Chapter 51 Diabetes PrepU

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

8:30 AM.

Which of the following clinical manifestations of type 2 diabetes occurs if glucose levels are very high? Oliguria Increased energy Hyperactivity Blurred vision

Blurred vision

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? Hydrocortisone 50% dextrose Epinephrine Glucagon

Glucagon

The nurse is educating the diabetic client on setting up a sick plan to manage blood glucose control during times of minor illness such as influenza. Which is the most important teaching item to include? Do not take insulin if not eating. Increase frequency of glucose self-monitoring. Decrease food intake until nausea passes. Take half the usual dose of insulin until symptoms resolve.

Increase frequency of glucose self-monitoring.

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

Ketones

A nurse is teaching a diabetic support group about the causes of type 1 diabetes. The teaching is determined to be effective when the group is able to attribute which of the following factors as a cause of type 1 diabetes?

Presence of autoantibodies against islet cells

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? 1/2 cup fruit juice or regular soft drink Three to six LifeSavers candies 1/2 tbsp honey or syrup 4 oz of skim milk

1/2 cup fruit juice or regular soft drink

Which of the following would be inconsistent as a cause of DKA?

Competency in injecting insulin

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? Lantus Regular Lispro NPH

Regular

The pancreas continues to release a small amount of basal insulin overnight, while a person is sleeping. The nurse knows that, if the body needs more sugar: Insulin will be released to facilitate the transport of sugar. Glycogenesis will be decreased by the liver. The pancreatic hormone glucagon will stimulate the liver to release stored glucose. The process of gluconeogenesis will be inhibited.

The pancreatic hormone glucagon will stimulate the liver to release stored glucose.

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

Underlying problem of insulin resistance

When the nurse is caring for a patient with type 1 diabetes, what clinical manifestation would be a priority to closely monitor? Polyphagia Hypoglycemia Hyponatremia Ketonuria

Hypoglycemia

A client with type 1 diabetes mellitus is receiving short-acting insulin to maintain control of blood glucose levels. In providing glucometer instructions, the nurse would instruct the client to use which site for most accurate findings? Upper arm Forearm Thigh Finger

Finger

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 NPH insulin in dextrose 5% in water 100 units of regular insulin in dextrose 5% in water 100 units of regular insulin in normal saline solution 100 units of neutral protamine Hagedorn (NPH) insulin in normal saline solution

100 units of regular insulin in normal saline solution

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

Accuracy of the dosage

A client with type 1 diabetes must undergo bowel resection in the morning. How should the nurse proceed while caring for him on the morning of surgery?

Administer half of the client's typical morning insulin dose as ordered.

Which assessment finding is most important in determining nursing care for a client with diabetes mellitus?

Fruity breath

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

Albumin

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

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

Which of the following is an age-related change that may affect diabetes? Select all that apply. Increased bowel motility Decreased vision Decreased renal function Taste changes Increased proprioception

Decreased renal function Taste changes Decreased vision

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

Hypokalemia and hypoglycemia

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

Intermediate-acting

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: adenohypophysis. alpha cells of the pancreas. parafollicular cells of the thyroid. beta cells of the pancreas.

beta cells of the pancreas.

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

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

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

10 to 15 minutes

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? Urine dipstick for glucose Glycosylated hemoglobin level Oral glucose tolerance test Fasting blood glucose level

Glycosylated hemoglobin level

Which of the following is the most rapid acting insulin? Humalog Ultralente NPH Regular

Humalog

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

Rapid-acting

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

Switch the client to a different oral antidiabetic agent.

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? History of radiographic contrast studies that used iodine The client's consumption of carbohydrates The client's exercise routine The client's mental and emotional status

The client's consumption of carbohydrates

A patient with diabetes mellitus is receiving an oral antidiabetic agent. The nurse observes for which of the following symptoms when caring for this patient? Hypoglycemia Polyuria Polydipsia Blurred vision

Hypoglycemia

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

Nervousness, diaphoresis, and confusion

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

No islet cell antibodies

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

Rapid, thready pulse

When the nurse is caring for a patient with type 1 diabetes, what clinical manifestation would be a priority to closely monitor?

Hypoglycemia

A client tells the nurse that she has been working hard for the past 3 months to control her type 2 diabetes with diet and exercise. To determine the effectiveness of the client's efforts, the nurse should check: urine glucose level. serum fructosamine level. glycosylated hemoglobin level. fasting blood glucose level.

glycosylated hemoglobin level.

Which instruction about insulin administration should a nurse give to a client? "Discard the intermediate-acting insulin if it appears cloudy." "Always follow the same order when drawing the different insulins into the syringe." "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."

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

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

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

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

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

"Test your blood glucose every 4 hours."

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? 8.5% 7.5 % 8.0% 6.5%

6.5%

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? Decreases risk of developing insulin resistance and hyperglycemia Decreases need for pancreas to produce more cells Increases ability for glucose to get into the cell and lowers blood sugar Creates an overall feeling of well-being and lowers risk of depression

Increases ability for glucose to get into the cell and lowers blood sugar

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? Glipizide Glyburide Metformin Repaglinide

Metformin

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

Need exogenous insulin.

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 cause wide fluctuations in the need for insulin. They increase the need for insulin. They decrease the need for insulin. They have no effect.

They increase the need for insulin.

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: "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 looks like you aren't following the ordered diabetic diet."

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

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? "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." "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."

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

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

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

138 mg/dL, 2 hours postprandial.

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

15 g of carbohydrates.

Which of the following statements is true regarding gestational diabetes? It occurs in most pregnancies. There is a low risk for perinatal complications. A glucose challenge test should be performed between 24 and 28 weeks. Its onset is usually in the first trimester.

A glucose challenge test should be performed between 24 and 28 weeks.

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? Administering a 500-ml bolus of normal saline solution Inserting a feeding tube and providing tube feedings 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 newly diagnosed with type 1 diabetes has an unusual increase in blood glucose from bedtime to morning. The physician suspects the patient is experiencing insulin waning. Based on this diagnosis, the nurse will expect which of the following changes to the patient's medication regimen? Administering a dose of intermediate-acting insulin before the evening meal Decreasing evening bedtime dose of intermediate-acting insulin and administering a bedtime snack Changing the time of injection of evening intermediate-acting insulin from dinnertime to bedtime Increasing morning dose of long-acting insulin

Administering a dose of intermediate-acting insulin before the evening meal

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? CVA Cardiac disease All options are correct. Type 2 diabetes

All options are correct.

A child is brought into the emergency department with vomiting, drowsiness, and blowing respirations. The father reports that the symptoms have been progressing throughout the day. The nurse suspects diabetic ketoacidosis (DKA). Which action should the nurse take first in the management of DKA? Give prescribed antiemetics. Begin fluid replacements. Administer bicarbonate to correct acidosis. Administer prescribed dose of insulin.

Begin fluid replacements.

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 urea nitrogen (BUN) 15 mg/dl Plasma bicarbonate 12 mEq/L Blood glucose level 1,100 mg/dl

Blood glucose level 1,100 mg/dl

Which of the following clinical characteristics is associated with type 2 diabetes (previously referred to as non-insulin dependent diabetes mellitus [NIDDM])? Usually thin at diagnosis Demonstrate islet cell antibodies Can control blood glucose through diet and exercise Ketosis-prone

Can control blood glucose through diet and exercise

A nurse is teaching a client about insulin infusion pump use. What intervention should the nurse include to prevent infection at the injection site? Use clean technique when changing the needle. Wear sterile gloves when inserting the needle. Take the ordered antibiotics before initiating treatment. Change the needle every 3 days.

Change the needle every 3 days.

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

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

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? Control blood glucose levels. Take the antidiabetic drugs regularly. Drink plenty of fluids. Eat a high-fiber diet.

Control blood glucose levels.

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? Psychiatrist Home health nurse Social worker Dietitian

Dietitian

A type 2 diabetic is ordered metformin (Glucophage) as part of the management regime. Which is the best nursing explanation for the action of this drug in controlling glucose levels? Stimulates insulin release Helps tissues use insulin more efficiently Delays digestion of carbohydrates Reduces the production of glucose by the liver

Helps tissues use insulin more efficiently

A 60-year-old patient comes to the ED with complaints of weakness, vision problems, increased thirst, increased urination, and frequent infections that do not seem to heal easily. The physician suspects that the patient has diabetes. Which of the following classic symptoms should the nurse watch for to confirm the diagnosis of diabetes?

Increased hunger

A nurse is providing education to a client who is newly diagnosed with diabetes mellitus. Which of the following symptoms would she include when reviewing classic symptoms associated with diabetes? Increased weight gain, increased appetite, and increased thirst Increased weight loss, increased dehydration, and increased fatigue Loss of appetite, increased urination, and dehydration Increased thirst, increased hunger, and increased urination

Increased thirst, increased hunger, and increased urination

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? Insulin production insufficient Little to relation to pre-diabetes Onset most common during adolescence Less common than type 1 diabetes

Insulin production insufficient

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 aids in the process of gluconeogenesis. It decreases the intestinal absorption of glucose. It enhances transport of glucose across the cell wall. It stimulates the pancreatic beta cells.

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? Hyperosmolar hyperglycemic nonketotic syndrome Hepatic disorder All options are correct Ketoacidosis

Ketoacidosis

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

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

The nurse is assessing a patient with nonproliferative (background) retinopathy. When examining the retina, what would the nurse expect to assess? (Select all that apply.) Microaneurysms Detachment Focal capillary single closure Leakage of fluid or serum (exudates) Blurred optic discs

Leakage of fluid or serum (exudates) Microaneurysms Focal capillary single closure

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

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

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?

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

The diabetic client asks the nurse why shoes and socks are removed at each office visit. Which assessment finding is most significant in determining the protocol for inspection of feet? Retinopathy Sensory neuropathy Autonomic neuropathy Nephropathy

Sensory neuropathy

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? Serum calcium level of 8.9 mg/dl Serum calcium level of 10.2 mg/dl Serum glucose level of 52 mg/dl Serum glucose level of 450 mg/dl

Serum glucose level of 52 mg/dl

After being sick for 3 days, a client with a history of diabetes mellitus is admitted to the hospital with diabetic ketoacidosis (DKA). The nurse should evaluate which diagnostic test results to prevent arrhythmias? Serum calcium level Serum chloride level Serum potassium level Serum sodium level

Serum potassium level

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

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:

Synthesis of glucose from noncarbohydrate sources.

A nurse is preparing to administer two types of insulin to a client with diabetes mellitus. Which of the following demonstrates that the nurse understands the correct procedure for preparing this medication? The short-acting insulin is withdrawn before the intermediate-acting insulin. Different types of insulin are not to be mixed in the same syringe. The intermediate-acting insulin is withdrawn before the short-acting insulin. If administered immediately, there is no requirement for withdrawing one type of insulin before another.

The short-acting insulin is withdrawn before the intermediate-acting insulin.

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

Using sterile technique during the dressing change

The nurse understands that a client with diabetes mellitus is at greater risk for developing which of the following complications? High blood pressure Lifelong obesity Elevated triglycerides Urinary tract infections

Urinary tract infections

A patient with type 1 diabetes mellitus is being taught about self-injection of insulin. Which of the following facts about site rotation should the nurse include in the teaching? Avoid the abdomen because absorption there is irregular. Choose a different site at random for each injection. Use all available injection sites within one area. Rotate sites from area to area every other day.

Use all available injection sites within one area.

The nurse is teaching a patient about self-administration of insulin and mixing of regular and neutral protamine Hagedorn (NPH) insulin. Which of the following is important to include in the teaching plan? When mixing insulin, the 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. There is no longer a need to inject air into the bottle of insulin before insulin is withdrawn.

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