Diabetes PrepU, Chapter 51 Diabetes PrepU, Diabetes, PREPU Chapter 46 Assessment and Management of Patients with Diabetes, Chapter 51: Assessment and Management of Patients With Diabetes, PrepU Questions, PrepU quiz #4 (301), Chapter 51: Caring for C…

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."

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

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

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 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?

"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."

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

Blurred vision

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

Which electrolyte replacement should the nurse anticipate being ordered by the health-care provider in the client diagnosed with DKA who has just been admitted to the ICU? 1.Glucose. 2.)Potassium. 3.Calcium. 4.Sodium

Potassium

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

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

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 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.

The client diagnosed with type 1 diabetes is found lying unconscious on the floor of the bathroom. Which intervention should the nurse implement first?

administer 50% dextrose

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 1 ampule of D5 solution, per physicians orders

The nurse at a freestanding health-care clinic is caring for a 56-year old male client who is homeless and is a type 2 diabetic controlled with insulin. Which action is an example of patient advocacy?

arrange for someone to give him insulin at a local homeless shelter

the home health nurse is completing the admission assessment for a 76-year old client diagnosed with type 2 diabetes controlled with 70/30 insulin. Which intervention should be included in the plan of care?

assess the client's ability to read small print

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.

Which clinical manifestation of type 2 diabetes occurs if glucose levels are very high?

blurred vision

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

the nurse administering 28 units of Humulin N, an intermediate acting insulin, to a client diagnosed with type 1 diabetes at 1600. Which intervention should the nurse implement?

ensure the client eats the bedtime snack

How to reverse hypoglycemia, what should the nurse tell the patient to keep on hand?

glucagon

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:

glycosylated hemoglobin level

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.

The client received 10 units of Humulin R, a fast-acting insulin, at 0700. At 1030 the CNA tells the nurse the client has a headache and is really acting "funny". which intervention should the nurse implement first?

go to the client's room and assess the client for hypoglycemia

A client with type 1 diabetes asks the nurse about taking an oral antidiabetic agent. The nurse explains that these medications are effective only if the client:

has type 2 diabetes

The client with type 2 diabetes controlled with biguanide oral diabetic medication is scheduled for a CT scan with contrast of the abdomen to evaluate pancreatic function. Which intervention should the nurse implement?

hold the biguanide medication for 48 hours prior to test

A client with diabetes mellitus is receiving an oral antidiabetic agent. The nurse observes for which symptom when caring for this client?

hypoglycemia

For a client with hyperglycemia, which assessment finding best supports a nursing diagnosis of Deficient fluid volume?

increased urine osmolarity

The elderly client is admitted to the ICU diagnosed with severe HHNS. Which collaborative intervention should the nurse include in the plan of care?

infused 0.9% normal saline intravenously

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 anatomical region, not among different regions

The nurse is assessing the feet of a client with long-term type 2 diabetes. Which assessment data warrant immediate intervention by the nurse?

the client has a necrotic big toe

Which of the following factors would a nurse identify as a most likely cause of diabetic ketoacidosis (DKA) in a client with diabetes?

the client has eaten and has not taken or received insulin

Which assessment data indicate the client diagnosed with DKA is responding to the medical treatment?

the client is A&Ox3

The nurse is developing a care plan for the client diagnosed with type 1 diabetes. The nurse identifies the problem "high risk for hyperlgycemia R/T noncompliance with the medication regimen." which statement is an appropriate short-term goal for the client?

the client will have a blood glucose level between 90 and 140 mg/dL

The charge nurse is making client assignments in the ICU. Which client should be assigned to the most experienced nurse?

the client with DKA who has multifocal premature ventricular contractions

An 18 year old female client, 5'4 tall, weighing 113 kg, comes to the clinic for a nonhealing wound on her lower leg, which she has had for 2 weeks. Which disease process should the nurse suspect the client has developed?

Type 2 diabetes

A client has been diagnosed with prediabetes and discusses treatment strategies with the nurse. What can be the consequences of untreated prediabetes?

Type 2 diabetes, heart disease and stroke

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

Ketones

Which statement is correct regarding glargine insulin?

it cannot be mixed with any other type of insulin

A client with type 1 diabetes has an elevated hemoglobin test, the nurse is most accurate in stating

it tells us your sugar results over 3 months

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?

ketoacidosis

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."

the ER nurse is caring for a client diagnosed with HHNS who has a blood glucose level of 680mg/dL. Which question should the nurse ask the client to determine the cause of this acute complication?

"Have you has some type of infection lately?"

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 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."

the client is admitted to the ICU diagnosed with DKA. Which intervention should the nurse implement?

1. maintain adequate ventilation 2. assess fluid volume status 3. administer IV potassium 4. check for urinary ketones 5. monitor I&O

The diabetic educator is teaching a class on diabetes type 1 and is discussing sick-day rules. Which interventions should the diabetes educator include in the discussion? select all that apply

1. take diabetic medication even if unable to eat the client's normal diabetic diet 2. if unable to eat, drink liquids equal to the client's normal caloric intake 5. call the HCP if glucose levels are higher than 180mg/dL

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

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

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

What is the duration of regular insulin?

4-6 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?

6.5%

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%

When administering insulin, which of the following is most important to keep in mind?

Accuracy of dose

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 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

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.

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 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.

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

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

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 clinical characteristic is associated with type 2 diabetes (previously referred to as non-insulin-dependent diabetes mellitus)?

HTN, tachycardia, stroke

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

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?

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

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

Intermediate-acting

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

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

The nurse is preparing to administer intermediate-acting insulin to a patient with diabetes. Which insulin will the nurse administer?

NPH

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

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 glucose level of 52 mg/dl

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, tachycardia

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

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:

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

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.

The client diagnosed with type 1 diabetes has a glycosylated hemoglobin (A1c) of 8.1%. Which interpretation should the nurse make based on this result?

This result is above recommended levels

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.

Which intervention is essential when performing dressing changes on a client with a diabetic foot ulcer?

Using sterile technique during the dressing change

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 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

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.

Which of the following would be considered a "free" item from the exchange list?

diet soda

Which information should be included in the teaching plan for a client receiving glargine, a "peakless" basal insulin?

do not mix with other insulins

Mixing regular and NPH insulin, what is important to teach the patient

draw up regular insulin first

The client diagnosed with type 2 diabetes is admitted to the ICU with hyperosmolar hyperglycemia nonketoic syndrome (HHNS) coma. Which assessment data should the nurse expect the client to exhibit?

dry mucous membranes

What should the nurse tell a patient with diabetes nephropathy to be cautious of?

monitor blood sugar level

A nurse expects to find which signs and symptoms in a client experiencing hypoglycemia?

nervousness, diaphoresis and confusion

the client diagnosed with HHNS was admitted yesterday with a blood glucose level of 780mg/dL. The clients blood glucose level is now 300mg/dL. Which intervention should the nurse implement?

notify the HCP to obtain an order to decrease insulin

the UAP on the medical floor tells the nurse the client diagnosed with DKA wants something else to eat for lunch. Which intervention should the nurse implement?

notify the dietician about the client's request

Which arterial blood gas results should the nurse expect in the client diagnosed with DKA?

pH: 7.30, Pao2: 90, Paco2: 30, HCO3: 18

The nurse is discussing the importance of exercising with a client diagnosed with type 2 diabetes whose diabetes is well controlled with diet and exercise. Which information should the nurse include in the teaching about diabetes?

perform warm up and cool down exercises

the nurse is discussing ways to prevent DKA with the client diagnosed with type 1 diabetes. Which instruction is most important to discuss with the client?

take the prescribed insulin even when unable to eat because of illness