Diabetes PrepU Quiz
A client, being evaluated for diabetes, asks how a blood glucose test is used to diagnosis this disease. What is the nurse's best response?
"A fasting blood sugar result of 126 mg/dL (6.99 mmol/L) or more on two separate occasions is diagnostic of diabetes."
A nurse is providing client education to a 13-year-old girl who was just diagnosed with type 1 diabetes mellitus. Which statement by the client will alert the nurse that special instructions regarding insulin are necessary?
"I am on the middle school track team."
A 59-year-old man with type 2 diabetes is prescribed metformin. When the client returns to the clinic, he reports that he has lost 8 pounds in a month. How should the nurse respond?
"Please continue taking the medication and monitoring your weight. This is an expected outcome of this drug therapy." Explanation: The nurse should advise the client to continue therapy as prescribed because weight loss is a beneficial adverse effect for type 2 diabetics. The client need not seek a decrease in dosage or change in medication, nor would discontinuation of the drug be warranted.
A client with type 1 diabetes has been prescribed 12 units of regular insulin and 34 units of NPH insulin in the morning. How should the nurse explain why two different types of insulin are required to control the client's blood glucose?
"The different onsets and peaks of the two types provide better overall glucose control." Explanation: Regular insulin will begin working within 30 to 60 minutes and peak within 2 to 4 hours and a 6- to 12-hour duration of action whereas NPH insulin has an onset of 60 to 90 minutes and peaks in 4 to 12 hours, with a 24-hour duration of action. By giving both drugs at once, the client gets rapid blood glucose control within 30 minutes from the regular insulin and the control lasts 24 hours due to NPH's long duration of action. NPH has no effect on the breakdown of regular insulin and there is not necessarily a reduced risk of adverse effects. NPH does not stimulate the pancreas toward increased insulin production.
What should be the nurse's initial response when a client diagnosed with type 1 diabetes suddenly reports feeling weak, shaky, and dizzy?
Perform a blood sugar analysis.
A 54-year-old male client is diagnosed with chronic renal failure and hyperglycemia. He asks if he can be prescribed sulfonylurea because it works well for his friend. If he were to be given sulfonylurea, this client's renal impairment may lead to what effect?
Accumulation and hypoglycemia
A nurse is preparing a teaching plan for a patient who is prescribed a meglitinide. What instruction should the nurse include in the teaching plan for the patient?
Avoid drug administration in the case of a skipped meal. Explanation: The nurse's teaching plan for the patient should instruct the patient taking meglitinides to avoid drug administration in the case of a skipped meal. The nurse should instruct the patient to take the meal within 15 to 30 minutes of administering the drug. The nurse should instruct the patient to report to the PHCP any instances of respiratory distress or muscular aches when administering metformin. The nurse should instruct the patient to avoid commercial weight-loss products, alcohol, dieting, and strenuous exercise programs unless approved by the PHCP.
What outcome would best indicate the nurse's teaching of a client newly-diagnosed with diabetes was effective and that drug therapy is appropriate?
Blood glucose level is stable with no diabetic complications.
A nurse is caring for a 48-year-old woman who has been hospitalized after injecting the wrong type of insulin. Which sign of hypoglycemia will the nurse be careful to observe for?
Blurred vision Explanation: Blurred or double vision (diplopia), fatigue, trembling, irritability, headache, nausea, numbness, muscle weakness, hunger, tachycardia, sweating, and nervousness are signs of a hypoglycemic reaction. Fruity breath can be an indication of ketoacidosis, and flushing of the face is a sign of hyperglycemia. Dry skin is unrelated to hypoglycemia.
The nurse is preparing to administer a mixture of 12 units regular insulin and 45 units NPH insulin to a client with a blood sugar of 378 mg/dL. After the nurse draws the medication into the syringe, what is the nurse's next action?
Check the dosage with another nurse.
A client with a recent diagnosis of type 2 diabetes has begun taking metformin. This drug will help the client achieve adequate blood sugar control through which mechanisms? (Select all that apply)
Decreasing glucose production by the liver Improving insulin sensitivity Decreasing glucose absorption in the GI tract Explanation: Metformin decreases hepatic glucose production, decreases intestinal absorption of glucose, and improves insulin sensitivity by increasing peripheral glucose uptake and use in skeletal muscle and adipose tissue through increased transport of glucose across the cell membrane. It does not promote urinary excretion of glucose or bind it to adipose tissue.
A patient receives 25 units of NPH insulin at 7 AM. At what time of day should the nurse advise the patient to be most alert for a potential hypoglycemic reaction?
Late afternoon Explanation: After an early morning dose of NPH insulin, the patient should be alert for a possible hypoglycemic reaction during mid- to late afternoon. The lengthy peak action time produces additional risks for hypoglycemic reactions.
A client prescribed metformin is scheduled to undergo diagnostic testing with the administration of parenteral radiographic contrast media containing iodine. What fact should direct the nurse's plan of care for this client?
Metformin should be discontinued at least 48 hours before and after diagnostic tests that use contrast medias. Explanation: Metformin should be discontinued at least 48 hours before diagnostic tests are performed with these materials and should not be resumed for at least 48 hours after the tests are done and tests indicate renal function is normal. By altering the metformin therapy, none of the other options are required.
The nurse walks into the room of a client with type 1 diabetes and finds the client pale and diaphoretic. The client reports a headache and being hungry. Immediately, the client is unable to talk. What is the nurse's immediate intervention for this client?
Place glucose gel between the gums and cheek.
The home care nurse is caring for an older adult client who has type 1 diabetes. The client has visual impairment and cannot read the numbers on the syringe when preparing insulin for administration nor afford the cost of prefilled auto syringes. What strategy might the nurse use to help this client comply with insulin needs between visits?
Prepare a week's supply of syringes and refrigerate. Explanation: Older adults can have many underlying problems that complicate diabetic therapy. Poor vision and/or coordination may make it difficult to prepare a syringe. A week's supply of syringes can be prepared and refrigerated for the usual dose of insulin. If the client is using insulin it is most likely because oral antidiabetic medications don't work. A magnifying glass is impractical because drawing up medication requires two hands and a magnifying glass will not help the client to see well enough to be safe. It is a big imposition to expect a neighbor to be constantly available and this would not be the best choice.
A client was diagnosed with type 2 diabetes several months ago and has presented for a scheduled follow-up appointment. Which stated behavior most clearly indicates that the client has established effective health maintenance?
The client frequently checks his/her blood glucose levels. Explanation: Vigilant blood glucose monitoring is imperative in the management of diabetes. This shows effective health maintenance even more clearly than exercising. Dietary modifications must be undertaken with care in people with diabetes to avoid health consequences. Explaining pathophysiology does not necessarily show effective health maintenance.
Which condition must be met in order for glyburide treatment to be effective?
The client must have functioning pancreatic beta cells.
The nurse in the emergency department receives a conscious client following a motor vehicle accident who has no known history of diabetes but whose blood glucose level is 325 mg/dL. What rationale does the nurse provide explaining this elevated blood glucose level?
The client's stress reaction likely caused an increase in blood sugar. Explanation: The stress reaction elevates the blood glucose concentration above the normal range. In severe stress situations, the blood glucose level can be very high (300 to 400 mg/dL). The body uses that energy to fight the insult or flee from the stressor. It would be unlikely for a hyperglycemic episode to cause a change in consciousness that would result in an accident. Eating food does not cause such a large increase in glucose levels. Pancreatic trauma does not normally cause a precipitous increase in blood glucose levels.
A hospital client with a diagnosis of type 1 diabetes is prescribed Humulin R on a sliding scale. Based on the client's blood glucose reading, the nurse administered 8 units of insulin at 07:45. The nurse should consequently check the client's blood glucose level at what time to monitor peak effectiveness of the medication?
between 09:45 and 10:45 Explanation: Humulin R peaks between 2 and 3 hours after administration, so monitoring should occur between 09:45 and 10:45.
A client's current condition requires rapid reduction of blood sugar levels. Which type of insulin will have the most rapid onset of action?
insulin lispro
