Ch 51: Diabetes
Which instruction about insulin administration should a nurse give to a client? "Store unopened vials of insulin in the freezer at temperatures well below freezing." "Discard the intermediate-acting insulin if it appears cloudy." "Shake the vials before withdrawing the insulin." "Always follow the same order when drawing the different insulins into the syringe."
Correct response: "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.
NPH is an example of which type of insulin? Short-acting Long-acting Intermediate-acting Rapid-acting
Correct response: Intermediate-acting Explanation: NPH is intermediate-acting insulin.
A nurse is preparing to administer insulin to a child who's just been diagnosed with type 1 diabetes. When the child's mother stops the nurse in the hall, she's crying and anxious to talk about her son's condition. The nurse's best response is: "If you'll wait in your son's room, the physician will talk with you as soon as he's free." "I'm going to give your son some insulin. Then I'll be happy to talk with you." "I can't talk now. I have to give your son his insulin as soon as possible." "Everything will be just fine. I'll be back in a minute and then we can talk."
Correct response: "I'm going to give your son some insulin. Then I'll be happy to talk with you." Explanation: Attending to the mother's needs is a critical part of caring for a sick child. In this case however, administering insulin in a prompt manner supersedes the mother's needs. By informing the mother that she's going to administer the insulin and will then make time to talk with her, the nurse recognizes the mother's needs as legitimate. She provides a reasonable response while attending to the priority of administering insulin as soon as possible. Telling the mother that she can't talk with her or telling her to wait for the physician could increase the mother's fear and anxiety. The nurse shouldn't tell the mother that everything will be fine; the nurse doesn't know that everything will be fine.
A client with type 1 diabetes has a highly elevated glycosylated hemoglobin (Hb) test result. In discussing the result with the client, the nurse is most accurate in stating: "Your insulin regimen must be altered significantly." "The test must be repeated following a 12-hour fast." "It tells us about your sugar control for the last 3 months." "It looks like you aren't following the ordered diabetic diet."
Correct response: "It tells us about your sugar control for the last 3 months." Explanation: The nurse is providing accurate information to the client when she states that the glycosylated Hb test provides an objective measure of glycemic control over a 3-month period. The test helps identify trends or practices that impair glycemic control, and it doesn't require a fasting period before blood is drawn. The nurse can't conclude that the result occurs from poor dietary management or inadequate insulin coverage.
A 16-year-old patient newly diagnosed with type 1 diabetes has a very low body weight despite eating regular meals. The patient is upset because friends frequently state, "You look anorexic." Which of the following statements would be the best response by the nurse to help this patient understand the cause of weight loss due to this condition? "Your body is using protein and fat for energy instead of glucose." "Don't worry about what your friends think; the carbohydrates you eat are being quickly digested, increasing your metabolism." "You may be having undiagnosed infections causing you to lose extra weight." "I will refer you to a dietician who can help you with your weight."
Correct response: "Your body is using protein and fat for energy instead of glucose." Explanation: Persons with type 1 diabetes, particularly those in poor control of the condition, tend to be thin because when the body cannot effectively utilize glucose for energy (no insulin supply), it begins to break down protein and fat as an alternate energy source. Patients may be underweight at the onset of type 1 diabetes because of rapid weight loss from severe hyperglycemia. The goal initially may be to provide a higher-calorie diet to regain lost weight and blood glucose control.
An agitated, confused client arrives in the emergency department. The client's history includes type 1 diabetes, hypertension, and angina pectoris. Assessment reveals pallor, diaphoresis, headache, and intense hunger. A stat blood glucose sample measures 42 mg/dl, and the client is treated for an acute hypoglycemic reaction. After recovery, the nurse teaches the client to treat hypoglycemia by ingesting: 10 to 15 g of a simple carbohydrate. 25 to 30 g of a simple carbohydrate. 2 to 5 g of a simple carbohydrate. 18 to 20 g of a simple carbohydrate.
Correct response: 10 to 15 g of a simple carbohydrate. Explanation: To reverse hypoglycemia, the American Diabetes Association recommends ingesting 10 to 15 g of a simple carbohydrate, such as three to five pieces of hard candy, two to three packets of sugar (4 to 6 tsp), or 4 oz of fruit juice. Then the client should check his blood glucose after 15 minutes. If necessary, this treatment may be repeated in 15 minutes. Ingesting only 2 to 5 g of a simple carbohydrate may not raise the blood glucose level sufficiently. Ingesting more than 15 g may raise it above normal, causing hyperglycemia.
The nurse is administering lispro (Humalog) insulin. Based on the onset of action, how soon should the nurse administer the injection prior to breakfast? 3 hours 10 to 15 minutes 1 to 2 hours 30 to 40 minutes
Correct response: 10 to 15 minutes Explanation: The onset of action of rapid-acting Humalog is within 10 to 15 minutes. It is used for rapid reduction of glucose level.
A 6 months' pregnant patient was evaluated for gestational diabetes mellitus. The doctor considered prescribing insulin based on the serum glucose result of: 80 mg/dL, 1 hour postprandial. 138 mg/dL, 2 hours postprandial. 120 mg/dL, 1 hour postprandial. 90 mg/dL before meals.
Correct response: 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.
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: I.V. bolus of dextrose 50%. 10 units of fast-acting insulin. 15 to 20 g of a fast-acting carbohydrate such as orange juice. I.M. or subcutaneous glucagon.
Correct response: 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 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? 7.5% 6.5% 8.0% 8.5%
Correct response: 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.
Every morning, a client with type 1 diabetes receives 15 units of Humulin 70/30. What does this type of insulin contain? 70% NPH insulin and 30% regular insulin 70 units of regular insulin and 30 units of NPH insulin 70% regular insulin and 30% NPH insulin 70 units of neutral protamine Hagedorn (NPH) insulin and 30 units of regular insulin
Correct response: 70% NPH insulin and 30% regular insulin Explanation: Humulin 70/30 insulin is a combination of 70% NPH insulin and 30% regular insulin.
Which of the following is true regarding gestational diabetes? There is a low risk for perinatal complications. Its onset is usually in the first trimester. It occurs in the majority of pregnancies. A glucose challenge test should be performed between 24 to 28 weeks.
Correct response: A glucose challenge test should be performed between 24 to 28 weeks. Explanation: A glucose challenge test should be performed between 24 to 48 weeks. It occurs in 2 to 5% of all pregnancies. Onset is usually in the second or third trimester. There is an above-normal risk for perinatal complications.
A patient newly diagnosed with type 1 diabetes has an unusual increase in blood glucose from bedtime to morning. The physician suspects the patient is experiencing insulin waning. Based on this diagnosis, the nurse will expect which of the following changes to the patient's medication regimen? Changing the time of injection of evening intermediate-acting insulin from dinnertime to bedtime Increasing morning dose of long-acting insulin Decreasing evening bedtime dose of intermediate-acting insulin and administering a bedtime snack Administering a dose of intermediate-acting insulin before the evening meal
Correct response: 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 (predinner 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 nurse is caring for a diabetic patient with a diagnosis of nephropathy. What would the nurse expect the urinalysis report to indicate? Red blood cells Albumin White blood cells Bacteria
Correct response: Albumin Explanation: Albumin is one of the most important blood proteins that leak into the urine. Although small amounts may leak undetected for years, its leakage into the urine 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 (Chart 51-10). The urine should be checked annually for the presence of microalbumin.
Matt Thompson, a 37-year-old farmer, has been diagnosed with pre diabetes. Following his visit with his primary care provider, you begin your client education session to discuss treatment strategies. What can be the consequences of untreated pre diabetes? All options are correct. CVA Type 2 diabetes Cardiac disease
Correct response: All options are correct. Explanation: The NIDDK has developed criteria that identify people with prediabetes, which can lead to type 2 diabetes, heart disease, and stroke.
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? Give prescribed antiemetics. Begin fluid replacements. Administer bicarbonate to correct acidosis. Administer prescribed dose of insulin.
Correct response: Begin fluid replacements. Explanation: Management of DKA is aimed at correcting dehydration, electrolyte loss, and acidosis before correcting the hypoglycemia with insulin.
A client is admitted with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which laboratory finding should the nurse expect in this client? Blood glucose level 1,100 mg/dl Plasma bicarbonate 12 mEq/L Arterial pH 7.25 Blood urea nitrogen (BUN) 15 mg/dl
Correct response: 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 client is admitted with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which laboratory finding should the nurse expect in this client? Blood urea nitrogen (BUN) 15 mg/dl Arterial pH 7.25 Blood glucose level 1,100 mg/dl Plasma bicarbonate 12 mEq/L
Correct response: 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 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? Miglitol Rosiglitazone Metformin Glyburide
Correct response: Miglitol Explanation: Alpha-glucosidase inhibitors include drugs such as miglitol and acarbose. Metformin is a biguanide. Glyburide is a sulfonylurea. Rosiglitazone is a thiazolidinedione.
Which of the following clinical characteristics is associated with type 2 diabetes (previously referred to as non-insulin dependent diabetes mellitus [NIDDM])? Ketosis-prone Can control blood glucose through diet and exercise Demonstrate islet cell antibodies Usually thin at diagnosis
Correct response: Can control blood glucose through diet and exercise Explanation: Oral hypoglycemic agents may improve blood glucose levels if dietary modification and exercise are unsuccessful. Individuals with type 2 diabetes are usually obese at diagnosis. Individuals with type 2 diabetes rarely demonstrate ketosis, except with stress or infection. Individuals with type 2 diabetes do not demonstrate islet cell antibodies.
An obese Hispanic client, age 65, is diagnosed with type 2 diabetes. Which statement about diabetes mellitus is true? Type 2 diabetes mellitus is less common than type 1 diabetes mellitus. Nearly two-thirds of clients with diabetes mellitus are older than age 60. Diabetes mellitus is more common in Hispanics and Blacks than in Whites. Approximately one-half of the clients diagnosed with type 2 diabetes are obese.
Correct response: Diabetes mellitus is more common in Hispanics and Blacks than in Whites. Explanation: Diabetes mellitus is more common in Hispanics and Blacks than in Whites. Only about one-third of clients with diabetes mellitus are older than age 60 and 85% to 90% have type 2. At least 80% of clients diagnosed with type 2 diabetes mellitus are obese.
Which of the following would the nurse most likely assess in a client with diabetes who is experiencing autonomic neuropathy? Erectile dysfunction Skeletal deformities Paresthesias Soft tissue ulceration
Correct response: 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.
Which of the following is the most rapid acting insulin? Ultralente Humalog Regular NPH
Correct response: Humalog Explanation: The onset of action of rapid-acting Humalog 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 is 3 to 4 hours. The onset of action of long-acting Ultralente is 6 to 8 hours.
An older adult patient is in the hospital being treated for sepsis related to a urinary tract infection. The patient has started to have an altered sense of awareness, profound dehydration, and hypotension. What does the nurse suspect the patient is experiencing? Multiple-organ dysfunction syndrome Diabetic ketoacidosis Hyperglycemic hyperosmolar syndrome Systemic inflammatory response syndrome
Correct response: Hyperglycemic hyperosmolar syndrome Explanation: Hyperglycemic hyperosmolar syndrome (HHS) occurs most often in older people (50 to 70 years of age) who have no known history of diabetes or who have type 2 diabetes (Reynolds, 2012). The clinical picture of HHS is one of hypotension, profound dehydration (dry mucous membranes, poor skin turgor), tachycardia, and variable neurologic signs (e.g., alteration of consciousness, seizures, hemiparesis) (see Table 51-7).
The nurse is educating the diabetic client 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? Do not take insulin if not eating. Increase frequency of glucose self-monitoring. Decrease food intake until nausea passes. Take half the usual dose of insulin until symptoms resolve.
Correct response: 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 nurse is assessing a client who is receiving total parenteral nutrition (TPN). Which finding suggests that the client has developed hyperglycemia? Cheyne-Stokes respirations Diaphoresis Increased urine output Decreased appetite
Correct response: 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.
Which of the following statements is correct regarding glargine (Lantus) insulin? It is absorbed rapidly. Its peak action occurs in 2 to 3 hours. It cannot be mixed with any other type of insulin. It is given twice daily.
Correct response: 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 not a peak in action. It is approved to give once daily.
A 53-year-old client is brought to the ED, via squad, where you practice nursing. He is demonstrating fast, deep, labored breathing and has a fruity odor to his breath. He has a history of type 1 diabetes. What could be the cause of his current serious condition? All options are correct Ketoacidosis Hyperosmolar hyperglycemic nonketotic syndrome Hepatic disorder
Correct response: 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. The most likely cause is ketoacidosis. 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. The most likely cause is ketoacidosis.
A patient who is diagnosed with type 1 diabetes would be expected to: Receive daily doses of a hypoglycemic agent. Be restricted to an American Diabetic Association diet. Have no damage to the islet cells of the pancreas. Need exogenous insulin.
Correct response: Need exogenous insulin. Explanation: Type 1 diabetes is characterized by the destruction of pancreatic beta cells that require exogenous insulin.
A nurse expects to find which signs and symptoms in a client experiencing hypoglycemia? Polyuria, headache, and fatigue Polydipsia, pallor, and irritability Nervousness, diaphoresis, and confusion Polyphagia and flushed, dry ski
Correct response: Nervousness, diaphoresis, and confusion Explanation: Signs and symptoms associated with hypoglycemia include nervousness, diaphoresis, weakness, light-headedness, confusion, paresthesia, irritability, headache, hunger, tachycardia, and changes in speech, hearing, or vision. If untreated, signs and symptoms may progress to unconsciousness, seizures, coma, and death. Polydipsia, polyuria, and polyphagia are symptoms associated with hyperglycemia.
An older adult patient that has diabetes type 2 comes to the emergency department with second-degree burns to the bottom of both feet and states, "I didn't feel too hot but my feet must have been too close to the heater." What does the nurse understand is most likely the reason for the decrease in temperature sensation? A faulty heater Peripheral neuropathy Autonomic neuropathy Sudomotor neuropathy
Correct response: Peripheral neuropathy Explanation: As the neuropathy progresses, the feet become numb. In addition, a decrease in proprioception (awareness of posture and movement of the body and of position and weight of objects in relation to the body) and a decreased sensation of light touch may lead to an unsteady gait. Decreased sensations of pain and temperature place patients with neuropathy at increased risk for injury and undetected foot infections.
A client is admitted to the unit with diabetic ketoacidosis (DKA). Which insulin would the nurse expect to administer intravenously? NPH Regular Lente Glargine
Correct response: 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.
The nurse is administering an insulin drip to a patient in ketoacidosis. What insulin does the nurse know is the only one that can be used intravenously? Regular Lispro NPH Lantus
Correct response: Regular Explanation: Short-acting insulins are called regular insulin (marked R on the bottle). Regular insulin is a clear solution and is usually administered 20 to 30 minutes before a meal, either alone or in combination with a longer-acting insulin. Regular insulin is the only insulin approved for IV use.
The diabetic client asks the nurse why shoes and socks are removed at each office visit. Which assessment finding is most significant in determining the protocol for inspection of feet? Retinopathy Sensory neuropathy Autonomic neuropathy Nephropathy
Correct response: 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 feet are inspected on each visit to insure no injury or pressure has occurred. Autonomic neuropathy, retinopathy, and nephropathy affect nerves to organs other than feet.
As a nurse educator, you have been invited to your local senior center to discuss health-maintaining strategies for older adults. During your education session on nutrition, you approach the subject of diabetes mellitus, its symptoms, and consequences. One of the women in your lecture group asks if you know the death rate from diabetes mellitus. What is your response? Seventh cause of death in the United States Ninth cause of death in the United States Fifth cause of death in the United States Tenth cause of death in the United States
Correct response: Seventh cause of death in the United States Explanation: At present, diabetes is the seventh cause of death in the United States.
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? Polyuria, polydipsia, and polyphagia Sweating, tremors, and tachycardia Dry skin, bradycardia, and somnolence Bradycardia, thirst, and anxiety
Correct response: Sweating, tremors, and tachycardia Explanation: Sweating, tremors, and tachycardia, thirst, and anxiety are early signs of hypoglycemia. Dry skin, bradycardia, and somnolence are signs and symptoms associated with hypothyroidism. Polyuria, polydipsia, and polyphagia are signs and symptoms of diabetes mellitus.
Which of the following factors would a nurse identify as a most likely cause of diabetic ketoacidosis (DKA) in a client with diabetes? The client has eaten and has not taken or received insulin. The client has not consumed sufficient calories. The client continues medication therapy despite adequate food intake. The client has been exercising more than usual.
Correct response: 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.
The pancreas continues to release a small amount of basal insulin overnight, while a person is sleeping. The nurse knows that, if the body needs more sugar: The process of gluconeogenesis will be inhibited. Insulin will be released to facilitate the transport of sugar. Glycogenesis will be decreased by the liver. The pancreatic hormone glucagon will stimulate the liver to release stored glucose.
Correct response: The pancreatic hormone glucagon will stimulate the liver to release stored glucose. Explanation: When sugar levels are low, glucagon promotes hyperglycemia by stimulating the release of stored glucose. Glycogenolysis and gluconeogenesis will both be increased. Insulin secretion would promote hypoglycemia.
Which of the following may be a potential cause of hypoglycemia in the patient diagnosed with diabetes mellitus? The patient has not been compliant with the prescribed treatment regimen. The patient has consumed food and has not taken or received insulin. The patient has not been exercising. The patient has not consumed food and continues to take insulin or oral antidiabetic medications.
Correct response: The patient has not consumed food and continues to take insulin or oral antidiabetic medications. Explanation: Hypoglycemia occurs when a patient with diabetes is not eating at all and continues to take insulin or oral antidiabetic medications. Hypoglycemia does not occur when the patient has not been compliant with the prescribed treatment regimen. If the patient has eaten and has not taken or received insulin, DKA is more likely to develop.
A client with diabetes mellitus develops sinusitis and otitis media accompanied by a temperature of 100.8° F (38.2° C). What effect do these findings have on his need for insulin? They have no effect. They increase the need for insulin. They decrease the need for insulin. They cause wide fluctuations in the need for insulin.
Correct response: They increase the need for insulin. Explanation: Insulin requirements increase in response to growth, pregnancy, increased food intake, stress, surgery, infection, illness, increased insulin antibodies, and some medications. Insulin requirements are decreased by hypothyroidism, decreased food intake, exercise, and some medications.
The nurse is teaching a patient about self-administration of insulin and mixing of regular and neutral protamine Hagedorn (NPH) insulin. Which of the following is important to include in the teaching plan? When mixing insulin, the regular insulin is drawn up into the syringe first. When mixing insulin, the NPH insulin is drawn up into the syringe first. There is no longer a need to inject air into the bottle of insulin before insulin is withdrawn. If two different types of insulin are ordered, they need to be given in separate injections.
Correct response: 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 drawing into the syringe. The American Diabetic Association (ADA) recommends that the regular insulin be drawn up first. The most important issues are (1) that patients are consistent in technique, so the wrong dose is not drawn in error or the wrong type of insulin, and (2) that patients 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.
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: at least once per week. at least five times per week. at least three times per week. every day.
Correct response: 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 nurse is providing dietary instructions to a client with hypoglycemia. To control hypoglycemic episodes, the nurse should recommend: eating a candy bar if light-headedness occurs. increasing saturated fat intake and fasting in the afternoon. increasing intake of vitamins B and D and taking iron supplements. consuming a low-carbohydrate, high-protein diet and avoiding fasting.
Correct response: consuming a low-carbohydrate, high-protein diet and avoiding fasting. Explanation: To control hypoglycemic episodes, the nurse should instruct the client to consume a low-carbohydrate, high-protein diet, avoid fasting, and avoid simple sugars. Increasing saturated fat intake and increasing vitamin supplementation wouldn't help control 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: serum fructosamine level. urine glucose level. glycosylated hemoglobin level. fasting blood glucose level.
Correct response: 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 type 1 diabetes asks the nurse about taking an oral antidiabetic agent. The nurse explains that these medications are effective only if the client: is pregnant and has type 2 diabetes. prefers to take insulin orally. has type 1 diabetes. has type 2 diabetes.
Correct response: has type 2 diabetes. Explanation: Oral antidiabetic agents are effective only in adult clients with type 2 diabetes. Oral antidiabetic agents aren't effective in type 1 diabetes. Pregnant and lactating women aren't ordered oral antidiabetic agents because the effect on the fetus or breast-fed infant is uncertain.