16 C. A fruity odor to the breath D. Serum glucose of 105 mg/dL

C. A fruity odor to the breath

Which action would be taken by the nurse caring for a client with type 1 diabetes mellitus who has a finger-stick glucose level of 258 mg/dL (14.3 mmol/L) at bedtime and a prescription for sliding-scale regular insulin? A. Call the health care provider B. Encourage intake of fluids C. Administer the insulin as prescribed D. Give the client 4 ounces of orange juice

C. Administer the insulin as prescribed

While obtaining a client's health history, which factor would the nurse identify as predisposing the client to type 2 diabetes? A. Having diabetes insipidus B. Eating low-cholesterol foods C. Being 20 pounds (9kg) overweight D. Drinking a daily alcoholic beverage

C. Being 20 pounds (9kg) overweight

Which statement will the nurse need to consider when developing the teaching plan for a client with type 2 diabetes prescribed an oral hypoglycemic medication? A. Oral hypoglycemics work by decreasing absorption of carbohydrates B. Oral hypoglycemics work by stimulating the pancreas to produce insulin C. Clients taking oral hypoglycemics may subconsciously relax dietary rules to gain a sense of control D. Serious adverse effects are not a problem for oral hypoglycemics

C. Clients taking oral hypoglycemics may subconsciously relax dietary rules to gain a sense of control

Which short-term goal is the priority for a client with a new insulin pump who is receiving discharge instructions? A. Plan daily intake incorporating diabetic diet guidelines B. Demonstrate proper subcutaneous insulin injection technique C. Demonstrate correct use of the insulin pump D. List three self-care activities that help control the diabetes

C. Demonstrate correct use of the insulin pump

Which action would the nurse take when a client with type 1 diabetes reports hunger, thirst, tiredness, and frequent urination? A. Administration prescribed insulin B. Notify the health care provider immediately C. Determine client's blood glucose level D. Provide a peanut butter and graham cracker snack

C. Determine client's blood glucose level

Why is 15g of a simple sugar administered when a client with diabetes experiences hypoglycemia? A. Inhibits glycogenesis B. Stimulates release of insulin C. Increases blood glucose levels D. Provides more storage of glucose

C. Increases blood glucose levels

Which adverse effect of metformin will a nurse teach a client with type 2 diabetes to monitor for when used as monotherapy? A. Weight gain B. Constipation C. Lactic acidosis D. Hypoglycemia

C. Lactic acidosis