ATI Diabetes
A nurse is planning a community health screening for a group of clients who are at risk for type II diabetes mellitus. Which of the following clients should the nurse include in the screening? A. Men who smoke B. Men and women who are obese C. Women who have hepatitis D. Men and women who consume high-protein and low-carbohydrate foods
B Explanation: There is a high correlation btw obesity and type 2 DM. Obesity plays a major role in the development of type 2 DM by decreasing the # of available insulin receptors in skeletal muscles and fat cells, which is referred to as peripheral insulin resistance. A reduced-calorie diet for obese clients tends to reverse the phenomenon of peripheral insulin resistance. Smoking can produce cardiovascular and pulmonary complications, but no studies have found that smoking leads to type 2 DM. Hepatitis increases the risk of cirrhosis but not type II DM There is no correlation btw a high protein/low carb diet and a risk btw type 2 DM
A nurse is reviewing laboratory values for a client who has diabetic ketoacidosis (DKA). Which of the following results should the nurse expect? A. pH 7.32, PaCO2 36 mm Hg, HCO3- 14 mEq/L B. pH 7.38, PaCO2 55 mm Hg, HCO3- 22 mEq/L C. pH 7.44, PaCO2 40 mm Hg, HCO3- 24 mEq/L D. pH 7.50, PaCO2 42 mm Hg, HCO3- 30 mEq/L
A Explanation: Metabolic acidosis is a common manifestation of DKA, low/acidic pH (normal 7.35-7.45), carbon dioxide with the normal range (35-45 mmHg), and a low bicarbonate value (normal 22-26 mEq/L)
A nurse is caring for a client who has a type 1 diabetes mellitus and is resistant to learning ow to self-inject insulin. Which of the following statements should the nurse make? A. "Tell me what I can do to help you overcome your fear of giving yourself injections." B. "Your provider will not be pleased that you refuse to give yourself insulin injections." C. "It's okay. I'm sure your partner will be able to learn how to give you the insulin injections." D. "You won't be able to go home unless you learn to give yourself insulin injections."
A Explanation: Therapeutic communication - offering of self. B. Non-therapeutic - challenging C. Non-therapeutic - unwarranted reassurance D. Non-therapeutic - threatening
A nurse is planning care for a client who has type 2 diabetes mellitus. Which of the following interventions should the nurse include in the plan? A. Encourage the client to control their weight B. Inspect the client's feet once a week C. Restrict the client's activity D. Apply moisturizer between the client's toes
A Explanation: Weight control will stabilize the client's blood glucose and improve glycosylated hemoglobin levels. Obesity is a risk factor for type 2 diabetes, and moderate calorie restriction can improve control of diabetes. The nurse should inspect the client's feet DAILY, INCREASE activity level, and NOT apply moisturizer btw the client's toes.
A nurse is monitoring the laboratory values of a client who has diabetes mellitus and is taking insulin. Which of the following results indicates a therapeutic outcome of insulin therapy? A. Fasting blood glucose 96 mg/dL B. Postprandial blood glucose 195 mg/dL C. Random blood glucose 210 mg/dL D. Preprandial blood glucose 60 mg/dL
A Explanations: This is within the expected reference range of 70-100 mg/dL for a fasting blood glucose level & indicates that the therapy is effective. Expected reference ranges: Postprandial (after a meal) blood glucose: <180 mg/dL Random blood glucose: <200 mg/dL Preprandial (before a meal) blood glucose: 70-130 mg/dL
A nurse is reviewing laboratory reports of a client who has HHS. Which of the following findings should the nurse expect? A. Blood pH 7.2 B. Blood osmolarity 350 mOsm/L C. Blood potassium 3.8 mg/dL D. Blood creatinine 0.8 mg/dL
B Explanation: pH 7.2 = metabolic acidosis = expected finding of DKA not HHS Indication of HHS is blood osmolarity ≥ 320 mOsm/L K+ 3.8 is normal (3.5 -5) Creatinine for HHS > 1.5 mg/dL
A nurse is teaching a client how to self-administer insulin. Which of the following actions should the nurse take to evaluate the client's understanding of the process within the psychomotor domain of learning? A. Ask the client if he wants to self-administer his insulin B. Have the client list the steps of the procedure C. Have the client demonstrate the procedure D. Ask the client if he understands the purpose of insulin
C Explanation: A. Affective domain of learning B. Cognitive domain of learning D. Cognitive domain of learning
A nurse is teaching a client who has type 1 diabetes mellitus about how to prevent complications during illness. Which of the following statements by the client indicates an understanding of the teaching. A. "I should stop taking my insulin if I feel nauseous." B. "I will test my urine for protein when I start to feel ill." C. "I will call my doctor if my blood sugar is more than 250." D. "I should check my blood sugar level every 8 hours."
C Explanation: The client should call the provider if their blood glucose levels exceed 250 mg/dL during illness. A. The client should continue to take the usual dosage of insulin even when not feeling well. B. The client should check their urine for ketones when blood levels are greater than 240 mg/dL D. The client should check their blood glucose levels every 4 hours during illness.
A nurse is caring for a client who has a BMI of 29 and expresses a desire to lose weight. Which of the following actions should the nurse take first? A. Refer the client to a nutritionist B. Discuss eating strategies with the client C. Determine the client's intention to change current eating habits D. Instruct the client to perform 30 min of vigorous exercise daily
C Explanation: When using the nursing process, the nurse should first assess the client's readiness to commit to a change in behavior. Everything else should be done, but not first.
A nurse is caring for a client who has type 2 diabetes mellitus and is experiencing a hypoglycemic-hyperosmolar state (HHS). Which of the following laboratory findings should the nurse expect? A. Serum pH 7.32 B. Blood glucose 250 mg/dL C. Blood glucose 425 mg/dL D. Serum pH 7.45
D Explanation: A client is experiencing HHS produces enough insulin to prevent ketosis but not enough to prevent hyperglycemia. Therefore the serum pH is within the expected reference range, glucose levels will be above 600 mg/dL. Blood glucose levels of 250 mg/dL and 425 mg/dL are both hyperglycemic, but HHS is associated with significantly higher blood glucose levels above 600 mg/dL.
A nurse is reviewing the laboratory values of a client who has a diabetic ketoacidosis. Which of the following laboratory values is consistent with diabetic ketoacidosis. A. Blood glucose 30 mg/dL B. Negative urine ketones C. Blood pH 7.38 D. Bicarbonate level 12 mEq/L
D Explanation: A client who has diabetic ketoacidosis should have a bicarbonate level that is <15 mEq/L due to the increased production of counter-regulatory hormones that lead to metabolic acidosis. A client who has DKA should have: Blood glucose >250 mg/dL Positive urine ketones pH <7.3
A nurse is an outpatient clinic is teaching a client who has a diabetic foot ulcer about foot care. Which of the following statements by the client indicates an understanding of the teaching? A. "I will let my feet air dry after washing." B. "I will wear sandals to allow air to circulate around my feet." C. "I will buy over-the-counter medicine to treat the calluses on my feet." D. "I will apply lotion to the dry areas of my feet but not between my toes."
D Explanation: Lotion can be used for dry areas of the feet, but the client should avoid applying lotion between the toes, as this area is prone to bacterial growth. A. Clients should dry their feet thoroughly after washing to prevent bacterial growth between the toes. B. The client should wear closed-toe shoes to prevent injury to their feet. C. OTC medications can impair skin integrity and lead to further injury
A nurse is providing teaching to a client who has type 2 diabetes mellitus about the pathophysiology of the disease. Which of the following statements by the client indicates and understanding of the teaching? A. My cells are resistant to the effects of insulin B. My body breaks down sugars too efficiently C. My pancreas does not produce insulin D. My body produces antibodies against pancreatic beta cells
A Explanation: Type 2 DM: resistance to insulin and decrease in the secretion of insulin by the pancreatic beta cells, and it does not break down sufficient glucose. Type 1 DM: does not secrete insulin b/c the body secretes antibodies that attack the beta cells of the pancreas and therefore does not secrete enough insulin to maintain homeostasis.
A nurse is checking laboratory values to determine if a client with diabetes mellitus is adhering to the treatment plan. Which of the following tests should the nurse use to make this determination? A. Glycosylated hemoglobin levels B. Urine sugar and acetone levels C. Glucose tolerance test D. Fasting serum glucose
A Explanation: Checking HbA1c (glycosylated hemoglobin) levels is an accurate method of determining if the client is routinely compliant. Glycosylated hemoglobin measures the percentage of hemoglobin that is connected to glucose. Since the lifespan of a red blood cell is 4 months, the value will not be affected by recent changes in the client's diet or medication. Urine sugar and acetone levels reflect how well-controlled the client has been for the last few hours. A glucose tolerance test is used to diagnose diabetes mellitus and commonly identifies type 2 and gestational diabetes. A fasting serum glucose provides information about the previous 24 hours.
A nurse is teaching an assistive personnel (AP) how to obtain a capillary finger-stick blood sample. Which of the following actions by the AP requires the nurse to intervene? A. Elevating the finger above heart level B. Rubbing the fingertip with an alcohol pad C. Puncturing the side of the fingertip D. Wrapping the fingertip in a warm cloth
A Explanation: Holding the finger below heart level/a dependent position will help increase the blood flow to the area and ensure an adequate specimen for collection. B. The client should clean the finger with an antiseptic swab or with soap and water. The client should allow the finger to dry completely. C. The client should puncture the side of the finger, avoiding sites beside bone. D. The client should wrap the finger in a warm cloth to increase blood flow to the area.
A nurse is providing teaching to a client who has type I diabetes mellitus about hypoglycemia. Which of the following manifestations should the nurse include in the teaching? A. Shakiness B. Urinary frequency C. Dry mucous membranes D. Excess thirst
A Explanation: The early manifestations of hypOglycemia are shakiness, fatigue, headache, difficulty thinking, sweating, nausea Manifestations of hypERglycemia: polyuria (increased urination), dehydration - dry mucous membranes & sunken eyeballs, polydipsia (excessive thirst)
A nurse in the emergency department is caring for a client who has fruity breath odor, a dry mouth, and extreme thirst. Which of the following assessments should the nurse make? A. Blood glucose level B. Pupillary reaction to light C. Deep tendon reflexes D. Liver function tests
A Explanation: The findings are indications of hyperglycemia and DKA. The nurse should check the client's blood glucose level as well as assess the client's respiratory status, vital signs, level of consciousness, and hydration status, including a laboratory assessment of his electrolyte levels. None of the other assessments are relevant.
A nurse is reviewing the health history of a client who has a DM type 2. Which of the following are risk factors for hyperglycemic-hyperosmolar state (HHS) SATA A. Evidence of recent myocardial infarction B. BUN 35 mg/dL C. Takes a calcium channel blocker D. Age 77 years E. Daily insulin injections
A, B, C, D Explanation: MI - hormone production is increased during stress & illness, which can stimulate the liver to produce glucose & decrease the effects of insulin BUN - normal 7-20 mg/dL, elevated levels indicate decreased kidney function & inability to filter high levels of blood glucose into the urine Ca++ blocker - increases risk of HHS 77 yo - age associated w/ decreased kidney & liver function, therefore associated with greater risk Daily insulin injections - does not increase the risk, insulin helps correct hyperglycemia and can help prevent DKA
A nurse is providing discharge teaching to a client who has diabetic ketoacidosis. Which of the following information should the nurse include about preventing DKA? SATA A. Drink 2 L fluids daily B. Monitor blood glucose every 4 hrs when ill C. Administer insulin as prescribed when ill D. Notify the provider when blood glucose is 200 mg/dL E. Report ketones in the urine after 24 hr of illness
A, B, C, E Explanation: Drinking adequate water can help prevent dehydration if the client develops DKA Blood glucose tends to increase during illness, blood glucose should be monitored more frequently and regular insulin regimen should be maintained Notify the provider when blood glucose is 250 mg/dL If there are ketones in the urine after 24 hours of illness, the provider should be notified
A nurse is presenting information to a group of clients about nutrition habits that prevent type 2 diabetes mellitus. Which of the following should the nurse include in the information: SATA A. Eat at regular intervals B. Decrease intake of saturated fats C. Increase daily fiber intake D. Limit saturated fat intake to 15% of daily caloric intake E. Include omega-3 fatty acids in the diet
A, B, C, E Explanation: Eating at regular intervals helps maintain blood glucose levels Decreasing saturated fat intake helps to lower LDL levels, which can prevent hyperlipidemia & diabetes Healthy nutrition includes increasing dietary fiber (helps reduce lipids, stabilize blood glucose) Saturated fat should be ≤7% of total daily caloric intake, not 15% Omega-3 fatty acids help prevent diabetes and heart disease
A nurse is planning teaching for a client who has type 1 diabetes mellitus. Which of the following instructions should the nurse plan to include? A. Consume no more than 3 servings of alcohol per day. B. Ingest food with alcohol to reduce alcohol-induced hypoglycemia C. Increase insulin dosage before planned exercise D. Rest for 3 days between periods of vigorous exercise
B Explanation: Alcohol inhibits the liver's production of glucose, consuming carbohydrates while drinking alcoholic beverages helps prevent hypoglycemia. A. Men should drink no more than 2 drinks/day, women should drink no more than 1 drink/day C. Clients should reduce insulin dosage before planned exercise to prevent hypoglycemia. D. The client should exercise at least 3x a week, w/o more than 2 consecutive days w/o exercise.
A nurse is conducting a home visit for an older adult client who has diabetes mellitus and takes regular insulin subcutaneously before each meal. The client appears disoriented and weak and has slurred speech. Which of the following conditions should the nurse consider first when responding to these manifestations? A. Dementia B. Hypoglycemia C. Infection D. Transient ischemic attack
B Explanation: Evidence-based practice indicates the nurse should first check the client for hypoglycemia by drawing a blood glucose level, the other options should be considered after hypoglycemia is ruled out. A client with hypoglycemia can have slurred speech, disorientation, weakness, and confusion near meal time each day b/c regular insulin peaks in 2-4 hours, causing a drop in the client's glucose. Other manifestations of hypoglycemia include irritability, mental confusion, double vision, hunger, tachycardia, diaphoresis, and palpitations. A client who has manifestations of dementia becomes cognitively impaired and can exhibit varying manifestations throughout each day (e.g. confusion, disorientation, and difficulty with self-expression). An older client who has an infection can have manifestations of disorientation, confusion, and a low-grade fever, as well as fatigue, malaise, tachypnea. A client who is having a transient ischemic attack may present with neurological deficits such as dizziness, loss of vision in an eye, double vision, weakness and aphasia.
A nurse is assessing a client who has diabetes mellitus and reports feeling anxious. Which of the following findings should the nurse expect if the client is hypoglycemic? A. Rapid, deep respirations B. Cool, clammy skin C. Abdominal cramping D. Orthostatic hypotension
B Explanation: Expected findings of hypoglycemia are cool/clammy skin, anxiety, nervousness, tachycardia, confusion Rapid, deep respirations, abdominal cramping, and orthostatic hypotension are expected findings of hyperglycemia
A nurse is teaching a client about glycosylated hemoglobin (HbA1c) testing. Which of the following client statements indicates an understanding of the teaching? A. "I need to fast after midnight the night before the test." B. "This test's result is a good indicator of my average blood glucose levels." C. "A level of 8-10 percent suggests adequate blood glucose control." D. "I will use my hemoglobin A1c level to adjust my daily insulin doses."
B Explanation: HbA1c reflects the client's glucose levels over a 120-day period, which is the life span of RBCs. Fasting is not required, ingested food does not have an impact on the lab values. The expected reference range for HbA1c for adults is 4-6%, a result higher than 6.5% can indicate diabetes. The client should use capillary blood glucose levels to adjust daily insulin doses with the provider's approval.
A nurse is caring for a client who has type 1 diabetes mellitus and a capillary blood glucose reading of 48 mg/dL. Which of the following findings should the nurse expect? A. Kussmaul respirations B. Diaphoresis C. Decreased skin turgor D. Ketonuria
B Explanation: Hypoglycemia blood glucose level below 70 mg/dL has expected findings of weakness, hunger, diaphoresis, nausea, shakiness, and confusion. Expected findings of hyperglycemia: Kussmaul respirations, dehydration/decreased skin turgor, ketonuria
A nurse is caring for a client who has type 2 DM and is displaying manifestations of hyperglycemia. Which of the following findings indicates the client has hyperglycemia? A. Hunger B. Increased urination C. Cold, clammy skin D. Tremors
B Explanation: Increased urination is a manifestation of hyperglycemia due to a deficiency of insulin, which can lead to osmotic diuresis (the kidney's excreting excess glucose through urine/water loss) Hypoglycemia can lead to a cholinergic response to central glucose deprivation and has manifestations of increased hunger and cold/clammy skin. It can also lead to adrenergic responses to central glucose deprivation which is manifested by tremors.
A nurse is preparing to administer a morning dose of insulin aspart to a client who has type 1 diabetes mellitus. Which of the following actions should the nurse take? A. Check blood glucose immediately after breakfast B. Administer insulin when breakfast arrives C. Hold breakfast for 1 hr after insulin administration D. Clarify the prescription because insulin should not be administered at this time
B Explanation: Insulin aspart is rapid acting, onset is 5-15 minutes, therefore it should be administered with breakfast Blood glucose should be taken before breakfast A type I DM will always need some kind of insulin - the question does not elaborate another type, so this option should be ruled out
A nurse is caring for a client who has diabetes mellitus and has developed peripheral neuropath. Which of the following measures should the nurse recommend to prevent injuries to the client's feet? A. Examine the skin of the feet weekly for alterations in skin integrity B. Monitor the temperature of bath water with a thermometer C. Shop for shoes early in the day D. Round the edges of toenails when trimming them
B Explanation: Peripheral neuropathy makes it difficult to determine if bath water is too hot. Therefore, to prevent injury, the client should use a bath thermometer to ensure a water temperature below 43.3° C (110° F) A. Examine the feet daily C. To make sure the shoes fit, the client should shop for them later in the day when the feet are likely to have slight swelling. D. Toenails should be trimmed straight across and smooth the edges with an emery board.
A nurse is reviewing the medical record for a client who is to begin therapy for DKA. Which of the following should the nurse expect? A. Administer an IV infusion of regular insulin at the 0.3 unit/kg/hr B. Administer a slow IV infusion of 3% sodium chloride C. Rapidly administer an IV infusion of 0.9% sodium chloride D. Add glucose to the IV infusion when blood glucose is 350 mg/dL
C Explanation: 0.9% sodium chloride is isotonic, will help maintain blood volume & perfusion to vital organs. Elevated sodium level use 0.45% sodium chloride Administer IV infusion of regular insulin at 0.1 unit/kg/hr to gradually lower blood glucose to prevent cerebral edema 3% sodium chloride is given to someone w/ hypOnatremia Add glucose to IV infusion when blood glucose is 250 mg/dL not 350 mg/dL to prevent hypoglycemia & prevent edema
A nurse is providing teaching about exercise to a client who has type 1 diabetes mellitus. Which of the following statements should the nurse include? A. You should exercise during peak insulin time B. Wear a medical alert ID tag when you exercise C. Exercise can decrease the effects of insulin and cause your blood glucose levels to increase D. You will get the most benefit from exercise when your glucose levels are higher than normal.
B Explanation: The client should wear a medical alert ID tag in the event of a hypoglycemic response b/c exercise can potentiate the effects of insulin and cause blood glucose levels to decrease. The client should avoid exercising within 1 hour of receiving insulin or at the peak time of insulin, because exercise can increase the absorption of insulin at the injection site and cause a marked drop in blood sugar at the insulin peak time. The client should plan to eat at least 1hour before exercise and drink carbohydrate liquid to decrease the risk of a hypoglycemic response. A client who exercises can potentiate the effects of insulin and cause the blood glucose levels to decrease. A client who has poorly controlled insulin-dependent diabetes mellitus should not exercise when blood glucose levels are >250 mg/dL or if ketones are noted in the urine; this is because there is an inadequate amount of insulin for transporting glucose
A nurse is planning dietary teaching for a client who has diabetes mellitus. Which of the following actions should the nurse plan to take first? A. Obtain sample menus from the dietitian to give to the client B. Ask the client to identify the types of foods she prefers C. Identify the recommended range of the client's blood glucose level D. Discuss long-term complications that can result from non-adherence to the dietary plan
B Explanation: The nurse should apply the nursing process priority-setting framework to plan the client care & prioritize nursing actions. Before the nurse can formulate a plan of action, implement a nursing intervention, or notify the provider of a change in the client's status, the nurse must first collect adequate data from the client. Assessing or collecting additional data will provide the nurse with the knowledge to make an appropriate decision. Therefore, the nurse should first ask the client about individual food preferences to provide an opportunity for the nurse to include these foods in her diet. Involving the client in the planning will promote her adherence to the dietary plan. All of the other actions should be taken, but after the data collection.
A nurse is caring for a client who is receiving total parenteral nutrition (TPN) which of the following actions should the nurse take? A. Administer 0.9% sodium chloride until TPN is available from the pharmacy B. Check the client's capillary blood glucose level every 4 hr C. Obtain the client's weight each week D. Change the IV tubing every 3 days
B Explanation: The nurse should check the client's capillary blood glucose level every 4 hours or according to facility policy due to the client's risk of hyperglycemia while receiving TPN. The dextrose concentration in TPN increases the risk of this complication. If TPN is unavailable, the nurse should administer 10% dextrose in water, or 20% dextrose in water if TPN is temporarily unavailable from the pharmacy. A client receiving TPN is at risk for fluid imbalance due to the fluid administration and hyperosmolarity of the TPN, therefore the nurse should monitor the client's weight DAILY. The nurse should change the IV tubing every 24 hours to decrease the risk of infection.
A nurse is assessing a client who has diabetic ketoacidosis and ketones in the urine. The nurse should expect which of the following findings: SATA A. Weight gain B. Fruity odor of breath C. Abdominal pain D. Kussmaul respirations E. Metabolic acidosis
B, C, D, E Explanation: Wt loss is expected = insulin deficiency means cells can't make use of glucose, which places the body in a catabolic state (breaking things down more than building things [anabolic state]) leading to wt loss, fluid loss from dehydration also leads to wt loss Fruity odor of breath = manifestation of elevated ketones Abd pain = manifestation of elevated ketones & acidosis Kussmaul respirations = hyperventilation = respiratory system trying to correct metabolic acidosis Metabolic acidosis = caused by glucose, protein, & fat breakdown, which produces ketones
A nurse is teaching a client who has type II diabetes mellitus about foot care. Which of the following statements by the client indicates an understanding of the teaching? A. I will apply moisturizer between my toes B. I will soak my feet daily C. I will be sure to wear cotton socks every day D. I'll use a heating pad to warm my feet
C Explanation: Clean cotton socks will absorb moisture and reduce risk of infection. Excess moisture can lead to infection & skin breakdown, which can be caused by moisturizer between the toes or soaking the feet. Avoid using heating pad or hot water bottle on the feet b/c reduced sensation can lead to burns.
A nurse is preparing to administer morning doses of insulin glargine and regular insulin to a client who has a blood glucose 278 mg/dL. Which of the following actions should the nurse take? A. Draw up the regular insulin and then the glargine insulin in the same syringe B. Draw up the glargine insulin then the regular insulin in the same syringe C. Draw up an administer regular and glargine insulin in separate syringes D. Administer the regular insulin, wait 1 hr, and then administer the glargine insulin
C Explanation: Glargine is long-acting insulin and should never be mixed in a syringe with any other insulin, but it can be administered at the same time in a separate syringe
A nurse is providing teaching to a client who has type 2 diabetes mellitus. The client states, "I eat pasta every day. I can't imagine giving it up." Which of the following responses should the nurse provide? A. "Let's discuss this with your doctor; giving up daily pasta may not be necessary." B. "Is there another favorite dish you can substitute?" C. "You don't have to give up pasta; just adjust the amount you eat." D. "You can use no-added-salt tomato products on your pasta."
C Explanation: The American Diabetes Association recommends individualizing carbohydrate restriction for each client. A careful assessment of the client's usual dietary practices and modifications is an important part of teaching clients to manage this disorder. A. The nurse can counsel clients & provide resources about appropriate dietary choices w/o consulting the provider. B. Although this idea has some merit, the client is expressing dismay about giving up pasta. Often, there is no substitute for what the client really enjoys. D. While reduced sodium intake is recommended for most clients, especially those who have hypertension, this is not a solution for this client's concern about pasta. Additionally, it does not relate to glycemic control, which is a critical issue for this client.
A nurse is caring for a client who has diabetic ketoacidosis. Which of the following findings should the nurse expect? A. Urine negative for ketones B. Distended neck veins C. Kussmaul respirations D. Elevated blood pressure
C Explanation: The nurse should expect a client with DKA to experience Kussmaul - deep and rapid - respirations, which are the bodies attempt to exhale carbon dioxide (an acid) to reverse the metabolic acidosis that occurs with DKA. Ketones would be present in the blood and urine. Distended neck veins are a finding of excess fluid volume, while dehydration (flattened neck veins, hypotension, dry skin, sunken eyeballs) is a finding of DKA. Orthostatic hypotension is common in patients with DKA due to the dehydration due to osmotic diuresis (the kidneys try to clear the excess glucose thru urine production, which takes water with it)
A nurse is providing discharge teaching for a client who ha type 2 diabetes mellitus and will be caring for herself at home. The client expresses concerns about preparing an appropriate diet for her diabetes due to her cultural beliefs and preferences. Which of the following responses should the nurse offer? A. "The home health dietitian will visit and help you learn to cook all over again." B. "The dietitian will give you a list of foods and dietary choices to keep your diabetes under control." C. "The dietitian will help you choose foods you are used to that also meet your health needs." D. "It may be difficult, but I know you can change your eating and cooking habits with some help from the dietitian."
C Explanation: This response shows respect for the client's food preferences and cultural needs by offering choices from among the client's usual foods. A. This statement implies judgment that the client's cooking is substandard or unacceptable. B. This statement implies that replacing the client's cultural food preferences is the only therapeutic option. D. This statement implies that the client's eating and cooking habits are substandard or unacceptable.
A nurse is caring for a client who has blood glucose 52 mg/dL. The client is lethargic but arousable. Which of the following actions should the nurse perform first A. Recheck blood glucose in 15 min B. Provide a carbohydrate and protein food C. Provide 15g of simple carbohydrates D. Report findings to provider
C Explanation: this is a priority nursing action question, all actions should be taken, but the biggest risk to the client is injury due to hypoglycemia. Give carbohydrate & protein if the next meal is more than 1 hour away after the blood glucose returns to normal
A nurse is teaching a client who has diabetes mellitus about insulin injections. The client's prescription includes evening doses of insulin glargine and regular insulin. Which of the following instructions should the nurse include? A. Inject the insulins intramuscularly B. Shake the insulins vigorously prior to administration C. Draw up the insulins into separate syringes D. Expect the insulins to appear cloudy
C Explanations: Insulin glargine is not compatible to mix with other insulins, though they can be administered at the same time. A. Insulin should be injected SubQ B. The insulins should be gently mixed prior to administration to prevent altering the chemistry of the medication D. The nurse should expect both insulins to appear clear, and should discard any that appear cloudy.
A nurse in a provider's office is teaching a client about foods that are high in fiber. Which of the following food choices made by the client indicate an understanding of the teaching? SATA A. Canned peaches B. White rice C. Black beans D. Whole-grain bread E. Tomato juice
C, D Explanation: Black beans and other beans and peas are high in fiber. Whole-grains consist of the entire kernel and are also high in fiber. Canned fruit is better for a low fiber diet, fresh fruit is higher in fiber. White rice is recommended for a low fiber diet, brown rice is higher in fiber. Canned juices are recommended for a low-fiber diet.
A nurse is teaching a client about lifestyle changes to manage a chronic illness. Which of the following strategies should the nurse use first to help the client make a commitment to these lifestyle changes? A. Identify the risks of nonadherence B. Schedule learning sessions to demonstrate the psychomotor skills the client will need C. Provide clearly written and easy to understand materials D. Help the client identify ways that these changes will result in positive personal outcomes
D Explanation: According to evidence-based practice, the motivation to change must precede taking steps to make the change. Therefore, helping clients identify ways that changes will promote positive outcomes should precede other educational strategies for making the changes. The client should first see how the changes directly affects his/her life, thus enhancing the motivation to make the changes. A. The client might perceive warnings about the dangers of nonadherence as a threat. This information should be presented after the client commits to making the recommended changes. B. This is unlikely to encourage the client to make an initial commitment, this strategy will likely strengthen the client's adherence to recommended life changes after the client has made an initial commitment to them. C. Good materials are helpful, but should be provided after the client commits to change.
A nurse is teaching a client who has diabetes mellitus. Which of the following should the nurse include as an expected finding of DKA? A. Decreased urine output B. Weight gain of 0.45 kg (1 lb) in 24 hr C. Rapid, shallow respirations D. Blood glucose levels above 300 mg/dL
D Explanation: Blood glucose levels above 300 mg/dL are an expected finding of DKA. Levels above 600 mg/dL are an expected finding of hyperglycemic-hyperosmolar state. Expected findings: increased urine output, weight loss, deep, labored breathing (Kussmaul breathing).
A nurse is providing teaching about food choices to a client who has diabetes mellitus. Which of the following statements by the client indicates an understanding of the teaching? A. "I will need to eliminate sweet desserts from my diet." B. "I should avoid using sucralose in my coffee." C. "I should consume alcohol between meals in moderation." D. "I should replace white bread with whole-grain bread."
D Explanation: Clients with diabetes mellitus have the same fiber requirements as the general population. Fiber content can be increased by substituting white bread, which is made with refined grains, with whole-grain bread, which retains the outer layer of the grain that is higher in fiber. Sweet desserts are not prohibited for clients who have diabetes mellitus. Instead, the should be consumed in moderation & substituted for other carbohydrates in the client's meal plan. Sucralose is non-nutritive sweetener that has been approved by the FDA for this use. It is considered safe for clients who have DM. Although clients who have DM can consume alcohol in moderation, the nurse should instruct the client to consume alcohol with food to avoid hypoglycemia.
A nurse is reviewing the laboratory results of a client who has diabetes mellitus. Which of the following results indicates the client's diabetes is controlled? A. HbA1c 8.5% B. Postprandial blood glucose 190 mg/dL C. Casual blood glucose 205 mg/dL D. Fasting blood glucose 95 mg/dL
D Explanation: Fasting blood glucose of 95 mg/dL is within the expected reference range of 70-110 mg/dL, which indicates that this client's diabetes is under control. HbA1c 8.5% is above expected reference range of below 7% A postprandial (after a meal) blood glucose of 190 mg/dL is above the expected value of <160 mg/dL A casual blood glucose of 205 mg/dL is above expected reference of under 200 mg/dL
A nurse is planning care for a client who is experiencing the Somogyi effect and takes intermittent-acting insulin. Which of the following actions should the nurse include in the plan? A. Move the evening intermediate-acting insulin dose 90 min before dinner B. Increase the client's morning caloric intake C. Omit the client's evening snack D. Monitor the client's nighttime blood glucose levels
D Explanation: The Somogyi effect describes a high blood glucose level in the morning after an extremely low blood glucose level during the night. This swing is caused by the release of the stress hormones to counter low glucose levels. Monitoring the client's nighttime blood glucose levels over time can provide an accurate diagnosis of the Somogyi effect. The nurse should plan to administer a smaller dose of intermediate-acting insulin at bedtime or increase the client's bedtime snacks to avoid conditions that can lead to the Somogyi effect. The nurse should evaluate the client's evening caloric intake based on the insulin dose and exercise programs during the day to avoid conditions that can lead to the Somogyi effect. The nurse should ensure the client receives a bedtime snack to decrease the chance of hypoglycemia during the night.
A nurse is caring for a client who is receiving total parenteral nutrition (TPN) through a central line. Which of the following actions should the nurse perform? A. Change the tubing every 12 hrs B. Check the client's blood glucose every 8 hrs C. Apply the new dressing to the IV site every 76 hrs D. Weigh the client daily
D Explanation: The nurse should weight the client who is receiving TPN daily due to the risk of fluid and electrolyte imbalances. Change the TPN tubing every 24 hrs to prevent bacteria from developing in the tubing The nurse should check the blood glucose every 4 hrs, hypoglycemia is an adverse effect of TPN The nurse should apply a new dressing to the client's IV site ever 24-72 hrs. The site should be observed for redness, irritation, or signs of infection.
A nurse is obtaining a capillary blood sample to determine a client's blood glucose level. The nurse prepares and punctures the client's finger for the procedure but does not obtain an adequate amount of blood. Which of the following actions should the nurse take next? A. Smear the small amount of blood onto the testing strip B. Hold the finger above heart level C. Massage the client's fingertip D. Wrap the client's finger in a warm washcloth
D Explanation: Warmth helps increase the blood flow to the client's finger. A. Smearing the blood on the reagent strip will lead to inaccurate result. B. To improve blood flow, the nurse should keep the client's hand in a dependent position. C. Massaging can hemolyze the specimen, leading to an inaccurate result.
A nurse is teaching foot care to a client who has diabetes mellitus. Which of the following information should the nurse include in the teaching: SATA A. Remove calluses using OTC remedies B. Apply lotion between toes C. Test water temperature with the fingers before bathing D. Trim toenails straight across E. Wear closed-toe shoes
D, E Explanation: A podiatrist should remove calluses or corns. OTC remedies can increase risk for injury & infection. Lotion between the toes increases moisture which can lead to growth of micro-organisms and infection Test bathwater with the wrist or a thermometer, the fingers may not be as sensitive Trim toenails straight across to prevent injury to the soft tissue of the toes Wear closed-toe shoes to prevent injury to the soft tissue of the toes
