Unit 6 - Diabetes Mellitus

Which finding should the nurse report to the client's health care provider for a client with unstable type 1 diabetes mellitus? Select all that apply.

- systolic blood pressure, 145 mm Hg - diastolic blood pressure, 87 mm Hg - high-density lipoprotein (HDL), 30 mg/dL (1.7 mmol/L) - glycosylated hemoglobin (HbA1c ), 10.2% (0.1) - triglycerides, 425 mg/dL (23.6 mmol/L)

An adult with type 2 diabetes is taking metformin 1,000 mg two times every day. The client asks the nurse about having an alcoholic drink. Which statement indicates the client understands the interaction of alcohol and metformin?

"If I know I'll be having alcohol, I shouldn't take metformin."

A client with diabetes mellitus presents to the clinic for a regular 3- month follow-up appointment. The nurse notes several small bandages covering cuts on the client's hands. The client says, "I'm so clumsy. I'm always cutting my finger cooking or burning myself on the iron." Which response by the nurse would be most appropriate?

"Keep all cuts clean and covered."

The nurse is coaching a diabetic client using an empowerment approach. The nurse should initiate teaching by asking which question?

"What activities are most important for you to be able to maintain control of your diabetes?"

The client with type 2 insulin-requiring diabetes asks the nurse about having alcoholic beverages. Which is the best response by the nurse?

"You can have one or two drinks a day as long as you have something to eat with them."

The health care provider (HCP) has prescribed insulin detemir for a client with type 2 diabetes requiring insulin. What should the nurse teach the client about this insulin?

"You do not mix insulin detemir; the solution is clear."

Which information should the nurse include when developing a teaching plan for a client newly diagnosed with type 2 diabetes mellitus? Select all that apply.

- A major risk factor for complications is obesity and central abdominal obesity. - Annual eye and foot examinations are recommended by the American and Canadian Diabetes Associations.

A client with type 2 diabetes has just started to take dulaglutide. The client reports having severe nausea. What should the nurse instruct the client to do to manage the nausea? Select all that apply.

- Eat small meals more frequently. - Drink ginger tea. - Avoid fried foods.

The nurse is teaching the client about home blood glucose monitoring. Which blood glucose measurement indicates hypoglycemia?

59 mg/dL (3.3 mmol/L)

A nurse is teaching a client with type 1 diabetes mellitus who jogs daily about the preferred sites for insulin absorption. What is the most appropriate site for a client who jogs?

Abdomen

When teaching the diabetic client about foot care, what should the nurse instruct the client to do?

Avoid going barefoot.

A client with diabetes mellitus asks the nurse to recommend something to remove corns from the toes. What should the nurse advise the client to do?

Consult a healthcare provider (HCP) about removing the corns.

Before supper, an adult client who has type 2 diabetes and requires insulin tells the nurse about having tremors and being weak and anxious. What should the nurse do next?

Have the client drink a glass of milk or orange juice.

A client is to receive glargine insulin in addition to a dose of aspart. When the nurse checks the blood glucose level at the bedside, it is >200 mg/dL (11.1 mmol/L). How should the nurse administer the insulins?

Put air into the glargine insulin vial, and draw up the correct dose in an insulin syringe; then with a different insulin syringe, put air into the aspart vial, and draw up the correct dose.

A client with type 1 diabetes mellitus has influenza. What should the nurse instruct the client to do?

Increase the frequency of self-monitoring (blood glucose testing).

To reduce the risk of developing type 2 diabetes mellitus, what should the nurse instruct the client to do?

Maintain weight in normal limits

The nurse should teach the diabetic client that which symptom is most indicative of hypoglycemia?

Nervousness

The nurse notes grapefruit juice on the breakfast tray of a client who is taking repaglinide. What should the nurse do next?

Remove the grapefruit juice from the client's tray and bring another juice of the client's preference.

The nurse is assessing the client's understanding of the use of medications. Which medication may cause a complication with the treatment plan of a client with diabetes?

Steroids

The nurse is checking the laboratory results of an adult client with type 1 diabetes (see chart). What laboratory result indicates a problem that should be managed?

blood glucose

An adult with type 2 diabetes mellitus has been NPO since 2200 in preparation for having a nephrectomy the next day. At 0600 on the day of surgery, the nurse reviews the client's medical record and laboratory results. Which finding should the nurse report to the health care provider?

blood glucose of 140 mg/dL (7.8 mmol/L)

A client with newly diagnosed type 1 diabetes is scheduled to receive regular insulin 10 units and NPH insulin 20 units every morning. When should the nurse schedule the administration of these medications?

both insulins 0.5 hours before breakfast

A client with type 1 diabetes mellitus is admitted to the emergency department. Which respiratory pattern in a client with diabetes mellitus requires immediate action?

deep, rapid respirations with long expirations

When evaluating teaching a client how to administer insulin, which action indicates that additional teaching is necessary? The client:

waits 30 minutes to eat breakfast after injecting rapid-acting insulin

A client with diabetes is taking insulin lispro injections. At what time should the nurse advise the client to eat?

within 10 to 15 minutes after the injection

The nurse is obtaining a health history from a client with diabetes mellitus who has been taking insulin for 20 years. Currently, the client reports having periods of hypoglycemia followed by periods of hyperglycemia. What should the nurse ask about the client's current management plan? Is the client:

injecting insulin at a site of lipodystrophy?

Which goal is a priority for the diabetic client who is taking insulin and has nausea and vomiting from a viral illness or influenza?

obtaining adequate food intake

The nurse has instructed a client newly diagnosed with diabetes how to self-inject insulin. Which is the best indicator that the client has learned how to give an insulin self-injection correctly? The client can:

perform the procedure safely and correctly.

The client with diabetes mellitus says, "If I could just avoid what you call carbohydrates in my diet, I guess I would be okay." The nurse should base the response to this comment on the knowledge that diabetes affects metabolism of which nutrients?

proteins, fats, and carbohydrates

A client with type 1 diabetes mellitus has diabetic ketoacidosis. Which finding has the greatest effect on fluid loss?

rapid, deep respirations

A client who uses an insulin pen asks the nurse how to dispose of the needles. The client's job requires frequent travel by airplane. What information should the nurse include in the teaching plan? Select all that apply.

- At home, dispose of needles in a sharps container or solid plastic container. - Carry a travel size disposal container and dispose of needles in the hotel recycling bin.

A client with type 2 insulin-requiring diabetes has the flu with nausea, body aches, and lack of appetite. The client's blood sugar is 180 mg/dL (10 mmol/L). The vital signs are temperature 101°F (38.3°C), pulse 88 bmp, and respirations 20 breaths/min. What should the nurse instruct the client to do? Select all that apply.

- Check blood sugar every 4 hours. - Drink 240 mL fluids every hour.

. The client has been recently diagnosed with type 2 diabetes and is taking metformin two times per day, 1,000 mg before breakfast and 1,000 mg before supper. The client is experiencing diarrhea, nausea, vomiting, abdominal bloating, and anorexia on admission to the hospital. The admission prescriptions include metformin. What should the nurse do? Select all that apply.

- Inform the client that the adverse effects of diarrhea, nausea, and upset stomach gradually subside over time. - Assess the client's renal function. - Monitor the client's glucose value prior to each meal.

A client is prescribed exenatide. What should the nurse instruct the client to do? Select all that apply.

- Review the one-time setup for each new pen. - Inject in the thigh, abdomen, or upper arm. - Administer the drug within 60 minutes before morning and evening meals.

A nurse is participating in a diabetes screening program. Which clients are at risk for developing type 2 diabetes? Select all that apply.

- a 32-year-old female who gave birth to a 9.5-lb (4,300-g) infant - a 44-year-old Native American (First Nations) who has a body mass index (BMI) of 32 - a 55-year-old Asian who has hypertension and two siblings with type 2 diabetes - a 12-year-old who is overweight

A client is to use an insulin pen. Which action indicates the client is using the pen correctly? Select all that apply.

- stores the unopened pens in the refrigerator - injects the insulin in sites around the abdomen - primes the pen by expelling any air

The client with type 1 diabetes mellitus is taught to take isophane insulin suspension NPH at 1700 each day. The client should be instructed that the greatest risk of hypoglycemia will occur at about what time?

0100, while sleeping

The nurse is administering the initial dose of a rapid-acting insulin to a client with type 1 diabetes. At what time should the nurse assess the client for hypoglycemia?

1 Hour