CH.51 - Diabetes PrepU ?'s, Diabetes Prep-U (easy), Prep U: Chapter 51: Assessment and Management of Patients With Diabetes

Which clinical manifestation of type 2 diabetes occurs if glucose levels are very high? a. Hyperactivity b. Blurred vision c. Oliguria d. Increased energy

Blurred vision Blurred vision occurs when blood glucose levels are very high. The other clinical manifestations are not consistent with type 2 diabetes.

Health teaching for a patient with diabetes who is prescribed Humulin N, an intermediate NPH insulin, would include which of the following advice? a) "Your insulin will begin to act in 15 minutes." b) "Your insulin will last 8 hours, and you will need to take it three times a day." c) "You should take your insulin after you eat breakfast and dinner." d) "You should expect your insulin to reach its peak effectiveness by 12 noon if you take it at 8:00 AM."

"You should take your insulin after you eat breakfast and dinner."

A hospitalized client is found to be comatose and hypoglycemic with a blood sugar of 50 mg/dL. Which of the following would the nurse do first? a) Check the client's urine for the presence of sugar and acetone. b) Administer 50% glucose intravenously. c) Infuse 1000 mL D5W over a 12-hour period. d) Encourage the client to drink orange juice with added sugar.

Administer 50% glucose intravenously.

Which statement is correct regarding glargine insulin? a) Its peak action occurs in 2 to 3 hours. b) It is absorbed rapidly. c) It cannot be mixed with any other type of insulin. d) It is given twice daily.

It cannot be mixed with any other type of insulin.

Which of the following insulins are used for basal dosage? A. Lispro (Humalog) B. Aspart (Novolog) C. NPH (Humulin N) D. Glarginet (Lantus)

Glarginet (Lantus) Lantus is used for basal dosage. NPH is an intermediate acting insulin, usually taken after food. Humalog and Novolog are rapid-acting insulins.

A nurse is preparing a client with type 1 diabetes for discharge. The client can care for himself; however, he's had a problem with unstable blood glucose levels in the past. Based on the client's history, he should be referred to which health care worker? a) Social worker b) Home health nurse c) Psychiatrist d) Dietitian

Dietitian

Which type of insulin acts most quickly? a) Glargine b) NPH c) Regular d) Lispro

NPH

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: a) "I'm going to give your son some insulin. Then I'll be happy to talk with you." b) "Everything will be just fine. I'll be back in a minute and then we can talk." c) "If you'll wait in your son's room, the physician will talk with you as soon as he's free." d) "I can't talk now. I have to give your son his insulin as soon as possible."

a) "I'm going to give your son some insulin. Then I'll be happy to talk with you."

When administering insulin to a client with type 1 diabetes, which of the following would be most important for the nurse to keep in mind? A. Technique for injecting B. Accuracy of the dosage C. Duration of the insulin D. Area for insulin injection

Accuracy of the dosage The measurement of insulin is most important and must be accurate because clients may be sensitive to minute dose changes. The duration, area, and technique for injecting should also to be noted.

When administering insulin to a client with type 1 diabetes, which of the following would be most important for the nurse to keep in mind? a. Duration of the insulin b. Accuracy of the dosage c. Area for insulin injection d. Technique for injecting

Accuracy of the dosage The measurement of insulin is most important and must be accurate because clients may be sensitive to minute dose changes. The duration, area, and technique for injecting should also to be noted.

A nurse is caring for a diabetic patient with a diagnosis of nephropathy. What would the nurse expect the urinalysis report to indicate? A. White blood cells B. Red blood cells C. Bacteria D. Albumin

Albumin 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. The urine should be checked annually for the presence of microalbumin.

A patient is admitted to the health care center with abdominal pain, nausea, and vomiting. The medical reports indicate a history of type 1 diabetes. The nurse suspects the patient's symptoms to be that of diabetic ketoacidosis (DKA). Which of the following actions will help the nurse confirm the diagnosis? a) Assessing for excessive sweating b) Assessing the patient's ability to move all extremities c) Assessing the patient's breath odor d) Assessing the patient's ability to take a deep breath

Assessing the patient's breath odor

Insulin is secreted by which of the following types of cells?

Beta cells

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? a) Decrease food intake until nausea passes. b) Increase frequency of glucose self-monitoring. c) Do not take insulin if not eating. d) Take half the usual dose of insulin until symptoms resolve.

Increase frequency of glucose self-monitoring.

The nurse is describing the action of insulin in the body to a client newly diagnosed with type 1 diabetes. Which of the following would the nurse explain as being the primary action? a) It stimulates the pancreatic beta cells. b) It decreases the intestinal absorption of glucose. c) It enhances transport of glucose across the cell wall. d) It aids in the process of gluconeogenesis.

It enhances transport of glucose across the cell wall.

Which is a by-product of fat breakdown in the absence of insulin and accumulates in the blood and urine? a) Hemoglobin b) Ketones c) Creatinine d) Cholesterol

Ketones

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

Maintenance of healthy blood pressure and prompt treatment of hypertension

A patient who is diagnosed with type 1 diabetes would be expected to: a) Receive daily doses of a hypoglycemic agent. b) Need exogenous insulin. c) Be restricted to an American Diabetic Association diet. d) Have no damage to the islet cells of the pancreas.

Need exogenous insulin.

Lispro (Humalog) is an example of which type of insulin? a) Short-acting b) Intermediate-acting c) Rapid-acting d) Long-acting

Rapid-acting

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

consuming a low-carbohydrate, high-protein diet and avoiding fasting.

The nurse is reviewing the initial laboratory test results of a client diagnosed with DKA. Which of the following would the nurse expect to find? a) Blood pH of 6.9 b) Blood glucose level of 250 mg/dL c) Serum bicarbonate of 19 mEq/L d) PaCO2 of 40 mm Hg

Blood pH of 6.9

A client's blood glucose level is 45 mg/dl. The nurse should be alert for which signs and symptoms? a) Polyuria, polydipsia, hypotension, and hypernatremia b) Coma, anxiety, confusion, headache, and cool, moist skin c) Polyuria, polydipsia, polyphagia, and weight loss d) Kussmaul's respirations, dry skin, hypotension, and bradycardia

Coma, anxiety, confusion, headache, and cool, moist skin

The nurse is administering lispro (Humalog) insulin. Based on the onset of action, how soon should the nurse administer the injection prior to breakfast? a) 30 to 40 minutes b) 10 to 15 minutes c) 3 hours d) 1 to 2 hours

b) 10 to 15 minutes

A nurse is teaching a client with type 1 diabetes how to treat adverse reactions to insulin. To reverse hypoglycemia, the client ideally should ingest an oral carbohydrate. However, this treatment isn't always possible or safe. Therefore, the nurse should advise the client to keep which alternate treatment on hand? a) Glucagon b) Hydrocortisone c) 50% dextrose d) Epinephrine

Glucagon

A client with diabetes mellitus is receiving an oral antidiabetic agent. The nurse observes for which symptom when caring for this client? a. Polyuria b. Hypoglycemia c. Blurred vision d. Polydipsia

Hypoglycemia The nurse should observe the client receiving an oral antidiabetic agent for signs of hypoglycemia. The time when the reaction might occur is not predictable and could be from 30 to 60 minutes to several hours after the drug is ingested. Polyuria, polydipsia, and blurred vision are symptoms of diabetes mellitus.

A nurse explains to a client that she will administer his first insulin dose in his abdomen. How does absorption at the abdominal site compare with absorption at other sites? a) Insulin is absorbed rapidly regardless of the injection site. b) Insulin is absorbed more rapidly at abdominal injection sites than at other sites. c) Insulin is absorbed unpredictably at all injection sites. d) Insulin is absorbed more slowly at abdominal injection sites than at other sites.

Insulin is absorbed more rapidly at abdominal injection sites than at other sites.

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

Increased hunger

A nurse is providing education to a client who is newly diagnosed with diabetes mellitus. What are classic symptoms associated with diabetes? a) Increased thirst, hunger, and urination b) Loss of appetite, increased urination, and dehydration c) Increased weight loss, dehydration, and fatigue d) Increased weight gain, appetite, and thirst

Increased thirst, hunger, and urination

The nurse is preparing to administer intermediate-acting insulin to a patient with diabetes. Which insulin will the nurse administer? a) Lispro (Humalog) b) Glargine (Lantus) c) NPH d) Iletin II

NPH

A nurse obtains a fingerstick glucose level of 45 mg/dl on a client newly diagnosed with diabetes mellitus. The client is alert and oriented, and the client's skin is warm and dry. How should the nurse intervene? A. Obtain a serum glucose level. B. Obtain a repeat fingerstick glucose level. C. Notify the physician. D. Give the client 4 oz of milk and a graham cracker with peanut butter.

Obtain a repeat fingerstick glucose level The nurse should recheck the fingerstick glucose level to verify the original result because the client isn't exhibiting signs of hypoglycemia. The nurse should give the client milk and a graham cracker with peanut butter or a glass of orange juice after confirming the low glucose level. It isn't necessary to notify the physician or to obtain a serum glucose level at this time.

Which clinical characteristic is associated with type 1 diabetes (previously referred to as insulin-dependent diabetes mellitus)? a) Requirement for oral hypoglycemic agents b) Presence of islet cell antibodies c) Obesity d) Rare ketosis

Presence of islet cell antibodies Explanation: Individuals with type 1 diabetes often have islet cell antibodies and are usually thin or demonstrate recent weight loss at the time of diagnosis. These individuals are prone to experiencing ketosis when insulin is absent and require exogenous insulin to preserve life.

A client is admitted to the unit with diabetic ketoacidosis (DKA). Which insulin would the nurse expect to administer intravenously? a) Glargine b) Lente c) Regular d) NPH

Regular 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.

A patient has been newly diagnosed with type 2 diabetes, and the nurse is assisting with the development of a meal plan. What step should be taken into consideration prior to making the meal plan? a) Determining whether the patient is on insulin or taking oral antidiabetic medication b) Ensuring that the patient understands that some favorite foods may not be allowed on the meal plan and substitutes will need to be found c) Reviewing the patient's diet history to identify eating habits and lifestyle and cultural eating patterns d) Making sure that the patient is aware that quantity of foods will be limited

Reviewing the patient's diet history to identify eating habits and lifestyle and cultural eating patterns

A client with diabetes is receiving an oral anti diabetic agent that acts to help the tissues use available insulin more efficiently. Which of the following agents would the nurse expect to administer? A. Glipizide B. Glyburide C. Repaglinide D. Metformin

Metformin Metformin is a biguanide and, along with the thiazolidinediones (rosiglitazone and pioglitazone), are categorized as insulin sensitizers; they help tissues use available insulin more efficiently. Glyburide and glipizide, which are sulfonylureas, and repaglinide, a meglitinide, are described as being insulin releasers because they stimulate the pancreas to secrete more insulin.

After teaching a client with type 1 diabetes, who is scheduled to undergo an islet cell transplant, which client statement indicates successful teaching? a) "I will receive a whole organ with extra cells to produce insulin." b) "They'll need to create a connection from the pancreas to allow enzymes to drain." c) "This transplant will provide me with a cure for my diabetes." d) "I might need insulin later on but probably not as much or as often."

"I might need insulin later on but probably not as much or as often."

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

"Your body is using protein and fat for energy instead of glucose."

Which of the following factors would a nurse identify as a most likely cause of diabetic ketoacidosis (DKA) in a client with diabetes? a) The client has eaten and has not taken or received insulin. b) The client has not consumed sufficient calories. c) The client continues medication therapy despite adequate food intake. d) The client has been exercising more than usual.

The client has eaten and has not taken or received insulin. 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.

A male client, aged 42, is diagnosed with diabetes mellitus. He visits the gym regularly and is a vegetarian. Which of the following factors is important when assessing the client? A. History of radiographic contrast studies that used iodine B. The client's exercise routine C. The client's mental and emotional status D. The client's consumption of carbohydrates

The client's consumption of carbohydrates While assessing a client, it is important to note the client's consumption of carbohydrates because he has high blood sugar. Although other factors such as the client's mental and emotional status, history of tests involving iodine, and exercise routine can be part of data collection, they are not as important to information related to the client's to be noted in a client with high blood sugar.

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

"Always follow the same order when drawing different insulins into the syringe." 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.

Which intervention is essential when performing dressing changes on a client with a diabetic foot ulcer? A. Applying a heating pad B. Debriding the wound three times per day C. Using sterile technique during the dressing change D. Cleaning the wound with a povidone-iodine solution

Using sterile technique during the dressing change The nurse should perform the dressing changes using sterile technique to prevent infection. Applying heat should be avoided in a client with diabetes mellitus because of the risk of injury. Cleaning the wound with povidone-iodine solution and debriding the wound with each dressing change prevents the development of granulation tissue, which is essential in the wound healing process.

The nurse is teaching a client about self-administration of insulin and about mixing regular and neutral protamine Hagedorn (NPH) insulin. Which information is important to include in the teaching plan? a) There is no need to inject air into the bottle of insulin before withdrawing the insulin. b) When mixing insulin, the regular insulin is drawn up into the syringe first. c) If two different types of insulin are ordered, they need to be given in separate injections. d) When mixing insulin, the NPH insulin is drawn up into the syringe first.

When mixing insulin, the regular insulin is drawn up into the syringe first.

A client is taking glyburide (DiaBeta), 1.25 mg P.O. daily, to treat type 2 diabetes. Which statement indicates the need for further client teaching about managing this disease? a) "I skip lunch when I don't feel hungry." b) "I avoid exposure to the sun as much as possible." c) "I always wear my medical identification bracelet." d) "I always carry hard candy to eat in case my blood sugar level drops."

a) "I skip lunch when I don't feel hungry."

A 6 months' pregnant patient was evaluated for gestational diabetes mellitus. The doctor considered prescribing insulin based on the serum glucose result of: A. 120 mg/dL, 1 hour postprandial. B. 138 mg/dL, 2 hours postprandial. C. 90 mg/dL before meals. D. 80 mg/dL, 1 hour postprandial.

138 mg/dL, 2 hours postprandial The goals for a 2-hour, postprandial blood glucose level are less than 120 mg/dL in a patient who might develop gestational diabetes.

The nurse is discussing the new medication that a client will be taking for treatment of rheumatoid arthritis. Which disease-modifying antirheumatic drug (DMARD) will the nurse educate the client about? a) Infliximab (Remicade) b) Methylprednisolone (Medrol) c) Methotrexate (Rheumatrex) d) Etanercept (Enbrel)

c) Methotrexate (Rheumatrex) --- Methotrexate is a DMARD that reduces the amount of joint damage and slows the damage to other tissues as well. Etanercept and Infliximab are TNF-alpha inhibitors that reduce pain and inflammation. Methylprednisolone is a steroid to reduce pain and inflammation and slow joint destruction.

The nurse is providing information about foot care to a client with diabetes. Which of the following would the nurse include? A. "Be sure to apply a moisturizer to feet daily." B. "Wash your feet in hot water every day." C. "Use a razor to remove corns or calluses." D. "Wear well-fitting comfortable rubber shoes."

"Be sure to apply a moisturizer to feet daily." The nurse should advise the client to apply a moisturizer to the feet daily. The client should use warm water not hot water to bathe his feet. Razors to remove corns or calluses must be avoided to prevent injury and infection. The client should wear well-fitting comfortable shoes, avoiding shoes made of rubber, plastic or vinyl which would cause the feet to perspire.

What is the only insulin that can be given intravenously? A. Regular B. Ultralente C. Lantus D. NPH

Regular Insulins other than regular are in suspensions that could be harmful if administered IV.

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

Sweating, tremors, and tachycardia

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? a) They decrease the need for insulin. b) They increase the need for insulin. c) They cause wide fluctuations in the need for insulin. d) They have no effect.

They increase the need for insulin.

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: A. at least three times per week. B. at least five times per week. C. every day. D. at least once per week.

at least three times per week 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.

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? a) Cardiac disease b) CVA c) All options are correct. d) Type 2 diabetes

c) All options are correct. --- The NIDDK has developed criteria that identify people with prediabetes, which can lead to type 2 diabetes, heart disease, and stroke.

During a follow-up visit 3 months following a new diagnosis of type 2 diabetes, a patient reports exercising and following a reduced-calorie diet. Assessment reveals that the patient has only lost 1 pound and did not bring the glucose-monitoring record. Which of the following tests will the nurse plan to obtain? a) Oral glucose tolerance test b) Fasting blood glucose level c) Glycosylated hemoglobin level d) Urine dipstick for glucose

c) Glycosylated hemoglobin level --- Glycosylated hemoglobin is a blood test that reflects average blood glucose levels over a period of approximately 2 to 3 months. When blood glucose levels are elevated, glucose molecules attach to hemoglobin in red blood cells. The longer the amount of glucose in the blood remains above normal, the more glucose binds to hemoglobin and the higher the glycated hemoglobin level becomes.

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? a) They decrease the need for insulin. b) They cause wide fluctuations in the need for insulin. c) They have no effect. d) They increase the need for insulin.

d) They increase the need for insulin.

For a client with hyperglycemia, which assessment finding best supports a nursing diagnosis of Deficient fluid volume? A. Increased urine osmolarity B. Cool, clammy skin C. Decreased serum sodium level D. Jugular vein distention

cool, clammy skin In hyperglycemia, urine osmolarity (the measurement of dissolved particles in the urine) increases as glucose particles move into the urine. The client experiences glucosuria and polyuria, losing body fluids and experiencing deficient fluid volume. Cool, clammy skin; jugular vein distention; and a decreased serum sodium level are signs of fluid volume excess, the opposite imbalance.

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? A. 7.5 % B. 8.0% C. 6.5% D. 8.5%

6.5% 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.

A client has been recently diagnosed with type 2 diabetes, and reports continued weight loss despite increased hunger and food consumption. This condition is called: A. anorexia. B. polyuria. C. polyphagia. D. polydipsia.

polyphagia While the needed glucose is being wasted, the body's requirement for fuel continues. The person with diabetes feels hungry and eats more (polyphagia). Despite eating more, he or she loses weight as the body uses fat and protein to substitute for glucose.

Which are consistent as causes of DKA? A. Illness or infection B. Competency in injecting insulin C. Undiagnosed and untreated diabetes D. Decreased or missed dose of insulin

undiagnosed and untreated diabetes Being able to competently inject insulin is not a cause of DKA. Undiagnosed and untreated diabetes decreased or missed dose of insulin, and illness or infection are potential causes of DKA.

After teaching a client with type 1 diabetes who is scheduled to undergo an islet cell transplant, which client statement indicates successful teaching? a. "This transplant will provide me with a cure for my diabetes." b. "I will receive a whole organ with extra cells to produce insulin." c. "They'll need to create a connection from the pancreas to allow enzymes to drain." d. "I might need insulin later on but probably not as much or as often."

"I might need insulin later on but probably not as much or as often." Transplanted islet cells tend to lose their ability to function over time, and approximately 70% of recipients resume insulin administration in 2 years. However, the amount of insulin and the frequency of its administration are reduced because of improved control of blood glucose levels. Thus, this type of transplant doesn't cure diabetes. It requires the use of two human pancreases to obtain sufficient numbers of islet cells for transplantation. A whole organ transplant requires a means for exocrine enzyme drainage and venous absorption of insulin.

A client is taking glyburide (DiaBeta), 1.25 mg P.O. daily, to treat type 2 diabetes. Which statement indicates the need for further client teaching about managing this disease? a) "I skip lunch when I don't feel hungry." b) "I avoid exposure to the sun as much as possible." c) "I always wear my medical identification bracelet." d) "I always carry hard candy to eat in case my blood sugar level drops."

"I skip lunch when I don't feel hungry."

A client is evaluated for type 1 diabetes. Which client comment correlates best with this disorder? A. "I'm thirsty all the time. I just can't get enough to drink." B. "I notice pain when I urinate." C. "It seems like I have no appetite. I have to make myself eat." D. "I have a cough and cold that just won't go away."

"I'm thirsty all the time. I just can't get enough to drink." The nurse should instruct a client with diabetes mellitus to check his blood glucose levels every 3 to 4 hours and take insulin or an oral antidiabetic agent as usual, even when he's sick. If the client's blood glucose level rises above 300 mg/dl, he should call his physician immediately. If the client is unable to follow the regular meal plan because of nausea, he should substitute soft foods, such as gelatin, soup, and custard.

A nurse is teaching a client recovering from diabetic ketoacidosis (DKA) about management of "sick days." The client asks the nurse why it is important to monitor the urine for ketones. Which statement is the nurse's best response? a) "Ketones are formed when insufficient insulin leads to cellular starvation. As cells rupture, they release these acids into the blood." b) "Excess glucose in the blood is metabolized by the liver and turned into ketones, which are an acid." c) "Ketones accumulate in the blood and urine when fat breaks down in the absence of insulin. Ketones signal an insulin deficiency that will cause the body to start breaking down stored fat for energy." d) "When the body does not have enough insulin, hyperglycemia occurs. Excess glucose is broken down by the liver, causing acidic by-products to be released."

"Ketones accumulate in the blood and urine when fat breaks down in the absence of insulin. Ketones signal an insulin deficiency that will cause the body to start breaking down stored fat for energy."

A client with diabetes mellitus must learn how to self-administer insulin. The physician has ordered 10 units of U-100 regular insulin and 35 units of U-100 isophane insulin suspension (NPH) to be taken before breakfast. When teaching the client how to select and rotate insulin injection sites, the nurse should provide which instruction? A. "Rotate injection sites within the same anatomic region, not among different regions." B. "Administer insulin into sites above muscles that you plan to exercise heavily later that day." C. "Inject insulin into healthy tissue with large blood vessels and nerves." D. "Administer insulin into areas of scar tissue or hypertrophy whenever possible."

"Rotate injection sites within the same anatomic region, not among different regions." The nurse should instruct the client to rotate injection sites within the same anatomic region. Rotating sites among different regions may cause excessive day-to-day variations in the blood glucose level; also, insulin absorption differs from one region to the next. Insulin should be injected only into healthy tissue lacking large blood vessels, nerves, or scar tissue or other deviations. Injecting insulin into areas of hypertrophy may delay absorption. The client shouldn't inject insulin into areas of lipodystrophy (such as hypertrophy or atrophy); to prevent lipodystrophy, the client should rotate injection sites systematically. Exercise speeds drug absorption, so the client shouldn't inject insulin into sites above muscles that will be exercised heavily.

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

"Test your blood glucose every 4 hours."

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: A. 10 to 15 g of a simple carbohydrate. B. 25 to 30 g of a simple carbohydrate. C. 2 to 5 g of a simple carbohydrate. D. 18 to 20 g of a simple carbohydrate.

10 to 15 g of a simple carbohydrate 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 insulin. Based on the onset of action, how long before breakfast should the nurse administer the injection? A. 10 to 15 minutes B. 30 to 40 minutes C. 1 to 2 hours D. 3 hours

10 to 15 minutes The onset of action of rapid-acting lispro insulin is within 10 to 15 minutes. It is used to rapidly reduce the glucose level.

A nurse is teaching a client with diabetes mellitus about self-management of his condition. The nurse should instruct the client to administer 1 unit of insulin for every: A. 10 g of carbohydrates. B. 15 g of carbohydrates. C. 20 g of carbohydrates. D. 25 g of carbohydrates.

15 g of carbohydrates The nurse should instruct the client to administer 1 unit of insulin for every 15 g of carbohydrates.

A client who is suspected of having diabetes is undergoing a postprandial glucose test. Which result would the nurse interpret as suggestive of diabetes? a) 70 mg /dL b) 110 mg/dL c) 220 mg/dL d) 160 mg/dL

160 mg/dL

A client is receiving insulin lispro at 7:30 AM. The nurse ensures that the client has breakfast by which time? a. 7:45 AM b. 8:00 AM c. 8:15 AM d. 8:30 AM

7:45 AM Insulin lispro has an onset of 5 to 15 minutes. Therefore, the nurse would need to ensure that the client has his breakfast by 7:45 AM at the latest. Otherwise, the client may experience hypoglycemia.

A client with type 1 diabetes is scheduled to receive 30 units of 70/30 insulin. There is no 70/30 insulin available. As a substitution, the nurse may give the client: a) 20 units regular insulin and 10 units NPH. b) 21 units regular insulin and 9 units NPH. c) 10 units regular insulin and 20 units NPH. d) 9 units regular insulin and 21 units neutral protamine Hagedorn (NPH).

9 units regular insulin and 21 units neutral protamine Hagedorn (NPH).

A client is diagnosed with diabetes mellitus. Which assessment finding best supports a nursing diagnosis of Ineffective coping related to diabetes mellitus? A. Recent weight gain of 20 lb (9.1 kg) B. Failure to monitor blood glucose levels C. Crying whenever diabetes is mentioned D. Skipping insulin doses during illness

Crying whenever diabetes is mentioned A client who cries whenever diabetes is mentioned is demonstrating ineffective coping. A recent weight gain and failure to monitor blood glucose levels would support a nursing diagnosis of Noncompliance: Failure to adhere to therapeutic regimen. Skipping insulin doses during illness would support a nursing diagnosis of Deficient knowledge related to treatment of diabetes mellitus.

A client with long-standing type 1 diabetes is admitted to the hospital with unstable angina pectoris. After the client's condition stabilizes, the nurse evaluates the diabetes management regimen. The nurse learns that the client sees the physician every 4 weeks, injects insulin after breakfast and dinner, and measures blood glucose before breakfast and at bedtime. Consequently, the nurse should formulate a nursing diagnosis of: A. Deficient knowledge (treatment regimen). B. Impaired adjustment. C. Health-seeking behaviors (diabetes control). D. Defensive coping.

Deficient knowledge (treatment regimen) The client should inject insulin before, not after, breakfast and dinner — 30 minutes before breakfast for the a.m. dose and 30 minutes before dinner for the p.m. dose. Therefore, the client has a knowledge deficit regarding when to administer insulin. By taking insulin, measuring blood glucose levels, and seeing the physician regularly, the client has demonstrated the ability and willingness to modify his lifestyle as needed to manage the disease. This behavior eliminates the nursing diagnoses of Impaired adjustment and Defensive coping. Because the nurse, not the client, questioned the client's health practices related to diabetes management, the nursing diagnosis of Health-seeking behaviors isn't warranted.

The client who is managing diabetes through diet and insulin control asks the nurse why exercise is important. Which is the best response by the nurse to support adding exercise to the daily routine? A. Decreases need for pancreas to produce more cells B. Increases ability for glucose to get into the cell and lowers blood sugar C. Creates an overall feeling of well-being and lowers risk of depression D. Decreases risk of developing insulin resistance and hyperglycemia

Increases ability for glucose to get into the cell and lowers blood sugar Exercise increases trans membrane glucose transporter levels in the skeletal muscles. This allows the glucose to leave the blood and enter into the cells where it can be used as fuel. Exercise can provide an overall feeling of well-being but is not the primary purpose of including in the daily routine of diabetic clients. Exercise does not stimulate the pancreas to produce more cells. Exercise can promote weight loss and decrease risk of insulin resistance but not the primary reason for adding to daily routine.

A patient who is diagnosed with type 1 diabetes would be expected to: A. Be restricted to an American Diabetic Association diet. B. Have no damage to the islet cells of the pancreas. C. Receive daily doses of a hypoglycemic agent. D. Need exogenous insulin.

Need exogenous insulin Type 1 diabetes is characterized by the destruction of pancreatic beta cells that require exogenous insulin.

A characteristic of type 2 diabetes includes which of the following? A. Little insulin B. No islet cell antibodies C. Ketosis-prone when insulin absent D. Often have islet antibodies

No Islet cell antibodies Type 2 diabetes is characterized by no islet cell antibodies or a decrease in endogenous insulin or increase with insulin resistance. Type 1 diabetes is characterized by production of little or no insulin; the patient is ketosis-prone when insulin is absent and often has islet cell antibodies.

A patient is diagnosed with type 1 diabetes. What clinical characteristics does the nurse expect to see in this patient? (Select all that apply.) a) Little endogenous insulin b) Ketosis-prone c) Older than 65 years of age d) Younger than 30 years of age e) Obesity at diagnoses

a) Little endogenous insulin b) Ketosis-prone d) Younger than 30 years of age

A nurse is assigned to care for a patient who is suspected of having type 2 diabetes. Select all the clinical manifestations that the nurse knows could be consistent with this diagnosis. a) Wounds that heal slowly or respond poorly to treatment b) Blurred or deteriorating vision c) Sudden weight loss and anorexia d) Fatigue and irritability e) Polyuria and polydipsia

a) Wounds that heal slowly or respond poorly to treatment b) Blurred or deteriorating vision d) Fatigue and irritability e) Polyuria and polydipsia

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? a) 8.5% b) 6.5% c) 8.0% d) 7.5%

b) 6.5% ---- 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.

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? a) Lispro b) Regular c) Lantus d) NPH

b) Regular

After taking glipizide (Glucotrol) for 9 months, a client experiences secondary failure. What should the nurse expect the physician to do? a) Restrict carbohydrate intake to less than 30% of the total caloric intake. b) Switch the client to a different oral antidiabetic agent. c) Initiate insulin therapy. d) Order an additional oral antidiabetic agent.

b) Switch the client to a different oral antidiabetic agent --- The nurse should anticipate that the physician will order a different oral antidiabetic agent. Many clients (25% to 60%) who take glipizide respond to a different oral antidiabetic agent. Therefore, it wouldn't be appropriate to initiate insulin therapy at this time. However, if a new oral antidiabetic agent is unsuccessful in keeping glucose levels at an acceptable level, insulin may be used in addition to the antidiabetic agent. Restricting carbohydrate intake isn't necessary.

A nurse is explaining the action of insulin to a client with diabetes mellitus. During client teaching, the nurse reviews the process of insulin secretion in the body. The nurse is correct when she states that insulin is secreted from the: a) alpha cells of the pancreas. b) beta cells of the pancreas. c) adenohypophysis. d) parafollicular cells of the thyroid.

b) beta cells of the pancreas.

Every morning, a client with type 1 diabetes receives 15 units of Humulin 70/30. What does this type of insulin contain? a) 70 units of regular insulin and 30 units of NPH insulin b) 70% regular insulin and 30% NPH insulin c) 70% NPH insulin and 30% regular insulin d) 70 units of neutral protamine Hagedorn (NPH) insulin and 30 units of regular insulin

c) 70% NPH insulin and 30% regular insulin

A health care provider prescribes short-acting insulin for a patient, instructing the patient to take the insulin 20 to 30 minutes before a meal. The nurse explains to the patient that Humulin-R, taken at 6:30 AM will reach peak effectiveness by: a) 2:30 PM. b) 12:30 PM. c) 8:30 AM. d) 10:30 AM.

c) 8:30 AM

After teaching a client with type 1 diabetes, who is scheduled to undergo an islet cell transplant, which client statement indicates successful teaching? a) "I will receive a whole organ with extra cells to produce insulin." b) "This transplant will provide me with a cure for my diabetes." c) "They'll need to create a connection from the pancreas to allow enzymes to drain." d) "I might need insulin later on but probably not as much or as often."

d) "I might need insulin later on but probably not as much or as often." --- Transplanted islet cells tend to lose their ability to function over time, and approximately 70% of recipients resume insulin administration in 2 years. However, the amount of insulin and the frequency of its administration are reduced because of improved control of blood glucose levels. Thus, this type of transplant doesn't cure diabetes. It requires the use of two human pancreases to obtain sufficient numbers of islet cells for transplantation. A whole organ transplant requires a means for exocrine enzyme drainage and venous absorption of insulin.

A 6 months' pregnant patient was evaluated for gestational diabetes mellitus. The doctor considered prescribing insulin based on the serum glucose result of: a) 90 mg/dL before meals. b) 120 mg/dL, 1 hour postprandial. c) 80 mg/dL, 1 hour postprandial. d) 138 mg/dL, 2 hours postprandial.

d) 138 mg/dL, 2 hours postprandial.

When administering insulin to a client with type 1 diabetes, which of the following would be most important for the nurse to keep in mind? a) Area for insulin injection b) Duration of the insulin c) Technique for injecting d) Accuracy of the dosage

d) Accuracy of the dosage

A nurse has been caring for a client newly diagnosed with diabetes mellitus. The client is overwhelmed by what he's facing and not sure he can handle giving himself insulin. This client has been discharged and the charge nurse is insisting the nurse hurry because she needs the space for clients being admitted. How should the nurse handle the situation? a) Tell the charge nurse she doesn't believe this client will be safe and refuse to rush. b) Ask the physician for a referral for a diabetes nurse-educator to see the client before discharge. c) Suggest the client find a supportive friend or family member to assist in his care. d) Ask the physician to delay the discharge because the client requires further teaching.

d) Ask the physician to delay the discharge because the client requires further teaching. --- The nurse's primary concern should be the safety of the client after discharge. She should provide succinct information to the physician concerning the client's needs, express her concern about ensuring the client's safety, and ask the physician to delay the client's discharge. The nurse shouldn't suggest that the client rely on a friend or family member because she doesn't know if a friend or family member will be available to help. Refusing to rush and telling the charge nurse she isn't sure the client will be safe demonstrate appropriate intentions, but these actions don't alleviate the pressure to discharge the client. Asking a physician to refer the client to a diabetic nurse-educator addresses the client's needs, but isn't the best response because there's no guarantee a diabetic nurse-educator will be available on such short notice.

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? a) Ninth cause of death in the United States b) Tenth cause of death in the United States c) Fifth cause of death in the United States d) Seventh cause of death in the United States

d) Seventh cause of death in the United States

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: a) glycosylated hemoglobin level. b) fasting blood glucose level. c) serum fructosamine level. d)urine glucose level.

glycosylated hemoglobin level. 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.

The nurse is educating a patient about the benefits of fruit versus fruit juice in the diabetic diet. The patient states, "What difference does it make if you drink the juice or eat the fruit? It is all the same." What is the best response by the nurse? A. "Eating the fruit is more satisfying than drinking the juice. You will get full faster." B. "Eating the fruit instead of drinking juice decreases the glycemic index by slowing absorption." C. "Eating the fruit will give you more vitamins and minerals than the juice will." D. "The fruit has less sugar than the juice."

"Eating the fruit instead of drinking juice decreases the glycemic index by slowing absorption." Eating whole fruit instead of drinking juice decreases the glycemic index, because fiber in the fruit slows absorption.

A client newly diagnosed with diabetes mellitus asks why he needs ketone testing when the disease affects his blood glucose levels. How should the nurse respond? A. "Ketones can damage your kidneys and eyes." B. "Ketones will tell us if your body is using other tissues for energy." C. "Ketones help the physician determine how serious your diabetes is." D. "The spleen releases ketones when your body can't use glucose."

"Ketones will tell us if your body is using other tissues for energy." The nurse should tell the client that ketones are a byproduct of fat metabolism and that ketone testing can determine whether the body is breaking down fat to use for energy. The spleen doesn't release ketones when the body can't use glucose. Although ketones can damage the eyes and kidneys and help the physician evaluate the severity of a client's diabetes, these responses by the nurse are incomplete.

A client has just been diagnosed with type 1 diabetes. When teaching the client and family how diet and exercise affect insulin requirements, the nurse should include which guideline? A. "You'll need more insulin when you exercise or decrease your food intake." B. "You'll need less insulin when you exercise or reduce your food intake." C. "You'll need more insulin when you exercise or increase your food intake." D. "You'll need less insulin when you increase your food intake."

"You'll need less insulin when you exercise or reduce your food intake." The nurse should advise the client that exercise, reduced food intake, hypothyroidism, and certain medications decrease insulin requirements. Growth, pregnancy, greater food intake, stress, surgery, infection, illness, increased insulin antibodies, and certain medications increase insulin requirements.

A physician orders blood glucose levels every 4 hours for a 4-year-old child with brittle type 1 diabetes. The parents are worried that drawing so much blood will traumatize their child. How can the nurse best reassure the parents? A. "Your child will need less blood work as his glucose levels stabilize." B. "Our laboratory technicians use tiny needles and they're really good with children." C. "Your child is young and will soon forget this experience." D. "I'll see if the physician can reduce the number of blood draws."

"Your child will need less blood work as his glucose levels stabilize." Telling the parents that the number of blood draws will decrease as their child's glucose levels stabilize engages them in the learning process and gives them hope that the present discomfort will end as the child's condition improves. Telling the parents that their child won't remember the experience disregards their concerns and anxiety. The nurse shouldn't offer to ask the physician if he can reduce the number of blood draws; the physician needs the laboratory results to monitor the child's condition properly. Although telling the parents that the laboratory technicians are gentle and use tiny needles may be reassuring, it isn't the most appropriate response.

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

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

A hospitalized client is found to be comatose and hypoglycemic with a blood sugar of 50 mg/dL. Which of the following would the nurse do first? A. Check the client's urine for the presence of sugar and acetone. B. Administer 50% glucose intravenously. C. Encourage the client to drink orange juice with added sugar. D. Infuse 1000 mL D5W over a 12-hour period.

Administer 50% glucose intravenously. The unconscious, hypoglycemic client needs immediate treatment with IV glucose. If the client does not respond quickly and the blood glucose level continues to be low, glucagon, a hormone that stimulates the liver to release glycogen, or 20 to 50 mL of 50% glucose is prescribed for IV administration. A dose of 1,000 mL D5W over a 12-hour period indicates a lower strength of glucose and a slow administration rate. Checking the client's urine for the presence of sugar and acetone is incorrect because a blood sample is easier to collect and the blood test is more specific and reliable. An unconscious client cannot be given a drink. In such a case glucose gel may be applied in the buccal cavity of the mouth.

A client with type 1 diabetes presents with a decreased level of consciousness and a fingerstick glucose level of 39 mg/dl. His family reports that he has been skipping meals in an effort to lose weight. Which nursing intervention is most appropriate? A. Administering 1 ampule of 50% dextrose solution, per physician's order B. Administering a 500-ml bolus of normal saline solution C. Inserting a feeding tube and providing tube feedings D. Observing the client for 1 hour, then rechecking the fingerstick glucose level

Administering 1 ampule of 50% dextrose solution, per physician's order The nurse should administer 50% dextrose solution to restore the client's physiological integrity. Feeding through a feeding tube isn't appropriate for this client. A bolus of normal saline solution doesn't provide the client with the much-needed glucose. Observing the client for 1 hour delays treatment. The client's blood glucose level could drop further during this time, placing him at risk for irreversible brain damage.

A client has been diagnosed with prediabetes and discusses treatment strategies with the nurse. What can be the consequences of untreated prediabetes? A. type 2 diabetes B. cardiac disease C. CVA D. All options are correct.

All options are correct The NIDDK has developed criteria that identify people with prediabetes, which can lead to type 2 diabetes, heart disease, and stroke.

Which clinical characteristic is associated with type 2 diabetes (previously referred to as non-insulin-dependent diabetes mellitus)? A. Clients demonstrate islet cell antibodies B. Blood glucose can be controlled through diet and exercise C. Client is usually thin at diagnosis D. Client is prone to ketosis

Blood glucose can be controlled through diet and exercise Oral hypoglycemic agents may improve blood glucose concentrations 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.

A client is admitted with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which laboratory finding should the nurse expect in this client? A. Blood urea nitrogen (BUN) 15 mg/dl B. Arterial pH 7.25 C. Plasma bicarbonate 12 mEq/L D. Blood glucose level 1,100 mg/dl

Blood glucose level 1,100 mg/dl 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 nurse educates a group of clients with diabetes mellitus on the prevention of diabetic nephropathy. Which of the following suggestions would be most important? A. Control blood glucose levels. B. Eat a high-fiber diet. C. Drink plenty of fluids. D. Take the antidiabetic drugs regularly.

Control blood glucose levels. Controlling blood glucose levels and any hypertension can prevent or delay the development of diabetic nephropathy. Drinking plenty of fluids does not prevent diabetic nephropathy. Taking antidiabetic drugs regularly may help to control blood glucose levels, but it is the control of these levels that is most important. A high-fiber diet is unrelated to the development of diabetic nephropathy.

An obese Hispanic client, age 65, is diagnosed with type 2 diabetes. Which statement about diabetes mellitus is true? A. Nearly two-thirds of clients with diabetes mellitus are older than age 60. B. Diabetes mellitus is more common in Hispanics and Blacks than in Whites. C. Approximately one-half of the clients diagnosed with type 2 diabetes are obese. D. Type 2 diabetes mellitus is less common than type 1 diabetes mellitus.

Diabetes mellitus is more common in Hispanics and Blacks than in Whites 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.

During a follow-up visit 3 months after a new diagnosis of type 2 diabetes, a client reports exercising and following a reduced-calorie diet. Assessment reveals that the client has only lost 1 pound and did not bring the glucose-monitoring record. Which value should the nurse measure? A. Glycosylated hemoglobin level B. Fasting blood glucose level C. Glucose via a urine dipstick test D. Glucose via an oral glucose tolerance test

Glycosylated hemoglobin level Glycosylated hemoglobin is a blood test that reflects the average blood glucose concentration over a period of approximately 2 to 3 months. When blood glucose is elevated, glucose molecules attach to hemoglobin in red blood cells. The longer the amount of glucose in the blood remains above normal, the more glucose binds to hemoglobin and the higher the glycosylated hemoglobin level becomes.

A nurse is assessing a client who is receiving total parenteral nutrition (TPN). Which finding suggests that the client has developed hyperglycemia? A. Cheyne-Stokes respirations B. Diaphoresis C. Decreased appetite D. Increased urine output

Increased urine output 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.

The nurse is preparing a presentation for a group of adults at a local community center about diabetes. Which of the following would the nurse include as associated with type 2 diabetes? A. Insufficient insulin production B. Little relation to prediabetes C. Less common than type 1 diabetes D. Onset most common during adolescence

Insufficient insulin production Type 2 diabetes is characterized by insulin resistance or insufficient insulin production. It is more common in aging adults and now accounts for 20% of all newly diagnosed cases. Type 1 diabetes is more likely in childhood and adolescence; although, it can occur at any age. It accounts for approximately 5% to 10% of all diagnosed cases of diabetes. Prediabetes can lead to type 2 diabetes.

The nurse is describing the action of insulin in the body to a client newly diagnosed with type 1 diabetes. Which of the following would the nurse explain as being the primary action? A. It stimulates the pancreatic beta cells. B. It decreases the intestinal absorption of glucose. C. It aids in the process of gluconeogenesis. D. It carries glucose into body cells.

It carries glucose into body cells Insulin carries glucose into body cells as their preferred source of energy. Besides, it promotes the liver's storage of glucose as glycogen and inhibits the breakdown of glycogen back into glucose. Insulin does not aid in gluconeogenesis but inhibits the breakdown of glycogen back into glucose. Insulin does not have an effect on the intestinal absorption of glucose.

A nurse expects to find which signs and symptoms in a client experiencing hypoglycemia? A. Polyphagia and flushed, dry skin B. Polyuria, headache, and fatigue C. Polydipsia, pallor, and irritability D. Nervousness, diaphoresis, and confusion

Nervousness, diaphoresis, and confusion 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.

A client who was diagnosed with type 1 diabetes 14 years ago is admitted to the medical-surgical unit with abdominal pain. On admission, the client's blood glucose level is 470 mg/dl. Which finding is most likely to accompany this blood glucose level? A. Arm and leg trembling B. Rapid, thready pulse C. Slow, shallow respirations D. Cool, moist skin

Rapid, thready pulse This client's abnormally high blood glucose level indicates hyperglycemia, which typically causes polyuria, polyphagia, and polydipsia. Because polyuria leads to fluid loss, the nurse should expect to assess signs of deficient fluid volume, such as a rapid, thready pulse; decreased blood pressure; and rapid respirations. Cool, moist skin and arm and leg trembling are associated with hypoglycemia. Rapid respirations — not slow, shallow ones — are associated with hyperglycemia.

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? A. Regular B. Lantus C. Lispro D. NPH

Regular 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? A. Sensory neuropathy B. Retinopathy C. Autonomic neuropathy D. Nephropathy

Sensory neuropathy 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.

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

Serum glucose level of 52 mg/dL Headache, sweating, tremor, pallor, and nervousness typically result from hypoglycemia, an insulin reaction in which serum glucose level drops below 70 mg/dl. Hypoglycemia may occur 4 to 18 hours after administration of isophane insulin suspension or insulin zinc suspension (Lente), which are intermediate-acting insulins. Although hypoglycemia may occur at any time, it usually precedes meals. Hyperglycemia, in which serum glucose level is above 180 mg/dl, causes such early manifestations as fatigue, malaise, drowsiness, polyuria, and polydipsia. A serum calcium level of 8.9 mg/dl or 10.2 mg/dl is within normal range and wouldn't cause the client's symptoms.

Which may be a potential cause of hypoglycemia in the client diagnosed with diabetes mellitus? A. The client has eaten but has not taken or received insulin. B. The client has not eaten but continues to take insulin or oral antidiabetic medications. C. The client has not been exercising. D. The client has not complied with the prescribed treatment regimen.

The client has not eaten but continues to take insulin or oral antidiabetic medications. Hypoglycemia occurs when a client with diabetes is not eating and continues to take insulin or oral antidiabetic medications. Hypoglycemia does not occur when the client has not been compliant with the prescribed treatment regimen. If the client has eaten and has not taken or received insulin, diabetic ketoacidosis is more likely to develop.

A client with type 2 diabetes asks the nurse why he can't have a pancreatic transplant. Which of the following would the nurse include as a possible reason? A. Need for exocrine enzymatic drainage B. Need for lifelong immunosuppressive therapy C. Underlying problem of insulin resistance D. Increased risk for urologic complications

Underlying problem of insulin resistance Clients with type 2 diabetes are not offered the option of a pancreas transplant because their problem is insulin resistance, which does not improve with a transplant. Urologic complications or the need for exocrine enzymatic drainage are not reasons for not offering pancreas transplant to clients with type 2 diabetes. Any transplant requires lifelong immunosuppressive drug therapy and is not the factor.

A controlled type 2 diabetic client states, "The doctor said if my blood sugars remain stable, I may not need to take any medication." Which response by the nurse is most appropriate? a) "Diet, exercise, and weight loss can eliminate the need for medication." b) "You will be placed on a strict low-sugar diet for better control." c) "You misunderstood the doctor. Let's ask for clarification." d) "Some doctors do not treat blood sugar elevation until symptoms appear."

a) "Diet, exercise, and weight loss can eliminate the need for medication."

A nurse is caring for a client with diabetes mellitus. The client has a blood glucose level of 40 mg/dL. Which of the following rapidly absorbed carbohydrate would be most effective? a) 1/2 cup fruit juice or regular soft drink b) 1/2 tbsp honey or syrup c) Three to six LifeSavers candies d) 4 oz of skim milk

a) 1/2 cup fruit juice or regular soft drink --- In a client with hypoglycemia, the nurse uses the rule of 15: Give 15 g of rapidly absorbed carbohydrate, wait 15 minutes, recheck the blood sugar, and administer another 15 g of glucose if the blood sugar is not above 70 mg/dL. One-half cup fruit juice or regular soft drink is equivalent to the recommended 15 g of rapidly absorbed carbohydrate. Eight ounces of skim milk is equivalent to the recommended 15 g of rapidly absorbed carbohydrate. One tablespoon of honey or syrup is equivalent to the recommended 15 g of rapidly absorbed carbohydrate. Six to eight LifeSavers candies is equivalent to the recommended 15 g of rapidly absorbed carbohydrate.

The nurse is describing the action of insulin in the body to a client newly diagnosed with type 1 diabetes. Which of the following would the nurse explain as being the primary action? a) It enhances transport of glucose across the cell wall. b) It decreases the intestinal absorption of glucose. c) It aids in the process of gluconeogenesis. d) It stimulates the pancreatic beta cells.

a) It enhances transport of glucose across the cell wall.

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? a) Ketoacidosis b) Hyperosmolar hyperglycemic nonketotic syndrome c) All options are correct d) Hepatic disorder

a) Ketoacidosis

The nurse is explaining glycosylated hemoglobin testing to a diabetic client. Which of the following provides the best reason for this order? a) Reflects the amount of glucose stored in hemoglobin over past several months. b) Provides best information on the body's ability to maintain normal blood functioning c) Is less costly than performing daily blood sugar test d) Best indicator for the nutritional state of the client

a) Reflects the amount of glucose stored in hemoglobin over past several months.

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

a) Serum glucose level of 52 mg/dl

A client with diabetes mellitus is receiving an oral antidiabetic agent. Which of the following aspects should the nurse observe when caring for this client? a) Signs of hypoglycemia b) Polyuria c) Polydipsia d) Blurred vision

a) Signs of hypoglycemia

A nurse is caring for a diabetic patient with a diagnosis of nephropathy. What would the nurse expect the urinalysis report to indicate? a) White blood cells b) Albumin c) Red blood cells d) Bacteria

b) Albumin --- 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

Which of the following are byproducts of fat breakdown, which accumulate in the blood and urine? a) Creatinine b) Ketones c) Cholesterol d) Hemoglobin

b) Ketones

A nurse is teaching a patient recovering from diabetic ketoacidosis (DKA) about management of "sick days." The patient asks the nurse why it is important to monitor the urine for ketones. Which of the following statements is the nurse's best response? a) Ketones are formed when insufficient insulin leads to cellular starvation. As cells rupture, they release these acids into the blood. b) Ketones accumulate in the blood and urine when fat breaks down. Ketones signal a deficiency of insulin that will cause the body to start to break down stored fat for energy. c) Excess glucose in the blood is metabolized by the liver and turned into ketones, which are an acid. d) When the body does not have enough insulin hyperglycemia occurs. Excess glucose is broken down by the liver, causing acidic byproducts to be released.

b) Ketones accumulate in the blood and urine when fat breaks down. Ketones signal a deficiency of insulin that will cause the body to start to break down stored fat for energy --- Ketones (or ketone bodies) are byproducts of fat breakdown, and they accumulate in the blood and urine. Ketones in the urine signal a deficiency of insulin and control of type 1 diabetes is deteriorating. When almost no effective insulin is available, the body starts to break down stored fat for energy.

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) Autonomic neuropathy b) Peripheral neuropathy c) A faulty heater d) Sudomotor neuropathy

b) Peripheral neuropathy

A client diagnosed with hyperosmolar hyperglycemic nonketotic syndrome (HHNS) is stabilized and prepared for discharge. When preparing the client for discharge and home management, which statement indicates that the client understands his condition and how to control it? a) "I will have to monitor my blood glucose level closely and notify the physician if it's constantly elevated." b) "If I experience trembling, weakness, and headache, I should drink a glass of soda that contains sugar." c) "I can avoid getting sick by not becoming dehydrated and by paying attention to my need to urinate, drink, or eat more than usual." d) "If I begin to feel especially hungry and thirsty, I'll eat a snack high in carbohydrates.

c) "I can avoid getting sick by not becoming dehydrated and by paying attention to my need to urinate, drink, or eat more than usual." The client stating that he'll remain hydrated and pay attention to his eating, drinking, and voiding needs indicates understanding of HHNS. Inadequate fluid intake during hyperglycemic episodes commonly leads to HHNS. By recognizing the signs of hyperglycemia (polyuria, polydipsia, and polyphagia) and increasing fluid intake, the client may prevent HHNS. Drinking a glass of nondiet soda would be appropriate for hypoglycemia. A client whose diabetes is controlled with oral antidiabetic agents usually doesn't need to monitor blood glucose levels. A high-carbohydrate diet would exacerbate the client's condition, particularly if fluid intake is low.

A client with type 1 diabetes presents with a decreased level of consciousness and a fingerstick glucose level of 39 mg/dl. His family reports that he has been skipping meals in an effort to lose weight. Which nursing intervention is most appropriate? a) Inserting a feeding tube and providing tube feedings b) Observing the client for 1 hour, then rechecking the fingerstick glucose level c) Administering 1 ampule of 50% dextrose solution, per physician's order d) Administering a 500-ml bolus of normal saline solution

c) Administering 1 ampule of 50% dextrose solution, per physician's order

A client with type 1 diabetes presents with a decreased level of consciousness and a fingerstick glucose level of 39 mg/dl. His family reports that he has been skipping meals in an effort to lose weight. Which nursing intervention is most appropriate? a) Observing the client for 1 hour, then rechecking the fingerstick glucose level b) Administering a 500-ml bolus of normal saline solution c) Administering 1 ampule of 50% dextrose solution, per physician's order d) Inserting a feeding tube and providing tube feedings

c) Administering 1 ampule of 50% dextrose solution, per physician's order

A diabetic nurse is working for the summer at a camp for adolescents with diabetes. When providing information on the prevention and management of hypoglycemia, what action should the nurse promote? a) Eat a meal or snack every 8 hours. b) Check blood sugar at least every 24 hours. c) Always carry a form of fast-acting sugar. d) Perform exercise prior to eating whenever possible.

c) Always carry a form of fast-acting sugar.

A patient is admitted to the health care center with abdominal pain, nausea, and vomiting. The medical reports indicate a history of type 1 diabetes. The nurse suspects the patient's symptoms to be that of diabetic ketoacidosis (DKA). Which of the following actions will help the nurse confirm the diagnosis? a) Assessing the patient's ability to take a deep breath b) Assessing for excessive sweating c) Assessing the patient's breath odor d) Assessing the patient's ability to move all extremities

c) Assessing the patient's breath odor --- DKA is commonly preceded by a day or more of polyuria, polydipsia, nausea, vomiting, and fatigue with eventual stupor and coma if not treated. The breath has a characteristic fruity odor due to the presence of ketoacids. Checking the patient's breath will help the nurse confirm the diagnosis.

A male client, aged 42 years, is diagnosed with diabetes mellitus. He visits the gym regularly and is a vegetarian. Which of the following factors is important when assessing the client? a) The client's mental and emotional status b) The client's exercise routine c) The client's consumption of carbohydrates d) History of radiographic contrast studies that used iodine

c) The client's consumption of carbohydrates

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? a) Nephropathy b) Retinopathy c) Sensory neuropathy d) Autonomic neuropathy

c) Sensory neuropathy --- 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.

A client with newly diagnosed type 2 diabetes is admitted to the metabolic unit. The primary goal for this admission is education. Which goal should the nurse incorporate into her teaching plan? a) Maintenance of blood glucose levels between 180 and 200 mg/dl b) An eye examination every 2 years until age 50 c) Weight reduction through diet and exercise d) Smoking reduction but not complete cessation

c) Weight reduction through diet and exercise

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? a) There is no longer a need to inject air into the bottle of insulin before insulin is withdrawn. b) When mixing insulin, the NPH insulin is drawn up into the syringe first. c) When mixing insulin, the regular insulin is drawn up into the syringe first. d) If two different types of insulin are ordered, they need to be given in separate injections.

c) When mixing insulin, the regular insulin is drawn up into the syringe first.

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: a) at least five times per week. b) at least once per week. c) at least three times per week. d) every day.

c) at least three times per week.

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: a) urine glucose level. b) serum fructosamine level. c) glycosylated hemoglobin level. d) fasting blood glucose level.

c) glycosylated hemoglobin level.

A client is admitted with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which laboratory finding should the nurse expect in this client? a) Arterial pH 7.25 b) Blood urea nitrogen (BUN) 15 mg/dl c) Plasma bicarbonate 12 mEq/L d) Blood glucose level 1,100 mg/dl

d) Blood glucose level 1,100 mg/dl --- 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 patient who is diagnosed with type 1 diabetes would be expected to: a) Be restricted to an American Diabetic Association diet. b) Receive daily doses of a hypoglycemic agent. c) Have no damage to the islet cells of the pancreas. d) Need exogenous insulin.

d) Need exogenous insulin. --- Type 1 diabetes is characterized by the destruction of pancreatic beta cells that require exogenous insulin.

Which of the following should be included in the teaching plan for a patient receiving glargine (Lantus),"peakless" basal insulin? a) It is rapidly absorbed, has a fast onset of action. b) Draw up the drug first, then add regular insulin. c) Administer the total daily dosage in two doses. d) Do not mix with other insulins.

d) Do not mix with other insulin --- Because glargine is in a suspension with a pH of 4, it cannot be mixed with other insulins because this would cause precipitation. When administering glargine (Lantus) insulin it is very important to read the label carefully and to avoid mistaking Lantus insulin for Lente insulin and vice versa.

Which of the following would be included in the teaching plan for a patient diagnosed with diabetes mellitus? a) The only diet change needed in the treatment of diabetes is to stop eating sugar. b) Sugar is found only in dessert foods. c) Once insulin injections are started in the treatment of type 2 diabetes, they can never be discontinued. d) Elevated blood glucose levels contribute to complications of diabetes, such as diminished vision.

d) Elevated blood glucose levels contribute to complications of diabetes, such as diminished vision.

A client has type 1 diabetes. Her husband finds her unconscious at home and administers glucagon, 0.5 mg subcutaneously. She awakens in 5 minutes. Why should her husband offer her a complex carbohydrate snack as soon as possible? a) To stimulate her appetite b) To decrease the amount of glycogen in her system c) To decrease the possibility of nausea and vomiting d) To restore liver glycogen and prevent secondary hypoglycemia

d) To restore liver glycogen and prevent secondary hypoglycemia

A client with type 2 diabetes asks the nurse why he can't have a pancreatic transplant. Which of the following would the nurse include as a possible reason? a) Need for lifelong immunosuppressive therapy b) Need for exocrine enzymatic drainage c) Increased risk for urologic complications d) Underlying problem of insulin resistance

d) Underlying problem of insulin resistance --- Clients with type 2 diabetes are not offered the option of a pancreas transplant because their problem is insulin resistance, which does not improve with a transplant. Urologic complications or the need for exocrine enzymatic drainage are not reasons for not offering pancreas transplant to clients with type 2 diabetes. Any transplant requires lifelong immunosuppressive drug therapy and is not the factor.

A nurse is developing a teaching plan for a client with diabetes mellitus. A client with diabetes mellitus should: a) use commercial preparations to remove corns. b) walk barefoot at least once each day. c) cut the toenails by rounding edges. d) wash and inspect the feet daily.

d) wash and inspect the feet daily.

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

hypokalemia and hypoglycemia Blood glucose needs to be monitored in clients receiving I.V. insulin because of the risk of hyperglycemia or hypoglycemia. Hypoglycemia might occur if too much insulin is administered. Hypokalemia, not hyperkalemia, might occur because I.V. insulin forces potassium into cells, thereby lowering the plasma level of potassium. Calcium and sodium levels aren't affected by I.V. insulin administration.

A nurse is preparing the daily care plan for a client with newly diagnosed diabetes mellitus. The priority nursing concern for this client should be: A. administering insulin routinely and as needed via a sliding scale. B. checking for the presence of ketones with each void. C. providing client education at every opportunity. D. monitoring blood glucose every 4 hours and as needed.

providing client education at every opportunity The nurse should use routine care responsibilities as teaching opportunities with the intention of preparing the client to understand and eventually manage his disease. Monitoring blood glucose, checking for the presence of ketones, and administering insulin are important when caring for a client with diabetes, but they aren't the priority of care.

A nurse is assigned to care for a postoperative client with diabetes mellitus. During the assessment interview, the client reports that he's impotent and says he's concerned about the effect on his marriage. In planning this client's care, the most appropriate intervention would be to: A. provide support for the spouse or significant other. B. suggest referral to a sex counselor or other appropriate professional. C. encourage the client to ask questions about personal sexuality. D. provide time for privacy.

suggest referral to a sex counselor or other appropriate professional The nurse should refer this client to a sex counselor or other professional. Making appropriate referrals is a valid part of planning the client's care. The nurse doesn't normally provide sex counseling.