Chapter 52: Nursing Management- Diabetes Mellitus
The nurse is assessing a client who is experiencing the onset of symptoms of type 1 diabetes. Which of the following questions is best for the nurse to ask? a. "Have you lost any weight lately?" b. "How long have you felt anorexic?" c. "Is your urine unusually dark coloured?" d. "Do you crave fluids containing sugar?"
A
The nurse is caring for a client who has just been diagnosed with type 2 diabetes and has a nursing diagnosis of imbalanced nutrition: more than body requirements. Which of the following client goals is most important? a. The client will have a glycosylated hemoglobin level of less than 7%. b. The client will have a diet and exercise plan that results in weight loss. c. The client will choose a diet that distributes calories throughout the day. d. The client will state the reasons for eliminating simple sugars in the diet.
A
The nurse is caring for a client with type 2 diabetes who has sensory neuropathy of the feet and legs and peripheral arterial disease. Which of the following information will the nurse include in client teaching? a. Choose flat-soled leather shoes. b. Set heating pads on a low temperature. c. Buy callus remover for corns or calluses. d. Soak the feet in warm water for an hour every day.
A
The nurse is assessing a client for diabetes at a clinic who has a fasting plasma glucose level of 6.7 mmol/L. Which of the following information should the nurse include in the plan of care? a. Self-monitoring of blood glucose. b. Use of low doses of regular insulin. c. Lifestyle changes to lower blood glucose. d. Effects of oral hypoglycemic medications.
C
The nurse is admitting a client with diabetic ketoacidosis (DKA) who has a serum potassium level of 2.9 mmol/L. Which of the following actions prescribed by the health care provider should the nurse take first? a. Infuse regular insulin at 20 units/hour. b. Place the client on a cardiac monitor. c. Administer IV potassium supplements. d. Obtain urine glucose and ketone levels.
B
The nurse is admitting a client with diabetic ketoacidosis. Which of the following prescriptions should the nurse implement first? a. Administer regular IV insulin 30 units. b. Infuse 1 L of normal saline per hour. c. Give sodium bicarbonate 50 mEq IV push. d. Start an infusion of regular insulin at 50 units/hour.
B
The nurse is assessing a client who is recovering from an episode of diabetic ketoacidosis and the client reports feeling anxious, nervous, and sweaty. Which of the following actions should the nurse take first? a. Administer 1 mg glucagon subcutaneously. b. Obtain a glucose reading using a finger stick. c. Have the client drink 120 mL of orange juice. d. Give the scheduled dose of lispro insulin.
B
The nurse is assessing a client's technique of self-monitoring of blood glucose (SMBG) as part of diabetes management. Which of the following actions indicate a need for further teaching? a. Washes the puncture site using soap and warm water. b. Chooses a puncture site in the centre of the finger pad. c. Hangs the arm down for a minute before puncturing the site. d. Says the result of 6.1 mmol/L indicates good blood sugar control.
B
The nurse is teaching about meal coverage to a client with diabetes who has just started on intensive insulin therapy. Which of the following types of insulin should the nurse discuss with the client? a. Glargine b. Lispro c. Detemir d. NPH
B
Which of the following actions should the nurse take first when teaching a client who is newly diagnosed with type 2 diabetes about home management of the disease? a. Ask the client's family to participate in the diabetes education program. b. Assess the client's perception of what it means to have diabetes mellitus. c. Demonstrate how to check glucose using capillary blood glucose monitoring. d. Discuss the need for the client to participate actively in diabetes management.
B
Which of the following client actions indicate a good understanding of the nurse's teaching about the use of an insulin pump? a. The client changes the site for the insertion site every week. b. The client programs the pump to deliver an insulin bolus after eating. c. The client takes the pump off at bedtime and starts it again each morning. d. The client states that diet will be less flexible when using the insulin pump.
B
Which of the following information should the nurse include when teaching a client who has type 2 diabetes about glyburide? a. Glyburide decreases glucagon secretion from the pancreas. b. Glyburide stimulates insulin production and release from the pancreas. c. Glyburide should be taken even if the morning blood glucose level is low. d. Glyburide should not be used for 48 hours after receiving IV contrast media.
B
Which of the following questions by the nurse will help identify autonomic neuropathy in a client with diabetes? a. "Have you observed any recent skin changes?" b. "Do you notice any bloating feeling after eating?" c. "Do you need to increase your insulin dosage when you are stressed?" d. "Have you noticed any painful new ulcerations or sores on your feet?"
B
The nurse is admitting a client with type 2 diabetes for an outpatient coronary arteriogram. Which of the following information obtained by the nurse is most important to report to the health care provider before the procedure? a. The client's admission blood glucose is 7.1 mmol/L. b. The client's most recent Hb A1C was 6.5%. c. The client took the prescribed metformin today. d. The client took the prescribed captopril this morning.
C
A client who has type 1 diabetes plans to take a swimming class daily at 1:00 P.M. Which of the following instructions should the nurse teach to the client? a. Check glucose level before, during, and after swimming. b. Delay eating the noon meal until after the swimming class. c. Increase the morning dose of neutral protamine Hagedorn (NPH) insulin. d. Time the morning insulin injection so that the peak occurs while swimming.
A
The health care provider suspects the Somogyi effect in a client whose 7:00 A.M. blood glucose is 12.2 mmol/L. Which action should the nurse plan to take? a. Check the client's blood glucose at 3:00 A.M. b. Administer a larger dose of long-acting insulin. c. Educate about the need to increase the rapid-acting insulin dose. d. Remind the client about the need to avoid snacking at bedtime.
A
The nurse is caring for a client who received aspart insulin at 8:00 A.M. Which of the following times is most important for the nurse to monitor for symptoms of hypoglycemia? a. 9:00 A.M. b. 11:30 A.M. c. 4:00 P.M. d. 8:00 P.M.
A
The nurse is teaching the client to administer a dose of 10 units of regular insulin and 28 units of NPH insulin. Which of the following statements by the client indicates a need for additional instruction? a. "I need to rotate injection sites among my arms, legs, and abdomen each day." b. "I will buy the 0.5 mL syringes because the line markings will be easier to see." c. "I should draw up the regular insulin first after injecting air into the NPH bottle." d. "I do not need to aspirate the plunger to check for blood before injecting insulin."
A
Which of the following hormones are considered as counter-regulatory hormones? (Select all that apply.) a. Glucagon b. Insulin c. Epinephrine d. Growth hormone e. Cortisol
ACDE
The nurse is preparing to assess a client who is pregnant and has no personal history of diabetes but does have a parent with diabetes. Which of the following actions should the nurse plan to take on this initial prenatal visit? a. Teach about appropriate use of regular insulin. b. Discuss the need for a fasting blood glucose level. c. Schedule an oral glucose tolerance test for the twenty-fourth week of pregnancy. d. Provide education about increased risk for fetal problems with gestational diabetes.
B
The nurse obtains the following information about a client before administration of metformin. Which of the following findings indicate a need to contact the health care provider before giving the metformin? a. The client's blood glucose level is 9.2 mmol/L. b. The client's blood urea nitrogen (BUN) level is 21.4 mmol/L. c. The client is scheduled for a chest x-ray in an hour. d. The client has gained 1 kg since yesterday.
B
Which of the following actions is most important for the nurse to take in order to assist a client with diabetes to engage in moderate daily exercise? a. Remind the client that exercise will improve self-esteem. b. Determine what type of exercise activities the client enjoys. c. Give the client a list of activities that are moderate in intensity. d. Teach the client about the effects of exercise on glucose level.
B
Which of the following laboratory values, noted by the nurse when reviewing the chart of a hospitalized client with diabetes, indicates the need for rapid assessment of the client? a. Hb A1C of 5.8% b. Noon blood glucose of 2.9 mmol/L c. Hb A1Cof 6.9% d. Fasting blood glucose of 7.2 mmol/L
B
The nurse is caring for a client with newly diagnosed type 1 diabetes who has received diet instruction. Which of the following client statements indicate a need for additional instruction? a. "I may have an occasional alcoholic drink if I include it in my meal plan." b. "I will need a bedtime snack because I take an evening dose of NPH insulin." c. "I may eat whatever I want, as long as I use enough insulin to cover the calories." d. "I will eat meals as scheduled, even if I am not hungry, to prevent hypoglycemia."
C
The nurse is caring for a client with newly diagnosed type 2 diabetes mellitus who asks the nurse what "type 2" means in relation to diabetes. Which of the following statements by the nurse about type 2 diabetes is correct? a. Insulin is not used to control blood glucose in clients with type 2 diabetes. b. Complications of type 2 diabetes are less serious than those of type 1 diabetes. c. Type 2 diabetes is usually diagnosed when the client is admitted with a hyperglycemic coma. d. Changes in diet and exercise may be sufficient to control blood glucose levels in type 2 diabetes.
D
The nurse is teaching a client with diabetes who rides a bicycle to work every day about morning administration of insulin. Which of the following sites should the nurse tell the client to use to administer the morning insulin? a. Arm b. Thigh c. Buttock d. Abdomen
D
To evaluate the effectiveness of treatment for a client with type 2 diabetes who is scheduled for a follow-up visit in the clinic, which of the following tests will the nurse plan to schedule for the client? a. Urine dipstick for glucose b. Oral glucose tolerance test c. Fasting blood glucose level d. Glycosylated hemoglobin level
D
Which of the following client teaching information is most important for the nurse to communicate to a client with gestational diabetes? a. Delivery will not affect blood glucose levels. b. Exercise should be avoided in the last month of pregnancy. c. Monitoring of blood glucose can stop as soon as the baby is delivered. d. A postpartum OGTT will be done at 2 months.
D
A client with type 1 diabetes who is on glargine and lispro insulin has called the clinic to report symptoms of a sore throat, cough, fever, and blood glucose level of 11.7 mmol/L. Which of the following information should the nurse tell the client? a. Use only the lispro insulin until the symptoms of infection are resolved. b. Monitor blood glucose every 4 hours and notify the clinic if it continues to rise. c. Decrease intake of carbohydrates until glycosylated hemoglobin is less than 7%. d. Limit intake of calorie-containing liquids until the glucose is less than 6.7 mmol/L.
B
A client with type 2 diabetes that is well-controlled with metformin develops an allergic rash to an antibiotic and the health care provider prescribes prednisone. Which of the following information should the nurse anticipate while the client is taking the prednisone? a. A diet higher in calories b. Administration of insulin c. Development of acute hypoglycemia d. Appearance of a rash caused by metformin-prednisone interactions.
B
A diagnosis of hyperglycemic hyperosmolar state (HHS) is made for a client with type 2 diabetes who is brought to the emergency department in an unresponsive state. Which of the following actions should the nurse anticipate? a. Give 50% dextrose as a bolus b. Insert a large-bore IV catheter c. Initiate oxygen by nasal cannula d. Administer glargine insulin
B
After the nurse has finished teaching a client about self-administration of the prescribed aspart insulin, which of the following client actions indicate good understanding of the teaching? a. The client avoids injecting the insulin into the upper abdominal area. b. The client cleans the skin with soap and water before insulin administration. c. The client places the insulin back in the freezer after administering the prescribed insulin dose. d. The client pushes the plunger down and immediately removes the syringe from the injection site.
B
The nurse administers intramuscular glucagon to a client who is unresponsive for treatment of hypoglycemia. Which of the following actions should the nurse take after the client regains consciousness? a. Assess the client for symptoms of hyperglycemia. b. Give the client a snack of crackers and peanut butter. c. Have the client drink a glass of orange juice or nonfat milk. d. Administer a continuous infusion of 5% dextrose for 24 hours.
B
Amitriptyline is prescribed for a diabetic client who has burning foot pain at night. Which of the following information should the nurse include when teaching the client about the new medication? a. Amitriptyline will decrease the depression caused by your foot pain. b. Amitriptyline will correct some of the blood vessel changes that cause pain. c. Amitriptyline will improve sleep and make you less aware of nighttime pain. d. Amitriptyline will help prevent the transmission of pain impulses to the brain.
D
The home health nurse is providing teaching to a client and family about how to use glargine and regular insulin safely. Which of the following actions by the client indicates that the teaching has been successful? a. The client administers the glargine 30-45 minutes before eating each meal. b. The client's family fills the syringes weekly and stores them in the refrigerator. c. The client draws up the regular insulin and then the glargine in the same syringe. d. The client disposes of the open vials of glargine and regular insulin after 4 weeks.
D
The nurse has completed teaching a client with type 2 diabetes about taking gliclazide. Which of the following client statements indicate a need for additional teaching? a. "Other medications besides the gliclazide may affect my blood sugar." b. "If I overeat at a meal, I will still take just the usual dose of medication." c. "When I become ill, I may have to take insulin to control my blood sugar." d. "My diabetes is not as likely to cause complications as if I needed to take insulin."
D
The nurse is caring for a client with diabetes who received 34 units of NPH insulin at 7:00 A.M. and is away from the nursing unit, awaiting diagnostic testing when lunch trays are distributed. Which of the following actions is best to prevent hypoglycemia? a. Save the lunch tray to be provided upon the client's return to the unit. b. Call the diagnostic testing area and ask that a 5% dextrose IV be started. c. Ensure that the client drinks a glass of orange juice at noon in the diagnostic testing area. d. Request that the client be returned to the unit to eat lunch if testing will not be completed promptly.
D
Which of the following actions by a client with type 1 diabetes indicates that the nurse should implement teaching about exercise and glucose control? a. The client always carries hard candies when engaging in exercise. b. The client goes for a vigorous walk when the glucose is 11.1 mmol/L. c. The client has a peanut butter sandwich before going for a bicycle ride. d. The client increases daily exercise when ketones are present in the urine.
D
Which of the following information about a client who receives rosiglitazone is most important for the nurse to report immediately to the health care provider? a. The client's blood pressure is 154/92. b. The client has a history of emphysema. c. The client's noon blood glucose is 4.7 mmol/L. d. The client has chest pressure when ambulating.
D