Med Surg: Chapter 30 Diabetes Mellitus: PREPU

A 60-year-old client comes to the ED reporting weakness, vision problems, increased thirst, increased urination, and frequent infections that do not seem to heal easily. The physician suspects that the client has diabetes. Which classic symptom should the nurse watch for to confirm the diagnosis of diabetes? A. Increased hunger B. Fatigue C. Dizziness D. Numbness

A

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

The nurse is administering an insulin drip to a patient in ketoacidosis. What insulin does the nurse know can be used intravenously? Select all that apply. A. Rapid-acting B. Intermediate-acting C. Long-acting D. Short-acting

A, D Insulins may be grouped into several categories based on the onset, peak, and duration of action. Rapid- and short-acting insulin can be administered by IV

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

A

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

D

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

B

A hospital patient has been ordered a sliding scale of Humulin R for the duration of her admission. The patient's medication administration record specifies the first administration time of the day at 08:00 and the nurse knows that breakfast trays typically arrive on the unit between 07:45 and 07:50. When should the nurse administer the patient's insulin? A. 08:00 B. 07:45 C. 08:15 D. 07:30

D Short-acting insulin, called regular insulin and marked "R" on the vial, is an unmodified clear solution that usually is administered 20 to 30 minutes before a meal

insulin is a hormone secreted by the Islets of Langerhans and is essential for the metabolism of carbohydrates, fats, and protein. The nurse understands the physiologic importance of gluconeogenesis, which refers to the: A. Storage of glucose as glycogen in the liver. B.Transport of potassium. C. Synthesis of glucose from noncarbohydrate sources. D. Release of glucose.

C

Which clinical characteristic is associated with type 1 diabetes (previously referred to as insulin-dependent diabetes mellitus)? A. Presence of islet cell antibodies B. Rare ketosis C. Requirement for oral hypoglycemic agents D. Obesity

A

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

A

Which is the primary reason for encouraging injection site rotation in an insulin dependent diabetic? A Promote absorption. B Avoid infection. C. Minimize discomfort. D Prevent muscle destruction.

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

B

A 16-year-old client newly diagnosed with type 1 diabetes has a very low body weight despite eating regular meals. The client is upset because friends frequently state, "You look anorexic." Which statement by the nurse would be the best response to help this client understand the cause of weight loss due to this condition? A. "You may be having undiagnosed infections, causing you to lose extra weight." B. "Your body is using protein and fat for energy instead of glucose." C. "I will refer you to a dietician who can help you with your weight." D. "Don't worry about what your friends think; the carbohydrates you eat are being quickly digested, increasing your metabolism."

B

A client with diabetes mellitus has a prescription for 5 units of U-100 regular insulin and 25 units of U-100 isophane insulin suspension (NPH) to be taken before breakfast. At about 4:30 p.m., the client experiences headache, sweating, tremor, pallor, and nervousness. What is the most probable cause of these signs and symptoms? A. Serum glucose level of 450 mg/dl B. Serum glucose level of 52 mg/dl C. Serum calcium level of 8.9 mg/dl D. Serum calcium level of 10.2 mg/dl

B Headache, sweating, tremor, pallor, and nervousness typically result from hypoglycemia, an insulin reaction in which serum glucose level drops below 70 mg/dl. Hypoglycemia may occur 4 to 18 hours after administration of isophane insulin suspension or insulin zinc suspension (Lente), which are intermediate-acting insulins. Although hypoglycemia may occur at any time, it usually precedes meals. Hyperglycemia, in which serum glucose level is above 180 mg/dl, causes such early manifestations as fatigue, malaise, drowsiness, polyuria, and polydipsia.

A type 2 diabetic is ordered metformin (Glucophage) as part of the management regime. Which is the best nursing explanation for the action of this drug in controlling glucose levels? A. Stimulates insulin release B. Reduces the production of glucose by the liver C. Delays digestion of carbohydrates D. Helps tissues use insulin more efficiently

D

Insulin is secreted by which of the following types of cells? A. Basal cells B. Neural cells C. Melanocytes D. Beta cells

D

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

A Glargine=lantus=long acting insulin

A patient with a diagnosis of type 2 diabetes has been vigilant about glycemic control since being diagnosed and has committed to increasing her knowledge about the disease. To reduce her risk of developing diabetic nephropathy in the future, this patient should combine glycemic control with what other preventative measure? A. Maintenance of a low-sodium, low-protein diet B.Subcutaneous injection of 5,000 units of heparin twice daily C. Vigorous physical activity at least three times weekly D Maintenance of healthy blood pressure and prompt treatment of hypertension

D

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 stimulates the pancreatic beta cells. B It aids in the process of gluconeogenesis. C It decreases the intestinal absorption of glucose. D It carries glucose into body cells.

D

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

D The duration of regular insulin is 4 to 6 hours; 3 to 5 hours is the duration for rapid-acting insulin such as Novolog. The duration of NPH insulin is 12 to 16 hours. The duration of Lantus insulin is 24 hours

A 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. "The spleen releases ketones when your body can't use glucose." C. "Ketones can damage your kidneys and eyes." D "Ketones help the physician determine how serious your diabetes is."

A

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. Decreases risk of developing insulin resistance and hyperglycemia B. Increases ability for glucose to get into the cell and lowers blood sugar C Creates an overall feeling of well-being and lowers risk of depression D. Decreases need for pancreas to produce more cells

B

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. Little relation to prediabetes B. Insufficient insulin production C. . Onset most common during adolescence D. Less common than type 1 diabetes

B

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 eaten and has not taken or received insulin. C. The client has not consumed sufficient calories. D. The client has been exercising more than usual.

B

A child is brought into the emergency department with vomiting, drowsiness, and blowing respirations. The father reports that the symptoms have been progressing throughout the day. The nurse suspects diabetic ketoacidosis (DKA). Which action should the nurse take first in the management of DKA? A. Give prescribed antiemetics. B. Administer bicarbonate to correct acidosis. C. Begin fluid replacements. D. Administer prescribed dose of insulin.

C Management of DKA is aimed at correcting dehydration, electrolyte loss, and acidosis before correcting the hyperglycemia with insulin

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. Cool, moist skin C. Rapid, thready pulse D. Arm and leg trembling

C

A client with status asthmaticus requires endotracheal intubation and mechanical ventilation. Twenty-four hours after intubation, the client is started on the insulin infusion protocol. The nurse must monitor the client's blood glucose levels hourly and watch for which early signs and symptoms associated with hypoglycemia? A Dry skin, bradycardia, and somnolence B. Bradycardia, thirst, and anxiety C.Sweating, tremors, and tachycardia D. Polyuria, polydipsia, and polyphagia

C

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.encourage the client to ask questions about personal sexuality. C. suggest referral to a sex counselor or other appropriate professional. D. provide time for privacy.

C

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 intermediate-acting insulin is withdrawn before the short-acting insulin. B If administered immediately, there is no requirement for withdrawing one type of insulin before another. C The short-acting insulin is withdrawn before the intermediate-acting insulin. D Different types of insulin are not to be mixed in the same syringe.

C

A nurse is providing dietary instructions to a client with hypoglycemia. To control hypoglycemic episodes, the nurse should recommend: A. eating a candy bar if light-headedness occurs. B.increasing intake of vitamins B and D and taking iron supplements. C. consuming a low-carbohydrate, high-protein diet and avoiding fasting. D. increasing saturated fat intake and fasting in the afternoon.

C

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 aids in the process of gluconeogenesis. B It stimulates the pancreatic beta cells. C It enhances the transport of glucose across the cell membrane. D It decreases the intestinal absorption of glucose.

C

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

C

Which instruction should a nurse give to a client with diabetes mellitus when teaching about "sick day rules"? A. "Don't take your insulin or oral antidiabetic agent if you don't eat." B. "It's okay for your blood glucose to go above 300 mg/dl while you're sick." C. "Test your blood glucose every 4 hours." D. D"Follow your regular meal plan, even if you're nauseous."

C The nurse should instruct a client with diabetes mellitus to check his blood glucose levels every 3 to 4 hours and take insulin or an oral antidiabetic agent as usual, even when he's sick. If the client's blood glucose level rises above 300 mg/dl, he should call his physician immediately. If the client is unable to follow the regular meal plan because of nausea, he should substitute soft foods, such as gelatin, soup, and custard

A 78-year-old patient with type 2 diabetes is brought to the emergency department by his daughter. The patient is found to have a blood glucose level of 623 mg/dL. The patient's daughter reports that the patient recently had a gastrointestinal virus and has been confused for the last 3 hours. A diagnosis of hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is made. What nursing action would be the priority? A. Administering antihypertensive medications B.Administering sodium bicarbonate intravenously for low bicarbonate levels C. Reversing acidosis by administering insulin D. Replacing fluids and electrolytes

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