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A client with type 1 diabetes arrives in the emergency department breathing deeply and stating, "I can't catch my breath." The client's vital signs are: T 98.4° F (36.9° C), P 112 beats/min, R 38/min, BP 91/54 mm Hg, and O2 saturation 99% on room air. What is important for the nurse to do immediately? 1 Check the blood glucose. 2 Administer oxygen. 3 Offer reassurance. 4 Attach a cardiac monitor.

1

The nurse is providing discharge teaching to a client with diabetes about injury prevention for peripheral neuropathy. Which statement by the client indicates a need for further teaching? 1 "I can break in my shoes by wearing them all day." 2 "I need to monitor my feet daily for blisters or skin breaks." 3 "I should never go barefoot." 4 "I should quit smoking."

1

The nurse is teaching a client with type 2 diabetes about the importance of weight control. Which comment by the client indicates a need for further teaching? 1 "I should begin exercising for at least an hour a day." 2 "I should monitor my diet." 3 "If I lose weight, I may not need to use the insulin anymore." 4 "Weight loss can be a sign of diabetic ketoacidosis."

1

Which client taking metformin does the nurse consider at highest risk for lactic acidosis? 1 Client who is receiving dialysis 2 Client who has hyperglycemia 3 Client who is also taking oral contraceptives 4 Client who is

1

Which laboratory assessment finding may be indicative of diabetes mellitus? 1 Glycosylated hemoglobin of 7.5% in a 30-year-old adult 2 Fasting blood glucose of 100 mg/dL in an 80-year-old adult 3 Glucose tolerance test of 139 mg/dL in a 23-year-old pregnant woman 4 Random blood glucose level of 126 mg/dL in a client asymptomatic for hyperglycemia

1

Which statements about the etiology and genetic risk for diabetes mellitus are correct? Select all that apply. 1 Type 2 diabetes results from genetic susceptibility in addition to controllable risk factors. 2 Type 1 diabetes results from genetic susceptibility. 3 Viral infections may act as a trigger for type 1 diabetes. 4 Metabolic syndrome is a known cause for type 1 diabetes. 5 Pancreatic beta cells are destroyed in type 2 diabetes.

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Which conditions are typical features of metabolic syndrome? Select all that apply. 1 Abdominal obesity 2 Hyperglycemia 3 Hypertension 4 Hyperlipidemia 5 Atherosclerosi

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A client has just been diagnosed with diabetes. Which factor is most important for the nurse to assess in the client before providing instruction about the disease and its management? 1 Current lifestyle Correct2 Educational and literacy level 3 Sexual orientation 4 Current energy level

2

A client newly diagnosed with diabetes is not ready or willing to learn diabetes control during the hospital stay. Which information is the priority for the nurse to teach the client and the client's family? 1 Causes and treatment of hyperglycemia 2 Causes and treatment of hypoglycemia 3 Dietary control 4 Guidelines for exercise

2

A client with diabetes mellitus has had a cholecystectomy. The nurse prioritizes blood glucose management in the client's plan of care for which reason? 1 Clients who are diagnosed with diabetes have increased anxiety. 2 Clients with postoperative hyperglycemia are prone to poor wound healing. 3 Clients with diabetes who undergo surgery are likely to develop hypoglycemia. 4 Clients with diabetes should not receive insulin when they do not eat a meal.

2

NPH and Regular insulin is ordered for a client with type 1 diabetes. Which action by the nurse is correct? 1 Administer both insulins at 0800. 2 Give two thirds of the daily dose before breakfast and one third before the evening meal. 3 Administer both insulins with the evening meal. 4 Administer both insulins at bedtime.

2

The fasting blood glucose of a client with diabetes measured using a home blood glucose meter is lower than the laboratory value. What is the cause of this difference? 1 There may be an error in the home blood glucose meter. 2 Laboratory tests measure glucose in the plasma. 3 Polycythemia causes a falsely higher value of blood glucose. 4 Anemia shows a falsely lower value of blood glucose.

2

The nurse is caring for a client who is receiving sitagliptin (Januvia). Which finding requires immediate attention? 1 Hemoglobin A1c 7% 2 Amylase 546 mg/dL 3 Arterial blood pH 7.35 4 Creatinine 1 mg/dL

2

The nurse is caring for a client with diabetes mellitus who received insulin aspart (NovoLog) at 8:00 AM. At which time does the nurse expect hypoglycemia most likely to occur in this client? 1 8:30 AM 2 11:00 AM 3 4:00 PM 4 8:30 PM

2

The nurse is providing discharge teaching to a client with newly diagnosed diabetes. Which statement by the client indicates a correct understanding about the need to wear a Medic-Alert bracelet? 1 "If I become hyperglycemic, it is a medical emergency." 2 "If I become hypoglycemic, I could become unconscious." 3 "Medical personnel may need confirmation of my insurance." 4 "I may need to be admitted to the hospital suddenly."

2

Which assessment finding is identified as a risk for type 2 diabetes mellitus (DM) and cardiovascular disease (CVD)? 1 Body mass index less than 25 kg/m2 2 Waist circumference of 40 inches or more 3 Fasting blood glucose level of 90 mg/dL 4 Blood pressure of 120/80 mm Hg

2

Which statement about blood pressure as it relates to diabetes mellitus is correct? 1 Individuals with diabetes and hypertension are at increased risk for liver damage. 2 Clients with diabetes should keep their blood pressure below 130/80 mm Hg. 3 Diabetic ketoacidosis is of higher concern in people with type 2 diabetes than is hypertension. 4 People with diabetes and hypertension are at higher risk for visual impairment from cataracts.

2

What techniques should a client with diabetes use to administer insulin injections? Select all that apply. 1 Inject insulin on the thigh for faster absorption. 2 Avoid injecting insulin on scarred sites. 3 Inject insulin into a different anatomic site every day. 4 Avoid injecting within a 2-inch radius around the navel. 5 Grasp a fold of the skin and inject insulin subcutaneously.

2.4.5

A diabetic client has a glycosylated hemoglobin (A1C) level of 9.4%. What does the nurse say to the client regarding this finding? 1 "Keep up the good work." 2 "This is not good at all." 3 "What are you doing differently?" 4 "You need more insulin."

3

The nurse is aware that insulin deficiency leads to metabolic acidosis. Which manifestation is a result of metabolic acidosis? 1 Frequent urination 2 Excessive hunger 3 Fruity odor on the breath 4 Decreased respiration rate

3

The nurse is teaching a client about the storage of NPH and regular insulins. Which information does the nurse convey? 1 Insulin vials must be refrigerated after they are opened. 2 Do not draw insulin more than 24 hours in advance of injecting it. 3 Refrigerate insulin vials not in use, or if the ambient temperature exceeds 86° F. 4 When storing premixed syringes with NPH and regular insulins, shake the syringe before using.

3

What measure should the caregiver of a client with diabetes take to treat moderate hypoglycemia? 1 Provide half a cup of fruit juice. 2 Offer 4 cubes, or teaspoons, of sugar. 3 Provide 15 g of carbohydrate and then take additional cheese 10 to 15 minutes after. 4 Subcutaneously inject 1 mg of glucagon

3

Which of the following is the process of converting proteins to glucose? 1 Ketogenesis 2 Glycogenesis 3 Gluconeogenesis 4 Proteolysis

3

In reviewing the health care provider admission requests for a client admitted in a hyperglycemic-hyperosmolar state, which request is inconsistent with this diagnosis? 1 20 mEq KCl for each liter of IV fluid 2 IV regular insulin at 2 units/hr 3 IV normal saline at 100 mL/hr 4 1 ampule NaHCO3 IV now

4

The nurse is administering metformin (Glucophage) to a client with type 2 diabetes prior to breakfast. Which finding during administration requires further follow-up by the nurse? 1 Premeal blood glucose level of 120 2 Pulse oximetry reading of 95% at 7 AM 3 Episode of diarrhea overnight 4 Scheduled angiogram of the leg later today

4

The nurse is instructing a client who has been newly diagnosed with diabetes mellitus. Which intervention does the nurse teach the client that will help prevent microvascular complications of diabetes? 1 "Do not walk without shoes." 2 "Avoid urinating frequently." 3 "Have your eyes checked annually." 4 "Keep your blood sugar in good control."

4

The nurse receives report on a 52-year-old client with type 2 diabetes: Which complication of diabetes does the nurse report to the provider? 1 Poor glucose control 2 Visual changes 3 Respiratory distress 4 Decreased peripheral perfusion

4

While teaching a client about insulin injection technique, the nurse explains that injecting into which area will cause the insulin to be most rapidly absorbed? 1 Thigh 2 Deltoid 3 Buttocks 4 Abdomen

4

The nurse is teaching a client about the movement of glucose in the body. Arrange the sequence of events that take place when blood glucose levels drop.

When blood glucose levels fall, insulin secretion stops and glucagon is released. Glucagon prevents hypoglycemia by triggering the release of glucose from cell storage sites. Glucagon causes the release of glucose from the liver. Glycogen is broken down to glucose in the liver during the process of glycogenolysis; similarly, amino acids are broken down to glucose in the process of gluconeogenesis. When liver glucose is unavailable, lipolysis and proteolysis provide fuel for energy.

A client has been newly diagnosed with diabetes mellitus. Which factors does the nurse emphasize should be monitored regularly by the client to prevent and detect complications of the disease? Select all that apply. A Vision B Hepatic function C Kidney function D Hemoglobin A1c E Feet F Urine

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