Chapter 51: Assessment and Management of Patients with Diabetes Prep U

When referred to a podiatrist, a client newly diagnosed with diabetes mellitus asks, "Why do you need to check my feet when I'm having a problem with my blood sugar?" The nurse's most helpful response to this statement is: "The physician wants to be sure your shoes fit properly so you won't develop pressure sores." "It's easier to get foot infections if you have diabetes." "The circulation in your feet can help us determine how severe your diabetes is." "Diabetes can affect sensation in your feet and you can hurt yourself without realizing it."

"Diabetes can affect sensation in your feet and you can hurt yourself without realizing it."

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? "Administer insulin into sites above muscles that you plan to exercise heavily later that day." "Rotate injection sites within the same anatomic region, not among different regions." "Administer insulin into areas of scar tissue or hypertrophy whenever possible." "Inject insulin into healthy tissue with large blood vessels and nerves."

"Rotate injection sites within the same anatomic region, not among different regions."

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? Inserting a feeding tube and providing tube feedings Administering a 500-ml bolus of normal saline solution Administering 1 ampule of 50% dextrose solution, per physician's order Observing the client for 1 hour, then rechecking the fingerstick glucose level

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

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

138 mg/dL, 2 hours postprandial.

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

Do not mix with other insulins.

Which information should be included in the teaching plan for a client receiving glargine, which is "peakless" basal insulin? Draw up the drug first, then add regular insulin. Do not mix with other insulins. Administer the total daily dosage in 2 doses. Glargine is rapidly absorbed and has a fast onset of action.

Do not mix with other insulins.

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

Increased urine output

NPH is an example of which type of insulin? Rapid-acting Long-acting Intermediate-acting Short-acting

Intermediate-acting

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? It stimulates the pancreatic beta cells. It aids in the process of gluconeogenesis. It decreases the intestinal absorption of glucose. It carries glucose into body cells.

It carries glucose into body cells.

What is the only insulin that can be given intravenously? NPH Ultralente Lantus Regular

Regular

A client with a history of type 1 diabetes is demonstrating fast, deep, labored breathing and has fruity odored breath. What could be the cause of the client's current serious condition? All options are correct. hepatic disorder hyperosmolar hyperglycemic nonketotic syndrome ketoacidosis

ketoacidosis

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? Onset most common during adolescence Less common than type 1 diabetes Little to no relation to pre-diabetes Insulin production insufficient

Insulin production insufficient

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: 15 g of carbohydrates. 25 g of carbohydrates. 10 g of carbohydrates. 20 g of carbohydrates.

15 g of carbohydrates.

What is the duration of regular insulin? 4 to 6 hours 24 hours 3 to 5 hours 12 to 16 hours

4 to 6 hours

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

7:45 AM

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: 12:30 PM. 10:30 AM. 2:30 PM. 8:30 AM.

8:30 AM.

The nurse is educating the client with diabetes 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? Take half the usual dose of insulin until symptoms resolve. Increase frequency of glucose self-monitoring. Decrease food intake until nausea passes. Do not take insulin if not eating.

Increase frequency of glucose self-monitoring.

Which type of insulin acts most quickly? Lispro Regular NPH Glargine

Lispro

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

Rapid-acting

A client with type 1 diabetes has a highly elevated glycosylated hemoglobin (Hb) test result. In discussing the result with the client, the nurse is most accurate in stating: "It looks like you aren't following the ordered diabetic diet." "The test must be repeated following a 12-hour fast." "It tells us about your sugar control for the last 3 months." "Your insulin regimen must be altered significantly."

"It tells us about your sugar control for the last 3 months."

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? Duration of the insulin Technique for injecting Area for insulin injection Accuracy of the dosage

Accuracy of the dosage

Which combination of adverse effects should a nurse monitor for when administering IV insulin to a client with diabetic ketoacidosis? Hyperkalemia and hyperglycemia Hypernatremia and hypercalcemia Hypocalcemia and hyperkalemia Hypokalemia and hypoglycemia

Hypokalemia and hypoglycemia

A client with type 1 diabetes is admitted to an acute care facility with diabetic ketoacidosis. To correct this acute diabetic emergency, which measure should the health care team take first? Correct diabetic ketoacidosis. Initiate fluid replacement therapy. Administer insulin. Determine the cause of diabetic ketoacidosis.

Initiate fluid replacement therapy.

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

It cannot be mixed with any other type of insulin.

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

Need exogenous insulin.

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? Need for lifelong immunosuppressive therapy Increased risk for urologic complications Underlying problem of insulin resistance Need for exocrine enzymatic drainage

Underlying problem of insulin resistance

A nurse is preparing a continuous insulin infusion for a child with diabetic ketoacidosis and a blood glucose level of 800 mg/dl. Which solution is the most appropriate at the beginning of therapy? 100 units of regular insulin in normal saline solution 100 units of NPH insulin in dextrose 5% in water 100 units of neutral protamine Hagedorn (NPH) insulin in normal saline solution 100 units of regular insulin in dextrose 5% in water

100 units of regular insulin in normal saline solution

A nurse is caring for a client with type 1 diabetes who exhibits confusion, light-headedness, and aberrant behavior. The client is conscious. The nurse should first administer: I.M. or subcutaneous glucagon. 10 units of fast-acting insulin. I.V. bolus of dextrose 50%. 15 to 20 g of a fast-acting carbohydrate such as orange juice.

15 to 20 g of a fast-acting carbohydrate such as orange juice.

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

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

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

Using sterile technique during the dressing change

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

Blood glucose level 1,100 mg/dl

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

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

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? Insufficient insulin production Little relation to prediabetes Onset most common during adolescence Less common than type 1 diabetes

Insufficient insulin production

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

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

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

Nervousness, diaphoresis, and confusion

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

Presence of islet cell antibodies

Which is the primary reason for encouraging injection site rotation in an insulin dependent diabetic? Avoid infection. Prevent muscle destruction. Promote absorption. Minimize discomfort.

Promote absorption.

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? Slow, shallow respirations Arm and leg trembling Cool, moist skin Rapid, thready pulse

Rapid, thready pulse

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? "I always carry hard candy to eat in case my blood sugar level drops." "I skip lunch when I don't feel hungry." "I always wear my medical identification bracelet." "I avoid exposure to the sun as much as possible."

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

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? "You may be having undiagnosed infections, causing you to lose extra weight." "Don't worry about what your friends think; the carbohydrates you eat are being quickly digested, increasing your metabolism." "I will refer you to a dietician who can help you with your weight." "Your body is using protein and fat for energy instead of glucose."

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

A client with diabetes mellitus has a blood glucose level of 40 mg/dL. Which rapidly absorbed carbohydrate would be most effective? 4 oz of skim milk 1/2 tbsp honey or syrup three to six LifeSavers candies 1/2 cup fruit juice or regular soft drink

1/2 cup fruit juice or regular soft drink

Which is the best nursing explanation for the symptom of polyuria in a client with diabetes mellitus? High sugar pulls fluid into the bloodstream, which results in more urine production. The body's requirement for fuel drives the production of urine. With diabetes, drinking more results in more urine production. Increased ketones in the urine promote the manufacturing of more urine.

High sugar pulls fluid into the bloodstream, which results in more urine production.

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? Fatigue Increased hunger Numbness Dizziness

Increased hunger

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

Ketosis-prone Younger than 30 years of age Little endogenous insulin

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? Bradycardia, thirst, and anxiety Polyuria, polydipsia, and polyphagia Dry skin, bradycardia, and somnolence Sweating, tremors, and tachycardia

Sweating, tremors, and tachycardia

Insulin is a hormone secreted by the Islets of Langerhans and is essential for the metabolism of carbohydrates, fats, and protein. The nurse understands the physiologic importance of gluconeogenesis, which refers to the: Transport of potassium. Storage of glucose as glycogen in the liver. Synthesis of glucose from noncarbohydrate sources. Release of glucose.

Synthesis of glucose from noncarbohydrate sources.

A client with diabetes mellitus develops sinusitis and otitis media accompanied by a temperature of 100.8° F (38.2° C). What effect do these findings have on his need for insulin? They increase the need for insulin. They decrease the need for insulin. They have no effect. They cause wide fluctuations in the need for insulin.

They increase the need for insulin.

A client receives a daily injection of glargine insulin at 7:00 a.m. When should the nurse monitor this client for a hypoglycemic reaction? Between 8:00 and 10:00 a.m. Between 4:00 and 6:00 p.m. Between 7:00 and 9:00 p.m. This insulin has no peak action and does not cause a hypoglycemic reaction.

This insulin has no peak action and does not cause a hypoglycemic reaction.

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: checking for the presence of ketones with each void. administering insulin routinely and as needed via a sliding scale. providing client education at every opportunity. monitoring blood glucose every 4 hours and as needed.

providing client education at every opportunity.