Hinkle Chapter 46 - Adult Diabetes

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

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. Erectile dysfunction C. Paresthesias D. Soft tissue ulceration

B. Erectile dysfunction Explanation: 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.

A nurse is assigned to care for a postoperative client with diabetes mellitus. During the assessment interview, the client reports that he's impotent and says he's concerned about the effect on his marriage. In planning this client's care, the most appropriate intervention would be to: A. provide support for the spouse or significant other. B. suggest referral to a sex counselor or other appropriate professional. C. encourage the client to ask questions about personal sexuality. D. provide time for privacy.

B. suggest referral to a sex counselor or other appropriate professional. Explanation: The nurse should refer this client to a sex counselor or other professional. Making appropriate referrals is a valid part of planning the client's care. The nurse doesn't normally provide sex counseling.

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

C. Diet soda Explanation: 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 with type 1 diabetes is experiencing polyphagia. The nurse knows to assess for which additional clinical manifestation(s) associated with this classic symptom? A. Weight gain B. Dehydration C. Muscle wasting and tissue loss D. Altered mental state

C. Muscle wasting and tissue loss Explanation: Polyphagia results from the catabolic state induced by insulin deficiency and the breakdown of proteins and fats. Although clients with type 1 diabetes may experience polyphagia (increased hunger), they may also exhibit muscle wasting, subcutaneous tissue loss, and weight loss due to impaired glucose and protein metabolism and impaired fatty acid storage.

Which is a characteristic of type 2 diabetes? A. ketosis-prone when insulin absent B. presence of islet antibodies C. insulin resistance D. little or no insulin

C. insulin resistance Explanation: Type 2 diabetes is characterized by either a decrease in endogenous insulin or an increase accompanied by insulin resistance. Type 1 diabetes is characterized by production of little or no insulin; the client with type 1 diabetes is ketosis-prone when insulin is absent and often has islet cell antibodies.

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. polydipsia. B. polyuria. C. polyphagia. D. anorexia.

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

D. "Always follow the same order when drawing the different insulins into the syringe." Explanation: 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 administering insulin to a client with type 1 diabetes, which of the following would be most important for the nurse to keep in mind? A. Technique for injecting B. Duration of the insulin C. Area for insulin injection D. Accuracy of the dosage

D. Accuracy of the dosage Explanation: The measurement of insulin is most important and must be accurate because clients may be sensitive to minute dose changes. The duration, area, and technique for injecting should also to be noted.

A client is admitted to the unit with diabetic ketoacidosis (DKA). Which insulin would the nurse expect to administer intravenously? A. NPH B. Lente C. Glargine D. Regular

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

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

A. "Ketones will tell us if your body is using other tissues for energy." Explanation: 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.

What is the duration of regular insulin? A. 4 to 6 hours B. 12 to 16 hours C. 3 to 5 hours D. 24 hours

A. 4 to 6 hours Explanation: 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.

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

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

The client with diabetes asks the nurse why shoes and socks are removed at each office visit. The nurse gives which assessment finding as the explanation for the inspection of feet? A. Sensory neuropathy B. Retinopathy C. Autonomic neuropathy D. Nephropathy

A. Sensory neuropathy Explanation: Neuropathy results from poor glucose control and decreased circulation to nerve tissues. Neuropathy involving sensory nerves located in the periphery can lead to lack of sensitivity, which increases the potential for soft tissue injury without client awareness. The client's feet are inspected on each visit to ensure no injury or pressure has occurred. Autonomic neuropathy, retinopathy, and nephropathy affect nerves to organs other than feet.

A client is receiving insulin lispro at 7:30 AM. The nurse ensures that the client has breakfast by which time? A. 8:30 AM B. 7:45 AM C. 8:15 AM D. 8:00 AM

B. 7:45 AM Explanation: Insulin lispro has an onset of 5 to 15 minutes. Therefore, the nurse would need to ensure that the client has his breakfast by 7:45 AM at the latest. Otherwise, the client may experience hypoglycemia.

Which statement best indicates that a client understands how to administer his own insulin injections? A. "I need to be sure no air bubbles remain." B. "I need to wash my hands before I give myself my injection." C. "If I'm not feeling well, I can get a friend or neighbor to help me." D. "I wrote down the steps in case I forget what to do."

D. "I wrote down the steps in case I forget what to do." Explanation: The fact that the client has written down each step of insulin administration provides the best assurance that he'll follow through with all the proper steps. Awareness of air bubbles and hand washing indicate that the client understands certain aspects of giving an injection, but doesn't confirm he understands all of the steps. Saying that he can ask a friend or neighbor for help indicates a need for further instruction.

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. "Destruction of special cells in the pancreas causes a decrease in insulin production. Glucose levels rise because insulin normally breaks it down." 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. "The tissues in your body are resistant to the action of insulin, making the glucose levels in your blood increase."

A. "Destruction of special cells in the pancreas causes a decrease in insulin production. Glucose levels rise because insulin normally breaks it down." Explanation: 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.

During a routine medical evaluation, a client is found to have a random blood glucose level of 210 mg/dL. Which client statement(s) made by the client are concerning to the nurse? Select all that apply. A. "I cannot seem to quench my thirst." B. "I sleep at least 8 hours each night." C. "I have lost 10 pounds without even trying." D. "I have to void nearly every hour." E. "At times my vision is blurry."

A. "I cannot seem to quench my thirst." C. "I have lost 10 pounds without even trying." D. "I have to void nearly every hour." E. "At times my vision is blurry." Explanation: Criteria for the diagnosis of diabetes include symptoms of diabetes plus a random or casual plasma glucose concentration equal to or greater than 200 mg/dL. Symptoms of diabetes include vision changes, polyuria (or the increased need to urinate), polydipsia (or increased thirst), and sudden weight loss.

A client with type 2 diabetes has recently been prescribed acarbose, and the nurse is explaining how to take this medication. The teaching is determined to be effective based on which statement by the client? A. "I will take this medication in the morning, with my first bite of breakfast." B. "It does not matter what time of day I take this medication." C. "I will take this medication in the morning, 15 minutes before breakfast." D. "This medication needs to be taken after the midday meal."

A. "I will take this medication in the morning, with my first bite of breakfast." Explanation: Alpha-glucosidase inhibitors such as acarbose and miglitol, delay absorption of complex carbohydrates in the intestine and slow entry of glucose into systemic circulation. They must be taken with the first bite of food to be effective.

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

A. "You should take your insulin after you eat breakfast and dinner." Explanation: 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 client with type 1 diabetes is scheduled to receive 30 units of 70/30 insulin. There is no 70/30 insulin available. As a substitution, the nurse may give the client: A. 21 units regular insulin and 9 units NPH. B. 20 units regular insulin and 10 units NPH. C. 9 units regular insulin and 21 units neutral protamine Hagedorn (NPH). D. 10 units regular insulin and 20 units NPH.

A. 21 units regular insulin and 9 units NPH. Explanation: A 70/30 insulin preparation is 70% NPH and 30% regular insulin. Therefore, a correct substitution requires mixing 21 units of NPH and 9 units of regular insulin. The other choices are incorrect dosages for the ordered insulin.

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

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

A client with type 1 diabetes presents with a decreased level of consciousness and a fingerstick glucose level of 39 mg/dl. His family reports that he has been skipping meals in an effort to lose weight. Which nursing intervention is most appropriate? A. Administering 1 ampule of 50% dextrose solution, per physician's order B. Inserting a feeding tube and providing tube feedings C. Observing the client for 1 hour, then rechecking the fingerstick glucose level D. Administering a 500-ml bolus of normal saline solution

A. Administering 1 ampule of 50% dextrose solution, per physician's order Explanation: The nurse should administer 50% dextrose solution to restore the client's physiological integrity. Feeding through a feeding tube isn't appropriate for this client. A bolus of normal saline solution doesn't provide the client with the much-needed glucose. Observing the client for 1 hour delays treatment. The client's blood glucose level could drop further during this time, placing him at risk for irreversible brain damage.

A client newly diagnosed with type 1 diabetes has an unusual increase in blood glucose from bedtime to morning. The physician suspects the client is experiencing insulin waning. Based on this diagnosis, the nurse expects which change to the client's medication regimen? A. Administering a dose of intermediate-acting insulin before the evening meal B. Changing the time of evening injection of intermediate-acting insulin from dinnertime to bedtime C. Increasing morning dose of long-acting insulin D. Decreasing evening bedtime dose of intermediate-acting insulin and administering a bedtime snack

A. Administering a dose of intermediate-acting insulin before the evening meal Explanation: Insulin waning is a progressive rise in blood glucose form bedtime to morning. Treatment includes increasing the evening (before dinner or bedtime) dose of intermediate-acting or long-acting insulin or instituting a dose of insulin before the evening meal if that is not already part of the treatment regimen.

A client with diabetic ketoacidosis was admitted to the intensive care unit 4 hours ago and has these laboratory results: blood glucose level 450 mg/dl, serum potassium level 2.5 mEq/L, serum sodium level 140 mEq/L, and urine specific gravity 1.025. The client has two IV lines in place with normal saline solution infusing through both. Over the past 4 hours, his total urine output has been 50 ml. Which physician order should the nurse question? A. Change the second IV solution to dextrose 5% in water. B. Add 40 mEq potassium chloride to an infusion of half normal saline solution and infuse at a rate of 10 mEq/hour. C. Hold insulin infusion for 30 minutes. D. Infuse 500 ml of normal saline solution over 1 hour

A. Change the second IV solution to dextrose 5% in water Explanation: The nurse should question the physician's order to change the second IV solution to dextrose 5% in water. The client should receive normal saline solution through the second IV site until his blood glucose level reaches 250 mg/dl. The client should receive a fluid bolus of 500 ml of normal saline solution. The client's urine output is low and his specific gravity is high, which reveals dehydration. The nurse should expect to hold the insulin infusion for 30 minutes until the potassium replacement has been initiated. Insulin administration causes potassium to enter the cells, which further lowers the serum potassium level. Further lowering the serum potassium level places the client at risk for life-threatening cardiac arrhythmias.

The nurse is preparing an educational session about foot care for clients with diabetes. Which information will the nurse include in the education? Select all that apply. A. Check the inside of shoes before putting them on. B. Check the bottom of the feet with a mirror every day. C. Apply lotion between the toes after bathing. D. Wear binding compression socks daily. E. Shave any calluses with a disposable razor.

A. Check the inside of shoes before putting them on B. Check the bottom of the feet with a mirror every day Explanation: The client with diabetes needs to be instructed on foot care in order to prevent the development of wounds. Information about foot care includes checking the inside of shoes before putting them on to ensure that there is nothing inside the shoe. The bottom of the feet should be checked every day and a mirror helps to visualize the bottom of the feet. The client should never go barefoot. Wearing binding compression socks would constrict the feet. The client with diabetes should wear well-fitted shoes. Calluses are not to be shaved as this could cause a wound. A podiatrist should be consulted for any calluses on the feet. Lotion is not to be applied between the toes after bathing since it can promote fungal growth due to moisture.

A nurse is teaching a client with type 1 diabetes how to treat adverse reactions to insulin. To reverse hypoglycemia, the client ideally should ingest an oral carbohydrate. However, this treatment isn't always possible or safe. Therefore, the nurse should advise the client to keep which alternate treatment on hand? A. Glucagon B. Epinephrine C. 50% dextrose D. Hydrocortisone

A. Glucagon Explanation: During a hypoglycemic reaction, a layperson may administer glucagon, an antihypoglycemic agent, to raise the blood glucose level quickly in a client who can't ingest an oral carbohydrate. Epinephrine isn't a treatment for hypoglycemia. Although 50% dextrose is used to treat hypoglycemia, it must be administered I.V. by a skilled health care professional. Hydrocortisone takes a relatively long time to raise the blood glucose level and therefore isn't effective in reversing hypoglycemia.

The client who is managing diabetes through diet and insulin control asks the nurse why exercise is important. Which is the best response by the nurse to support adding exercise to the daily routine? A. Increases ability for glucose to get into the cell and lowers blood sugar B. Decreases need for pancreas to produce more cells C. Creates an overall feeling of well-being and lowers risk of depression D. Decreases risk of developing insulin resistance and hyperglycemia

A. Increases ability for glucose to get into the cell and lowers blood sugar Explanation: Exercise increases trans membrane glucose transporter levels in the skeletal muscles. This allows the glucose to leave the blood and enter into the cells where it can be used as fuel. Exercise can provide an overall feeling of well-being but is not the primary purpose of including in the daily routine of diabetic clients. Exercise does not stimulate the pancreas to produce more cells. Exercise can promote weight loss and decrease risk of insulin resistance but not the primary reason for adding to daily routine.

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

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

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. Insulin production insufficient B. Onset most common during adolescence C. Less common than type 1 diabetes D. Little to no relation to pre-diabetes

A. Insulin production insufficient Explanation: Type 2 diabetes is characterized by insulin resistance or insufficient insulin production. It is more common in aging adults, and now accounts for 20% of all newly diagnosed cases. Type 1 diabetes is more likely in childhood and adolescence although it can occur at any age. It accounts for approximately 5% to 10% of all diagnosed cases of diabetes. Pre-diabetes can lead to type 2 diabetes.

Which term refers to the progressive increase in blood glucose from bedtime to morning? A. Insulin waning B. Dawn phenomenon C. Diabetic ketoacidosis (DKA) D. Somogyi effect

A. Insulin waning Explanation: Insulin waning is a progressive rise in blood glucose from bedtime to morning. The dawn phenomenon occurs when blood glucose is relatively normal until about 3 a.m., when the level begins to rise. The Somogyi effect occurs when blood glucose is normal or elevated at bedtime, decreases at 2 to 3 a.m. to hypoglycemia levels, and subsequently increases as a result of the production of counter-regulatory hormones. DKA is caused by an absence or markedly inadequate amount of insulin. This insulin deficit results in disorders in the metabolism of carbohydrates, proteins, and fats. The primary clinical features of DKA are hyperglycemia, ketosis, dehydration, electrolyte loss, and acidosis.

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

A. It cannot be mixed with any other type of insulin. Explanation: Because this insulin is in a suspension with a pH of 4, it cannot be mixed with other insulins because this would cause precipitation. There is no peak in action. It is approved to give once daily.

The nurse is describing the action of insulin in the body to a client newly diagnosed with type 1 diabetes. Which of the following would the nurse explain as being the primary action? A. It enhances the transport of glucose across the cell membrane. B. It stimulates the pancreatic beta cells. C. It aids in the process of gluconeogenesis. D. It decreases the intestinal absorption of glucose.

A. It enhances the transport of glucose across the cell membrane. Explanation: Insulin carries glucose into body cells as their preferred source of energy. Besides, it promotes the liver's storage of glucose as glycogen and inhibits the breakdown of glycogen back into glucose. Insulin does not aid in gluconeogenesis but inhibits the breakdown of glycogen back into glucose.

Which is a by-product of fat breakdown in the absence of insulin and accumulates in the blood and urine? A. Ketones B. Creatinine C. Hemoglobin D. Cholesterol

A. Ketones Explanation: Ketones are by-products of fat breakdown in the absence of insulin, and they accumulate in the blood and urine. Creatinine, hemoglobin, and cholesterol are not by-products of fat breakdown.

The nurse is educating the patient with diabetes about the importance of increasing dietary fiber. What should the nurse explain is the rationale for the increase? Select all that apply. A. May improve blood glucose levels B. Decrease the need for exogenous insulin C. Help reduce cholesterol levels D. Increase potassium levels E. May reduce postprandial glucose levels

A. May improve blood glucose levels B. Decrease the need for exogenous insulin C. Help reduce cholesterol levels Explanation: Increased fiber in the diet may improve blood glucose levels, decrease the need for exogenous insulin, and lower total cholesterol and low-density lipoprotein levels in the blood (ADA, 2008b; Geil, 2008).

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

A. Metformin Explanation: 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.

Which of the following factors should the nurse take into consideration when planning meals and selecting the type and dosage of insulin or oral hypoglycemic agent for an elderly patient with diabetes mellitus? A. Patient's eating and sleeping habits B. Patient's history C. Patient's ability to self-administer insulin D. Cognitive problems

A. Patient's eating and sleeping habits Explanation: The eating and sleeping habits of older adults differ from those of young or middle-aged persons. The nurse should take this into consideration when planning meals and selecting the proper type and dosage of insulin or oral hypoglycemic agent. The nurse should evaluate the patient's ability to self-administer insulin before developing a teaching program. Cognitive problems and patient history may not be taken into consideration when planning meals and selecting the proper type and dosage of insulin or oral hypoglycemic agent.

Which may be a potential cause of hypoglycemia in the client diagnosed with diabetes mellitus? A. The client has not eaten but continues to take insulin or oral antidiabetic medications. B. The client has not complied with the prescribed treatment regimen. C. The client has not been exercising. D. The client has eaten but has not taken or received insulin.

A. The client has not eaten but continues to take insulin or oral antidiabetic medications. Explanation: Hypoglycemia occurs when a client with diabetes is not eating and continues to take insulin or oral antidiabetic medications. Hypoglycemia does not occur when the client has not been compliant with the prescribed treatment regimen. If the client has eaten and has not taken or received insulin, diabetic ketoacidosis is more likely to develop.

A client is diagnosed with diabetes mellitus. The client reports visiting the gym regularly and is a vegetarian. Which of the following factors is important to consider when the nurse assesses the client? A. The client's consumption of carbohydrates B. The client's exercise routine C. History of radiographic contrast studies that used iodine D. The client's mental and emotional status

A. The client's consumption of carbohydrates Explanation: While assessing a client, it is important to ask about consumption of carbohydrates due to the client's high blood sugar. Although other factors such as the client's mental and emotional status, history of tests involving iodine, and exercise routine can be part of data collection, they are not the priority when assessing a client with high blood sugar.

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

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

A nurse is preparing to administer two types of insulin to a client with diabetes mellitus. What is the correct procedure for preparing this medication? A. The short-acting insulin is withdrawn before the intermediate-acting insulin. B. The intermediate-acting insulin is withdrawn before the short-acting insulin. C. Different types of insulin are not to be mixed in the same syringe. D. If administered immediately, there is no requirement for withdrawing one type of insulin before another.

A. The short-acting insulin is withdrawn before the intermediate-acting insulin. Explanation: When combining two types of insulin in the same syringe, the short-acting regular insulin is withdrawn into the syringe first and the intermediate-acting insulin is added next. This practice is referred to as "clear to cloudy."

The greatest percentage of people have which type of diabetes? A. Type 2 B. Impaired glucose tolerance C. Type 1 D. Gestational

A. Type 2 Explanation: Type 2 diabetes accounts for 90% to 95% of all diabetes. Type 1 accounts for 5% to 10% of all diabetes. Gestational diabetes has an onset during pregnancy. Impaired glucose tolerance is defined as an oral glucose tolerance test value between 140 mg/dL and 200 mg/dL.

A client with type 1 diabetes mellitus is being taught about self-injection of insulin. Which fact about site rotation should the nurse include in the teaching? A. Use all available injection sites within one area. B. Avoid the abdomen because absorption there is irregular. C. Rotate sites from area to area every other day. D. Choose a different site at random for each injection.

A. Use all available injection sites within one area Explanation: Systematic rotation of injection sites within an anatomic area is recommended to prevent localized changes in fatty tissue. To promote consistency in insulin absorption, the client should be encouraged to use all available injection sites within one area rather than randomly rotating sites from area to area.

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

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

The nurse is teaching a client about self-administration of insulin and about mixing regular and neutral protamine Hagedorn (NPH) insulin. Which information is important to include in the teaching plan? A. When mixing insulin, the regular insulin is drawn up into the syringe first. B. When mixing insulin, the NPH insulin is drawn up into the syringe first. C. There is no need to inject air into the bottle of insulin before withdrawing the insulin. D. If two different types of insulin are ordered, they need to be given in separate injections.

A. When mixing insulin, the regular insulin is drawn up into the syringe first. Explanation: When rapid-acting or short-acting insulins are to be given simultaneously with longer-acting insulins, they are usually mixed together in the same syringe; the longer-acting insulins must be mixed thoroughly before being drawn into the syringe. The American Diabetic Association recommends that the regular insulin be drawn up first. The most important issues are that patients (1) are consistent in technique, so the wrong dose is not drawn in error or the wrong type of insulin, and (2) do not inject one type of insulin into the bottle containing a different type of insulin. Injecting cloudy insulin into a vial of clear insulin contaminates the entire vial of clear insulin and alters its action.

A 1200c diet and exercise are prescribed for a client with newly diagnosed DM2. The nurse teaches client about meal planning using exchange lists, which is determined to be effective based on which statement by the client? A. "For dinner I ate 2 ounces of sliced turkey, 1 cup mashed sweet potatoes, half a cup of carrots, half a cup of peas, a 3-ounce dinner roll, 1 medium banana, a diet soda." B. "For dinner I ate a 3-ounce hamburger on a bun, with ketchup, pickle, and onion; a green salad with 1 tsp Italian dressing; 1 c of watermelon; diet soda." C. "For dinner, 2 cups of cooked pasta with 3-oz of boiled shrimp, 1 c plum tomatoes, half a cup of peas in a garlic-wine sauce, 2 cups fresh strawberries, ice water with lemon." D. "For dinner I ate 4-ounces of sliced roast beef on a bagel with lettuce, tomato, and onion; 1 ounce low-fat cheese; 1 tbsp mayonnaise; 1 cup fresh strawberry shortcake; unsweetened iced tea."

B. "For dinner I ate a 3-ounce hamburger on a bun, with ketchup, pickle, and onion; a green salad with 1 tsp Italian dressing; 1 c of watermelon; diet soda." Explanation: There are six main exchange lists: bread/starch, vegetable, milk, meat, fruit, and fat. Foods within one group (in the portion amounts specified) contain equal numbers of calories and are approximately equal in grams of protein, fat, and carbohydrate. Meal plans can be based on a recommended number of choices from each exchange list. Foods on one list may be interchanged with one another, allowing for variety while maintaining as much consistency as possible in the nutrient content of foods eaten. For example, 2 starch = 2 slices bread or a hamburger bun, 3 meat = 3 oz lean beef patty, 1 vegetable = green salad, 1 fat = 1 tbsp salad dressing, 1 fruit = 1 cup watermelon; "free" items like diet soda are optional.

A client diagnosed with hyperosmolar hyperglycemic nonketotic syndrome (HHNS) is stabilized and prepared for discharge. When preparing the client for discharge and home management, which statement indicates that the client understands his condition and how to control it? A. "I will have to monitor my blood glucose level closely and notify the physician if it's constantly elevated." B. "I can avoid getting sick by not becoming dehydrated and by paying attention to my need to urinate, drink, or eat more than usual." C. "If I experience trembling, weakness, and headache, I should drink a glass of soda that contains sugar." D. "If I begin to feel especially hungry and thirsty, I'll eat a snack high in carbohydrates."

B. "I can avoid getting sick by not becoming dehydrated and by paying attention to my need to urinate, drink, or eat more than usual." Explanation: The client stating that he'll remain hydrated and pay attention to his eating, drinking, and voiding needs indicates understanding of HHNS. Inadequate fluid intake during hyperglycemic episodes commonly leads to HHNS. By recognizing the signs of hyperglycemia (polyuria, polydipsia, and polyphagia) and increasing fluid intake, the client may prevent HHNS. Drinking a glass of non-diet soda would be appropriate for hypoglycemia. A client whose diabetes is controlled with oral antidiabetic agents usually doesn't need to monitor blood glucose levels. A high-carbohydrate diet would exacerbate the client's condition, particularly if fluid intake is low.

The nurse instructs the client with diabetes on self-care during days of illness. Which client statement indicates that teaching has been effective? Select all that apply. A. "I will skip my diabetes medication for the day." B. "I will eat soft foods if I cannot tolerate regular food." C. "I will call the doctor if I have vomiting or diarrhea." D. "I will test my blood sugar level every 3 to 4 hours." E. "I will increase my intake of fluids."

B. "I will eat soft foods if I cannot tolerate regular food." C. "I will call the doctor if I have vomiting or diarrhea." D. "I will test my blood sugar level every 3 to 4 hours." E. "I will increase my intake of fluids." Explanation: During periods of illness, the client with diabetes should be instructed to increase the intake of fluids to prevent dehydration. The blood glucose level should be checked every 3 to 4 hours. The health care provider should be contacted if vomiting or diarrhea occurs as extreme fluid loss may cause dehydration. Soft foods should be substituted for regularly ingested foods if the regular meal plan cannot be followed. The client should be instructed to take regular diabetes medication as prescribed.

A client is evaluated for type 1 diabetes. Which client comment correlates best with this disorder? A. "It seems like I have no appetite. I have to make myself eat." B. "I'm thirsty all the time. I just can't get enough to drink." C. "I notice pain when I urinate." D. "I have a cough and cold that just won't go away."

B. "I'm thirsty all the time. I just can't get enough to drink." Explanation: Classic signs and symptoms of diabetes mellitus are polydipsia (excessive thirst), polyuria (excessive urination), and polyphagia (excessive appetite). Decreased appetite, lingering cough and cold, and pain on urination aren't related to diabetes. Decreased appetite reflects a GI disorder; cough and cold indicate an upper respiratory problem; and pain on urination suggests a urinary tract infection.

A client has just been diagnosed with type 1 diabetes. When teaching the client and family how diet and exercise affect insulin requirements, the nurse should include which guideline? A. "You'll need more insulin when you exercise or increase your food intake." B. "You'll need less insulin when you exercise or reduce your food intake." C. "You'll need less insulin when you increase your food intake." D. "You'll need more insulin when you exercise or decrease your food intake."

B. "You'll need less insulin when you exercise or reduce your food intake." Explanation: The nurse should advise the client that exercise, reduced food intake, hypothyroidism, and certain medications decrease insulin requirements. Growth, pregnancy, greater food intake, stress, surgery, infection, illness, increased insulin antibodies, and certain medications increase insulin requirements.

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 dextrose 5% in water B. 100 units of regular insulin in normal saline solution C. 100 units of NPH insulin in dextrose 5% in water D. 100 units of neutral protamine Hagedorn (NPH) insulin in normal saline solution

B. 100 units of regular insulin in normal saline solution Explanation: 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.

Glycosylated hemoglobin reflects blood glucose concentrations over which period of time? A. 1 month B. 3 months C. 6 months D. 9 months

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

A client with diabetes comes to the clinic for a follow-up visit. The nurse reviews the client's glycosylated hemoglobin test results. Which result would indicate to the nurse that the client's blood glucose level has been well controlled? A. 7.5% B. 6.5% C. 8.5% D. 8.0%

B. 6.5% Explanation: Normally, the level of glycosylated hemoglobin is less than 7%. Thus, a level of 6.5% would indicate that the client's blood glucose level is well controlled. According to the American Diabetes Association, a glycosylated hemoglobin of 7% is equivalent to an average blood glucose level of 150 mg/dl. Thus, a level of 7.5% would indicate less control. Amount of 8% or greater indicate that control of the client's blood glucose level has been inadequate during the previous 2 to 3 months.

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

B. Albumin Explanation: Nephropathy, or kidney disease secondary to diabetic microvascular changes in the kidney, is a common complication of diabetes. Consistent elevation of blood glucose levels stresses the kidney's filtration mechanism, allowing blood proteins to leak into the urine and thus increasing the pressure in the blood vessels of the kidney. Albumin is one of the most important blood proteins that leak into the urine, and its leakage is among the earliest signs that can be detected. Clinical nephropathy eventually develops in more than 85% of people with microalbuminuria but in fewer than 5% of people without microalbuminuria. The urine should be checked annually for the presence of proteins, which would include microalbumin.

A client is admitted to the health care center with abdominal pain, nausea, and vomiting. The medical reports indicate a history of type 1 diabetes. The nurse suspects the client's symptoms to be those of diabetic ketoacidosis (DKA). Which action will help the nurse confirm the diagnosis? A. Assess for excessive sweating B. Assess the client's breath odor C. Assess the client's ability to take a deep breath D. Assess the client's ability to move all extremities

B. Assess the client's breath odor Explanation: DKA is commonly preceded by a day or more of polyuria, polydipsia, nausea, vomiting, and fatigue, with eventual stupor and coma if not treated. The breath has a characteristic fruity odor due to the presence of ketoacids. Checking the client's breath will help the nurse confirm the diagnosis.

A nurse expects to note an elevated serum glucose level in a client with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which other laboratory finding should the nurse anticipate? A. Serum alkalosis B. Below-normal serum potassium level C. Serum ketone bodies D. Elevated serum acetone level

B. Below-normal serum potassium level Explanation: A client with HHNS has an overall body deficit of potassium resulting from diuresis, which occurs secondary to the hyperosmolar, hyperglycemic state caused by the relative insulin deficiency. An elevated serum acetone level and serum ketone bodies are characteristic of diabetic ketoacidosis. Metabolic acidosis, not serum alkalosis, may occur in HHNS.

The nurse is educating the client with diabetes on setting up a sick plan to manage blood glucose control during times of minor illness such as influenza. Which is the most important teaching item to include? A. Take half the usual dose of insulin until symptoms resolve. B. Increase frequency of glucose self-monitoring. C. Do not take insulin if not eating. D. Decrease food intake until nausea passes.

B. Increase frequency of glucose self-monitoring. Explanation: Minor illnesses such as influenza can present a special challenge to a diabetic client. The body's need for insulin increases during illness. Therefore, the client should take the prescribed insulin dose, increase the frequency of glucose monitoring, and maintain adequate fluid intake to counteract the dehydrating effects of hyperglycemia. Clear liquids and juices are encouraged. Taking less than normal dose of insulin may lead to ketoacidosis.

A client newly diagnosed with type 1 diabetes asks the nurse why injection site rotation is important. What is the nurse's best response? A. Minimize discomfort. B. Promote absorption. C. Avoid infection. D. Prevent muscle destruction.

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

Which of the following is an age-related change that may affect diabetes? Select all that apply. A. Increased bowel motility B. Taste changes C. Increased proprioception D. Decreased vision E. Decreased renal function

B. Taste changes D. Decreased vision E. Decreased renal function Explanation: Age-related changes include decreased renal function, taste changes, decreased vision, decreased bowel motility, and decreased proprioception.

Which factor is the focus of nutrition intervention for clients with type 2 diabetes? A. Protein metabolism B. Weight loss C. Carbohydrate intake D. Blood glucose level

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

A patient is diagnosed with type 1 diabetes. What clinical characteristics does the nurse expect to see in this patient? Select all that apply. A. Older than 65 years of age B. Younger than 30 years of age C. Obesity at diagnoses D. Ketosis-prone E. Little or no endogenous insulin

B. Younger than 30 years of age D. Ketosis-prone E. Little or no endogen Explanation: Type I diabetes mellitus is associated with the following characteristics: onset any age, but usually young (<30 y); usually thin at diagnosis, recent weight loss; etiology includes genetic, immunologic, and environmental factors (e.g., virus); often have islet cell antibodies; often have antibodies to insulin even before insulin treatment; little or no endogenous insulin; need exogenous insulin to preserve life; and ketosis prone when insulin absent.

A 1200 c diet & exercise are prescribed for client with newly diagnosed DM2. The nurse is teaching the client about meal planning using exchange lists. The teaching is determined to be effective based on? A. "I ate 2 c of cooked pasta with 3 oz of boiled shrimp, 1 c plum tomatoes, 1/2 c of peas in a garlic-wine sauce, 2 c strawberries, and ice water with lemon." B. "For dinner I ate 2 ounces of sliced turkey, 1 cup mashed sweet potatoes, half a cup of carrots, half a cup of peas, a 3-ounce dinner roll, 1 medium banana, and a diet soda." C. "For dinner I ate a 3-ounce hamburger on a bun, with ketchup, pickle, and onion; a green salad with 1 teaspoon Italian dressing; 1 cup of watermelon; and a diet soda." D. "For dinner I ate 4-ounces of sliced roast beef on a bagel with lettuce, tomato, and onion; 1 ounce low-fat cheese; 1 tablespoon mayonnaise; 1 cup fresh strawberry shortcake; and unsweetened iced tea."

C. "For dinner I ate a 3-ounce hamburger on a bun, with ketchup, pickle, and onion; a green salad with 1 teaspoon Italian dressing; 1 cup of watermelon; and a diet soda." Explanation: There are six main exchange lists: bread/starch, vegetable, milk, meat, fruit, and fat. Foods within one group (in the portion amounts specified) contain equal numbers of calories and are approximately equal in grams of protein, fat, and carbohydrate. Meal plans can be based on a recommended number of choices from each exchange list. Foods on one list may be interchanged with one another, allowing for variety while maintaining as much consistency as possible in the nutrient content of foods eaten. For example, 2 starch = 2 slices bread or a hamburger bun, 3 meat = 3 oz lean beef patty, 1 vegetable = green salad, 1 fat = 1 tbsp salad dressing, 1 fruit = 1 cup watermelon; "free" items like diet soda are optional.

After teaching a client with type 1 diabetes who is scheduled to undergo an islet cell transplant, which client statement indicates successful teaching? A. "They'll need to create a connection from the pancreas to allow enzymes to drain." B. "This transplant will provide me with a cure for my diabetes." C. "I might need insulin later on but probably not as much or as often." D. "I will receive a whole organ with extra cells to produce insulin."

C. "I might need insulin later on but probably not as much or as often." Explanation: Transplanted islet cells tend to lose their ability to function over time, and approximately 70% of recipients resume insulin administration in 2 years. However, the amount of insulin and the frequency of its administration are reduced because of improved control of blood glucose levels. Thus, this type of transplant doesn't cure diabetes. It requires the use of two human pancreases to obtain sufficient numbers of islet cells for transplantation. A whole organ transplant requires a means for exocrine enzyme drainage and venous absorption of 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. "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." B. "Excess glucose in the blood is metabolized by the liver and turned into ketones, which are an acid." C. "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 are formed when insufficient insulin leads to cellular starvation. As cells rupture, they release these acids into the blood."

C. "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." Explanation: Ketones (or ketone bodies) are by-products of fat breakdown in the absence of insulin, and they accumulate in the blood and urine. Ketones in the urine signal an insulin deficiency and that control of type 1 diabetes is deteriorating. When almost no effective insulin is available, the body starts to break down stored fat for energy.

A nurse is caring for a client with type 1 diabetes who exhibits confusion, light-headedness, and aberrant behavior. The client is conscious. The nurse should first administer: A. I.M. or subcutaneous glucagon. B. I.V. bolus of dextrose 50%. C. 15 to 20 g of a fast-acting carbohydrate such as orange juice. D. 10 units of fast-acting insulin.

C. 15 to 20 g of a fast-acting carbohydrate such as orange juice. Explanation: This client is experiencing hypoglycemia. Because the client is conscious, the nurse should first administer a fast-acting carbohydrate, such as orange juice, hard candy, or honey. If the client has lost consciousness, the nurse should administer I.M. or subcutaneous glucagon or an I.V. bolus of dextrose 50%. The nurse shouldn't administer insulin to a client who's hypoglycemic; this action will further compromise the client's condition.

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

C. Blood glucose level 1,100 mg/dl Explanation: HHNS occurs most frequently in older clients. It can occur in clients with either type 1 or type 2 diabetes mellitus but occurs most commonly in those with type 2. The blood glucose level rises to above 600 mg/dl in response to illness or infection. As the blood glucose level rises, the body attempts to rid itself of the excess glucose by producing urine. Initially, the client produces large quantities of urine. If fluid intake isn't increased at this time, the client becomes dehydrated, causing BUN levels to rise. Arterial pH and plasma bicarbonate levels typically remain within normal limits.

A nurse is teaching a client about insulin infusion pump use. What intervention should the nurse include to prevent infection at the injection site? A. Use clean technique when changing the needle. B. Take the ordered antibiotics before initiating treatment. C. Change the needle every 3 days. D. Wear sterile gloves when inserting the needle.

C. Change the needle every 3 days. Explanation: The nurse should teach the client to change the needle every 3 days to prevent infection. The client doesn't need to wear gloves when inserting the needle. Antibiotic therapy isn't necessary before initiating treatment. Sterile technique, not clean technique, is needed when changing the needle.

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. Crying whenever diabetes is mentioned D. Skipping insulin doses during illness

C. Crying whenever diabetes is mentioned Explanation: A client who cries whenever diabetes is mentioned is demonstrating ineffective coping. A recent weight gain and failure to monitor blood glucose levels would support a nursing diagnosis of Noncompliance: Failure to adhere to therapeutic regimen. Skipping insulin doses during illness would support a nursing diagnosis of Deficient knowledge related to treatment of diabetes mellitus.

A client with a serum glucose level of 618 mg/dl is admitted to the facility. He's awake and oriented, has hot dry skin, and has the following vital signs: temperature of 100.6° F (38.1° C), heart rate of 116 beats/minute, and blood pressure of 108/70 mm Hg. Based on these assessment findings, which nursing diagnosis takes highest priority? A. Decreased cardiac output related to elevated heart rate B. Ineffective thermoregulation related to dehydration C. Deficient fluid volume related to osmotic diuresis D. Imbalanced nutrition: Less than body requirements related to insulin deficiency

C. Deficient fluid volume related to osmotic diuresis Explanation: A serum glucose level of 618 mg/dl indicates hyperglycemia, which causes polyuria and fluid volume deficit, making Deficient fluid volume related to osmotic diuresis the highest priority. In this client, tachycardia is more likely to result from fluid volume deficit than from decreased cardiac output because his blood pressure is normal. Although the client's serum glucose is elevated, food isn't a priority because fluids and insulin should be administered to lower the serum glucose level. Therefore, a diagnosis of Imbalanced nutrition: Less than body requirements isn't appropriate. A temperature of 100.6° F isn't life-threatening, eliminating Ineffective thermoregulation as the top priority.

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. Health-seeking behaviors (diabetes control). B. Defensive coping. C. Deficient knowledge (treatment regimen). D. Impaired adjustment.

C. Deficient knowledge (treatment regimen) Explanation: 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.

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. 6-hour glucose tolerance test B. Fasting blood glucose test C. Serum glycosylated hemoglobin (Hb A1c) D. Urine ketones

C. HbA1c Explanation: Hb A1c is the most reliable indicator of glucose use because it reflects blood glucose levels for the prior 3 months. Although a fasting blood glucose test and a 6-hour glucose tolerance test yield information about a client's use of glucose, the results are influenced by such factors as whether the client recently ate breakfast. Presence of ketones in the urine also provides information about glucose use but is limited in its diagnostic significance.

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

C. Hypokalemia and hypoglycemia Explanation: Blood glucose needs to be monitored in clients receiving IV insulin because of the risk of hyperglycemia or hypoglycemia. Hypoglycemia might occur if too much insulin is administered. Hypokalemia, not hyperkalemia, might occur because I.V. insulin forces potassium into cells, thereby lowering the plasma level of potassium. Calcium and sodium levels aren't affected by IV insulin administration.

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

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

A nurse is assessing a client who is receiving total parenteral nutrition (TPN). Which finding suggests that the client has developed hyperglycemia? A. Cheyne-Stokes respirations B. Diaphoresis C. Increased urine output D. Decreased appetite

C. Increased urine output Explanation: Glucose supplies most of the calories in TPN; if the glucose infusion rate exceeds the client's rate of glucose metabolism, hyperglycemia arises. When the renal threshold for glucose reabsorption is exceeded, osmotic diuresis occurs, causing an increased urine output. A decreased appetite and diaphoresis suggest hypoglycemia, not hyperglycemia. Cheyne-Stokes respirations are characterized by a period of apnea lasting 10 to 60 seconds, followed by gradually increasing depth and frequency of respirations. Cheyne-Stokes respirations typically occur with cerebral depression or heart failure.

A client is admitted with diabetic ketoacidosis (DKA). Which order from the physician should the nurse implement first? A. Administer sodium bicarbonate 50 mEq IV push. B. Start an infusion of regular insulin at 50 U/hr. C. Infuse 0.9% normal saline solution 1 L/hr for 2 hours. D. Administer regular insulin 30 U IV push.

C. Infuse 0.9% normal saline solution 1 L/hr for 2 hours Explanation: In addition to treating hyperglycemia, management of DKA is aimed at correcting dehydration, electrolyte loss, and acidosis before correcting the hyperglycemia with insulin. In dehydrated clients, rehydration is important for maintaining tissue perfusion. Initially, 0.9% sodium chloride (normal saline) solution is administered at a rapid rate, usually 0.5 to 1 L/hr for 2 to 3 hours.

A patient is prescribed Glucophage, an oral antidiabetic agent classified as a biguanide. The nurse knows that a primary action of this drug is its ability to: A. Stimulate the beta cells of the pancreas to secrete insulin. B. Increase the absorption of carbohydrates in the intestines. C. Inhibit the production of glucose by the liver. D. Decrease the body's sensitivity to insulin.

C. Inhibit the production of glucose by the liver. Explanation: The action of the biguanides can be found in Table 30-6 in the text.

A diabetic client using insulin reports weight gain. Which response from the nurse explains the most likely cause of the weight increase? A. Weight gain is attributed to fluid retention. B. Faulty fat metabolism is shut off. C. Insulin is an anabolic hormone. D. Insulin provides more efficient use of glucose.

C. Insulin is an anabolic hormone Explanation: Insulin is an anabolic hormone that is known to cause weight gain. Insulin does lower blood glucose levels by allowing for active transport of glucose into the cells. Faulty fat and protein metabolism will cease once glucose provides the needed the fuel for energy. The restoration of normal metabolism is not the primary cause for weight gain in a client prescribed insulin. Fluid retention is not indicated in this client.

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

C. Lispro Explanation: 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.

The nurse suspects that a patient with diabetes has developed proliferative retinopathy. The nurse confirms this by the presence of which of the following diagnostic signs? A. Microaneurysm formation B. Decreased capillary permeability C. Neovascularization into the vitreous humor D. The leakage of capillary wall fragments into surrounding areas

C. Neovascularization into the vitreous humor Explanation: Proliferative retinopathy, an ocular complication of diabetes, occurs because of the abnormal growth of new blood vessels on the retina that bleed into the vitreous and block light. Blood vessels in the vitreous form scar tissue that can pull and detach the retina. Neovascularization into the vitreous humor is considered a diagnostic sign.

A client who was diagnosed with type 1 diabetes 14 years ago is admitted to the medical-surgical unit with abdominal pain. On admission, the client's blood glucose level is 470 mg/dl. Which finding is most likely to accompany this blood glucose level? A. Slow, shallow respirations B. Arm and leg trembling C. Rapid, thready pulse D. Cool, moist skin

C. Rapid, thready pulse Explanation: This client's abnormally high blood glucose level indicates hyperglycemia, which typically causes polyuria, polyphagia, and polydipsia. Because polyuria leads to fluid loss, the nurse should expect to assess signs of deficient fluid volume, such as a rapid, thready pulse; decreased blood pressure; and rapid respirations. Cool, moist skin and arm and leg trembling are associated with hypoglycemia. Rapid respirations — not slow, shallow ones — are associated with hyperglycemia.

A patient has been newly diagnosed with type 2 diabetes, and the nurse is assisting with the development of a meal plan. What step should be taken into consideration prior to making the meal plan? A. Ensuring that the patient understands that some favorite foods may not be allowed on the meal plan and substitutes will need to be found B. Determining whether the patient is on insulin or taking oral antidiabetic medication C. Reviewing the patient's diet history to identify eating habits and lifestyle and cultural eating patterns D. Making sure that the patient is aware that quantity of foods will be limited

C. Reviewing the patient's diet history to identify eating habits and lifestyle and cultural eating patterns Explanation: The first step in preparing a meal plan is a thorough review of the patient's diet history to identify eating habits and lifestyle and cultural eating patterns.

A client with type 1 diabetes reports waking up in the middle of the night feeling nervous and confused, with tremors, sweating, and a feeling of hunger. Morning fasting blood glucose readings have been 110 to 140 mg/dL. The client admits to exercising excessively and skipping meals over the past several weeks. Based on these symptoms, the nurse plans to instruct the client to A. skip the evening neutral protamine Hagedorn insulin dose on days when exercising and skipping meals. B. eat a complex carbohydrate snack in the evening before bed. C. check blood glucose at 3:00 a.m. D. administer an increased dose of neutral protamine Hagedorn insulin in the evening.

C. check blood glucose at 3:00 AM Explanation: In the Somogyi effect, the client has a normal or elevated blood glucose concentration at bedtime, which decreases to hypoglycemic levels at 2 to 3 a.m., and subsequently increases as a result of the production of counter-regulatory hormones. It is important to check blood glucose in the early morning hours to detect the initial hypoglycemia.

A client tells the nurse that she has been working hard for the past 3 months to control her type 2 diabetes with diet and exercise. To determine the effectiveness of the client's efforts, the nurse should check: A. serum fructosamine level. B. urine glucose level. C. glycosylated hemoglobin level. D. fasting blood glucose level.

C. glycosylated hemoglobin level Explanation: Because some of the glucose in the bloodstream attaches to some of the hemoglobin and stays attached during the 120-day life span of red blood cells, glycosylated hemoglobin levels provide information about blood glucose levels during the previous 3 months. Fasting blood glucose and urine glucose levels give information only about glucose levels at the point in time when they were obtained. Serum fructosamine levels provide information about blood glucose control over the past 2 to 3 weeks.

A client with a history of type 1 diabetes is demonstrating fast, deep, labored breathing and has fruity odored breath. What could be the cause of the client's current serious condition? A. hepatic disorder B. All options are correct. C. ketoacidosis D. hyperosmolar hyperglycemic nonketotic syndrome

C. ketoacidosis Explanation: Kussmaul respirations (fast, deep, labored breathing) are common in ketoacidosis. Acetone, which is volatile, can be detected on the breath by its characteristic fruity odor. If treatment is not initiated, the outcome of ketoacidosis is circulatory collapse, renal shutdown, and death. Ketoacidosis is more common in people with diabetes who no longer produce insulin, such as those with type 1 diabetes. People with type 2 diabetes are more likely to develop hyperosmolar hyperglycemic nonketotic syndrome because with limited insulin, they can use enough glucose to prevent ketosis but not enough to maintain a normal blood glucose level.

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. "Damage to your pancreas causes an increase in the amount of glucose that it releases, and there is not enough insulin to control it." B. "The amount of glucose that your body makes overwhelms your pancreas and decreases your production of insulin." C. "The tissues in your body are resistant to the action of insulin, making the glucose levels in your blood increase." 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." Explanation: 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 controlled type 2 diabetic client states, "The doctor said if my blood sugars remain stable, I may not need to take any medication." Which response by the nurse is most appropriate? A. "Some doctors do not treat blood sugar elevation until symptoms appear." B. "You misunderstood the doctor. Let's ask for clarification." C. "You will be placed on a strict low-sugar diet for better control." D. "Diet, exercise, and weight loss can eliminate the need for medication."

D. "Diet, exercise, and weight loss can eliminate the need for medication." Explanation: Dieting, exercise, and weight loss can control and/or delay the need for medication to treat type 2 diabetes mellitus in some clients. Because the client is controlling blood sugars, changing the diet is not indicated. Controlling blood glucose levels will prevent multisystem complications and should be the mainstay of treatment for diabetes mellitus. Although clarification is appropriate, stating the client misunderstood can close the line of communication between client and nurse.

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. "Your insulin will last 8 hours, and you will need to take it three times a day." D. "You should take your insulin after you eat breakfast and dinner."

D. "You should take your insulin after you eat breakfast and dinner." Explanation: 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 physician orders blood glucose levels every 4 hours for a 4-year-old child with brittle type 1 diabetes. The parents are worried that drawing so much blood will traumatize their child. How can the nurse best reassure the parents? A. "Your child is young and will soon forget this experience." B. "Our laboratory technicians use tiny needles and they're really good with children." C. "I'll see if the physician can reduce the number of blood draws." D. "Your child will need less blood work as his glucose levels stabilize."

D. "Your child will need less blood work as his glucose levels stabilize." Explanation: Telling the parents that the number of blood draws will decrease as their child's glucose levels stabilize engages them in the learning process and gives them hope that the present discomfort will end as the child's condition improves. Telling the parents that their child won't remember the experience disregards their concerns and anxiety. The nurse shouldn't offer to ask the physician if he can reduce the number of blood draws; the physician needs the laboratory results to monitor the child's condition properly. Although telling the parents that the laboratory technicians are gentle and use tiny needles may be reassuring, it isn't the most appropriate response.

Once digested, what percentage of carbohydrates is converted to glucose? A. 70 B. 80 C. 90 D. 100

D. 100 Explanation: Once digested, 100% of carbohydrates are converted to glucose. However, approximately 50% of protein foods are also converted to glucose, but this has minimal effect on blood glucose concentration.

A patient who is 6 months' pregnant was evaluated for gestational diabetes mellitus. The doctor considered prescribing insulin based on the serum glucose result of: A. 90 mg/dL before meals. B. 80 mg/dL, 1 hour postprandial. C. 120 mg/dL, 1 hour postprandial. D. 138 mg/dL, 2 hours postprandial.

D. 138 mg/dL, 2 hours postprandial. Explanation: The goals for a 2-hour, postprandial blood glucose level are less than 120 mg/dL in a patient who might develop gestational diabetes.

The nurse is reviewing the initial laboratory test results of a client diagnosed with DKA. Which of the following would the nurse expect to find? A. Serum bicarbonate of 19 mEq/L B. Blood glucose level of 250 mg/dL C. PaCO2 of 40 mm Hg D. Blood pH of 6.9

D. Blood pH of 6.9 Explanation: With DKA, blood glucose levels are elevated to 300 to 1000 mg/dL or more. Urine contains glucose and ketones. The blood pH ranges from 6.8 to 7.3. The serum bicarbonate level is decreased to levels from 0 to 15 mEq/L. The compensatory breathing pattern can lower the partial pressure of carbon dioxide in arterial blood (PaCO2) to levels of 10 to 30 mm Hg.

Which of the following insulins are used for basal dosage? A. NPH (Humulin N) B. Lispro (Humalog) C. Aspart (Novolog) D. Glargine (Lantus)

D. Glargine (Lantus) Explanation: Lantus is used for basal dosage. NPH is an intermediate acting insulin, usually taken after food. Humalog and Novolog are rapid-acting insulins.

Which is the best nursing explanation for the symptom of polyuria in a client with diabetes mellitus? A. The body's requirement for fuel drives the production of urine. B. Increased ketones in the urine promote the manufacturing of more urine. C. With diabetes, drinking more results in more urine production. D. High sugar pulls fluid into the bloodstream, which results in more urine production.

D. High sugar pulls fluid into the bloodstream, which results in more urine production. Explanation: The hypertonicity from concentrated amounts of glucose in the blood pulls fluid into the vascular system, resulting in polyuria. The urinary frequency triggers the thirst response, which then results in polydipsia. Ketones in the urine and body requirements do not affect the production of urine.

A client with diabetes mellitus is receiving an oral antidiabetic agent. The nurse observes for which condition when caring for this client? A. Polyuria B. Blurred vision C. Polydipsia D. Hypoglycemia

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

A patient with diabetic ketoacidosis (DKA) has had a large volume of fluid infused for rehydration. What potential complication from rehydration should the nurse monitor for? A. Hyponatremia B. Hyperkalemia C. Hyperglycemia D. Hypokalemia

D. Hypokalemia Explanation: Because a patient's serum potassium level may drop quickly as a result of rehydration and insulin treatment, potassium replacement must begin once potassium levels drop to normal in the patient with DKA.

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

D. The client has eaten and has not taken or received insulin. Explanation: If the client has eaten and has not taken or received insulin, DKA is more likely to develop. Hypoglycemia is more likely to develop if the client has not consumed food and continues to take insulin or oral antidiabetic medications, if the client has not consumed sufficient calories, or if client has been exercising more than usual.

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. Need for exocrine enzymatic drainage B. Increased risk for urologic complications C. Need for lifelong immunosuppressive therapy D. Underlying problem of insulin resistance

D. Underlying problem of insulin resistance Explanation: 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.

During a class on exercise for clients with diabetes mellitus, a client asks the nurse educator how often to exercise. To meet the goals of planned exercise, the nurse educator should advise the client to exercise: A. at least once per week. B. at least five times per week. C. every day. D. at least three times per week

D. at least three times per week Explanation: Clients with diabetes must exercise at least three times per week to meet the goals of planned exercise — lowering the blood glucose level, reducing or maintaining the proper weight, increasing the serum high-density lipoprotein level, decreasing serum triglyceride levels, reducing blood pressure, and minimizing stress. Exercising once per week wouldn't achieve these goals. Exercising more than three times per week, although beneficial, would exceed the minimum requirement.

A client with type 1 diabetes has been on a regimen of multiple daily injection therapy. He's being converted to continuous subcutaneous insulin therapy via an insulin pump. While teaching the client about continuous subcutaneous insulin therapy, the nurse should tell him that the regimen includes the use of: A. short- and intermediate-acting insulins. B. short- and long-acting insulins. C. intermediate- and long-acting insulins. D. rapid-acting insulin only.

D. rapid-acting insulin only. Explanation: A continuous subcutaneous insulin regimen uses a basal rate and boluses of rapid-acting insulin. Multiple daily injection therapy uses a combination of rapid-acting and intermediate- or long-acting insulins.

Every morning, a client with type 1 diabetes receives 15 units of Humulin 70/30. What does this type of insulin contain? A. 70 units of regular insulin and 30 units of NPH insulin B. 70% regular insulin and 30% NPH insulin C. 70% NPH insulin and 30% regular insulin D. 70 units of neutral protamine Hagedorn (NPH) insulin and 30 units of regular insulin

C. 70% NPH insulin and 30% regular insulin Explanation: Humulin 70/30 insulin is a combination of 70% NPH insulin and 30% regular insulin.

A nurse is inspecting the feet of a client with diabetes and finds a tack sticking in the sole of one foot. The client denies feeling anything unusual in the foot. Which is the best rationale for this finding? A. High blood sugar decreases blood circulation to nerves. B. In diabetes, the autonomic nerves are affected. C. Motor neuropathy causes muscles to weaken and atrophy. D. Nephropathy is a common complication of diabetes mellitus.

A. High blood sugar decreases blood circulation to nerves Explanation: Diabetic neuropathy results from poor glucose control and decreased blood circulation to nerve tissues. The lack of sensitivity increases the potential for soft tissue injury without awareness. Autonomic neuropathy is a complication of diabetes mellitus but not significant with peripheral injuries. Motor neuropathy does occur with poor glucose control but not specific to this injury. Nephropathy is a common complication that directly affects the kidneys.

Which of the following is a risk factor for the development of diabetes mellitus? Select all that apply. A. Hypertension B. Obesity C. History of gestational diabetes D. Family history E. Age greater of 45 years or older

A. Hypertension B. Obesity C. History of gestational diabetes D. Family history E. Age greater of 45 years or older Explanation: Risk factors for the development of diabetes mellitus include hypertension, obesity, family history, age of 45 years or older, and a history of gestational diabetes.

A hospitalized, insulin-dependent patient with diabetes has been experiencing morning hyperglycemia. The patient will be awakened once or twice during the night to test blood glucose levels. The health care provider suspects that the cause is related to the Somogyi effect. Which of the following indicators support this diagnosis? Select all that apply. A. Increase in blood glucose from 3:00 AM until breakfast B. Decrease in blood sugar to a hypoglycemic level between 2:00 to 3:00 AM C. Elevated blood glucose at bedtime D. Normal bedtime blood glucose E. Rise in blood glucose about 11:00 AM

A. Increase in blood glucose from 3:00 AM until breakfast B. Decrease in blood sugar to a hypoglycemic level between 2:00 to 3:00 AM D. Normal bedtime blood glucose Explanation: The Somogyi effect is nocturnal hypoglycemia followed by rebound hyperglycemia in the morning.

A group of students are reviewing the various types of drugs that are used to treat diabetes mellitus. The students demonstrate understanding of the material when they identify which of the following as an example of an alpha-glucosidase inhibitor? A. Miglitol B. Glyburide C. Metformin D. Rosiglitazone

A. Miglitol Explanation: Alpha-glucosidase inhibitors include drugs such as miglitol and acarbose. Metformin is a biguanide. Glyburide is a sulfonylurea. Rosiglitazone is a thiazolidinedione.

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

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

After taking glipizide (Glucotrol) for 9 months, a client experiences secondary failure. What should the nurse expect the physician to do? A. Order an additional oral antidiabetic agent. B. Initiate insulin therapy. C. Restrict carbohydrate intake to less than 30% of the total caloric intake. D. Switch the client to a different oral antidiabetic agent.

A. Order an additional oral antidiabetic agent Explanation: The nurse should anticipate that the physician will order a different oral antidiabetic agent. Many clients (25% to 60%) who take glipizide respond to a different oral antidiabetic agent. Therefore, it wouldn't be appropriate to initiate insulin therapy at this time. However, if a new oral antidiabetic agent is unsuccessful in keeping glucose levels at an acceptable level, insulin may be used in addition to the antidiabetic agent. Restricting carbohydrate intake isn't necessary.

A nurse prepares teaching for a client with newly-diagnosed diabetes. Which statements about the role of insulin will the nurse include in the teaching? Select all that apply. A. "Insulin interferes with the release of growth hormone from the pituitary." B. "Insulin promotes synthesis of proteins in various body tissues." C. "Insulin promotes the storage of fat in adipose tissue." D. "Insulin interferes with glucagon from the pancreas." E. "Insulin permits entry of glucose into the cells of the body."

B. "Insulin promotes synthesis of proteins in various body tissues." C. "Insulin promotes the storage of fat in adipose tissue." E. "Insulin permits entry of glucose into the cells of the body." Explanation: Insulin is a hormone secreted by the endocrine part of the pancreas. In addition to lowering blood glucose by permitting entry of glucose into the cells, insulin also promotes protein synthesis and the storage of fat in adipose tissue. Somatostatin exerts a hypoglycemic effect by interfering with glucagon from the pancreas and the release of growth hormone from the pituitary.

A female patient with diabetes who weighs 150 pounds has an ideal body weight of 118 pounds. She can lose 1 pound per week and drop her extra 32 pounds in approximately 8 months. To meet this goal, the nurse advises the patient to decrease her calories by: A. 2,000 per week. B. 2,500 per week. C. 3,000 per week. D. 3,500 per week.

Explanation: A person needs to decrease caloric intake by 3,500 for each lb of weight that is lost. To lose 1 lb per week, a person would decrease his or her daily caloric intake by 500 calories (500 calories × 7 days = 3,500 calories = 1 lb).