Diabetes Review

Rank the different types of insulin based on their duration of action beginning with the shortest to the longest duration. 1 Humulin N 2 Lantus 3 Lispro 4 Humulin R

3 Lispro 4 Humulin R 1 Humulin N 2 Lantus Rationale: Lispro is a rapid-acting insulin. Humulin R is a short-acting insulin. Humulin N is an intermediate-acting insulin. Lantus is a long-acting insulin.

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

A. "Always follow the same order when drawing the different insulins into the syringe." Rationale: The nurse should instruct the client to always follow the same order when drawing the different insulins into the syringe. Insulin should never be shaken because the resulting froth prevents withdrawal of an accurate dose and may damage the insulin protein molecules. Insulin should never be frozen because the insulin protein molecules may be damaged. The client doesn't need to discard intermediate-acting insulin if it's cloudy; this finding is normal.

During a routine medical evaluation, a client is found to have a random blood glucose level of 210 mg/dL. Which client statement(s) made by the client are concerning to the nurse? Select all that apply. A. "At times my vision is blurry." B. "I have to void nearly every hour." C. "I cannot seem to quench my thirst." D. "I sleep at least 8 hours each night." E. "I have lost 10 pounds without even trying."

A. "At times my vision is blurry." B. "I have to void nearly every hour." C. "I cannot seem to quench my thirst." E. "I have lost 10 pounds without even trying." Rationale: Criteria for the diagnosis of diabetes include symptoms of diabetes plus a random or casual plasma glucose concentration equal to or greater than 200 mg/dL. Symptoms of diabetes include vision changes, polyuria (or the increased need to urinate), polydipsia (or increased thirst), and sudden weight loss.

The nurse is teaching glucose monitoring and insulin administration to a child with type 1 diabetes and the parents. Which comment by a parent demonstrates a need for additional teaching? A. "During exercise we should wait to check blood sugars until after our child completes the activity." B. "If our child is sick we should check blood glucose levels more often." C. "We should check our child's blood glucose levels before meals." D. "Blood glucose level, food intake, and activity need to all be considered when calculating insulin dosage."

A. "During exercise we should wait to check blood sugars until after our child completes the activity." Rationale: Blood glucose monitoring needs to be performed more often during prolonged exercise. Frequent glucose monitoring before, during, and after exercise is important to recognize hypoglycemia or hyperglycemia. Frequent glucose monitoring if the child is sick is also important to recognize changes in glucose levels and prevent hypoglycemia or hyperglycemia. The parents are correct that they will check their child's glucose before meals; they should also check it before bedtime snacks. Blood glucose level should never be the only factor considered when calculating insulin dosing. Food intake and recent or expected activity/exercise must be factored in.

A nurse is educating a client about the benefits of fruit versus fruit juice in the diabetic diet. The client states, "What difference does it make if you drink the juice or eat the fruit? It is all the same." What are the best responses by the nurse? Select all that apply. A. "Eating the fruit instead of drinking juice decreases the glycemic index by slowing absorption." B. "Eating the fruit is more satisfying than drinking the juice. You will get full faster." C. "Eating the fruit will give you more vitamins and minerals than the juice will." D. "Eating the fruit will lead to hyperglycemia and the fruit juice will not lead to hyperglycemia." E. "The fruit has less sugar than the juice."

A. "Eating the fruit instead of drinking juice decreases the glycemic index by slowing absorption." E. "The fruit has less sugar than the juice." Rationale: Eating whole fruit instead of drinking juice decreases the glycemic index, because fiber in the fruit slows absorption. A serving of juice has more sugar than a serving of fruit. Whether a fruit is more satisfying and has more vitamins and minerals than the fruit's juice are dependent on the types of fruit and juices. Eating fruit does not lead to hyperglycemia.

The nurse is teaching a 12-year-old girl with type 2 diabetes mellitus and her parents about dietary measures to control her glucose levels. Which comment by the child indicates a need for additional teaching? A. "I can eat two small cookies with each meal." B. "I can have an apple or orange for snacks." C. "I can have nonfat milk to drink." D. "I will be eating more breads and cereals."

A. "I can eat two small cookies with each meal." Rationale: Cookies, cakes, candy, potato chips, and crackers are high in sugars and fats and should be eaten in moderation as special treats; they would not be included with each meal. An apple or orange makes a good snack. Nonfat milk is a better option than whole milk. Long-acting carbohydrates should be the largest category of foods eaten.

The nurse instructs the client with diabetes on self-care during days of illness. Which client statement indicates that teaching has been effective? Select all that apply. A. "I will increase my intake of fluids." B. "I will skip my diabetes medication for the day." C. "I will test my blood sugar level every 3 to 4 hours." D. "I will call the doctor if I have vomiting or diarrhea." E. "I will eat soft foods if I cannot tolerate regular food."

A. "I will increase my intake of fluids." C. "I will test my blood sugar level every 3 to 4 hours." D. "I will call the doctor if I have vomiting or diarrhea." E. "I will eat soft foods if I cannot tolerate regular food." Rationale: During periods of illness, the client with diabetes should be instructed to increase the intake of fluids to prevent dehydration. The blood glucose level should be checked every 3 to 4 hours. The health care provider should be contacted if vomiting or diarrhea occurs as extreme fluid loss may cause dehydration. Soft foods should be substituted for regularly ingested foods if the regular meal plan cannot be followed. The client should be instructed to take regular diabetes medication as prescribed.

The nurse is preparing to administer the child's ordered lispro (Humalog) insulin at 0800. When will the child's blood glucose level begin to decline? A. 0815 B. 0845 C. 0900 D. 0930

A. 0815 Rationale: The onset of rapid acting insulins like lispro (Humalog) is within 15 minutes. The onset of short-acting insulin is 30 to 60 minutes. The onset of intermediate-acting insulin is 1-3 hours, and long-acting insulin's onset is 1-2 hours.

The nurse is administering lispro insulin. Based on the onset of action, how long before breakfast should the nurse administer the injection? A. 10 to 15 minutes B. 30 to 40 minutes C. 1 to 2 hours D. 3 hours

A. 10 to 15 minutes Rationale: The onset of action of rapid-acting lispro insulin is within 10 to 15 minutes. It is used to rapidly reduce the glucose level.

When the dawn phenomenon occurs, the patient has relatively normal blood glucose until approximate what time of day? A. 3 AM B. 5 AM C. 7 AM D. 9 AM

A. 3 AM Rationale: During the dawn phenomenon, the patient has a relatively normal blood glucose level until about 3 AM, when the level begins to rise.

The nurse is reviewing the recommended diet with the parents and child who was diagnosed with type 2 diabetes. The nurse determines that the parents and child understand the information when they identify that they will restrict carbohydrate intake to which amount at each of the three main meals? A. 45 grams B. 15 grams C. 30 grams D. 60 grams

A. 45 grams Rationale: Typically, carbohydrate intake is restricted to 45 grams at each of the three main meals of the day.

A 10-year-old child is newly diagnosed with type 1 diabetes. The child's hemoglobin A1C level is being monitored. The nurse determines that additional intervention is needed with the child based on which result? A. 8.5% B. 6.5% C. 7.5 % D. 7.0%

A. 8.5% Rationale: The goal for hemoglobin A1C in children between the ages of 6 and 12 years is less than 8%. Therefore, a result of 8.5% would indicate that additional intervention is needed to achieve the recommended goal.

A client with type 1 diabetes is scheduled to receive 30 units of 70/30 insulin. There is no 70/30 insulin available. As a substitution, the nurse may give the client: A. 9 units regular insulin and 21 units neutral protamine Hagedorn (NPH). B. 21 units regular insulin and 9 units NPH. C. 10 units regular insulin and 20 units NPH. D. 20 units regular insulin and 10 units NPH.

A. 9 units regular insulin and 21 units neutral protamine Hagedorn (NPH). Rationale: A 70/30 insulin preparation is 70% NPH and 30% regular insulin. Therefore, a correct substitution requires mixing 21 units of NPH and 9 units of regular insulin. The other choices are incorrect dosages for the ordered insulin.

A client newly diagnosed with type 1 diabetes has an unusual increase in blood glucose from bedtime to morning. The physician suspects the client is experiencing insulin waning. Based on this diagnosis, the nurse expects which change to the client's medication regimen? A. Administering a dose of intermediate-acting insulin before the evening meal B. Changing the time of evening injection of intermediate-acting insulin from dinnertime to bedtime C. Decreasing evening bedtime dose of intermediate-acting insulin and administering a bedtime snack D. Increasing morning dose of long-acting insulin

A. Administering a dose of intermediate-acting insulin before the evening meal Rationale: Insulin waning is a progressive rise in blood glucose form bedtime to morning. Treatment includes increasing the evening (before dinner or bedtime) dose of intermediate-acting or long-acting insulin or instituting a dose of insulin before the evening meal if that is not already part of the treatment regimen.

Insulin is secreted by which of the following types of cells? A. Beta cells B. Melanocytes C. Neural cells D. Basal cells

A. Beta cells Rationale: Insulin is secreted by the beta cells, in the islets of Langerhans of the pancreas. In diabetes, cells may stop responding to insulin, or the pancreas may decrease insulin secretion or stop insulin production completely. Melanocytes are what give the skin its pigment. Neural cells transmit impulses in the brain and spinal cord. Basal cells are a type of skin cell.

A nurse is assigned to care for a patient who is suspected of having type 2 diabetes. Select all the clinical manifestations that the nurse knows could be consistent with this diagnosis. A. Blurred or deteriorating vision B. Fatigue and irritability C. Polyuria and polydipsia D. Sudden weight loss and anorexia E. Wounds that heal slowly or respond poorly to treatment

A. Blurred or deteriorating vision B. Fatigue and irritability C. Polyuria and polydipsia E. Wounds that heal slowly or respond poorly to treatment Rationale: All the options are correct except for weight loss and anorexia. Obesity is almost always associated with type 2 diabetes.

Which factors will cause hypoglycemia in a client with diabetes? Select all that apply. A. Client has not consumed food and continues to take insulin or oral antidiabetic medications. B. Client has not consumed sufficient calories. C. Client has been exercising more than usual. D. Client has been sleeping excessively. E. Client is experiencing effects of the aging process.

A. Client has not consumed food and continues to take insulin or oral antidiabetic medications. B. Client has not consumed sufficient calories. C. Client has been exercising more than usual. Rationale: Hypoglycemia can occur when a client with diabetes is not eating at all and continues to take insulin or oral antidiabetic medications, is not eating sufficient calories to compensate for glucose-lowering medications, or is exercising more than usual. Excessive sleep and aging are not factors in the onset of hypoglycemia.

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

A. Decreased renal function B. Taste changes C. Decreased vision Rationale: Age-related changes include decreased renal function, taste changes, decreased vision, decreased bowel motility, and decreased proprioception.

A child is prescribed glargine insulin. What information would the nurse include when teaching the child and parents about this insulin? A. Do not mix this insulin with other insulins. B. Give the dose first thing in the morning. C. Store the insulin in the refrigerator until just before giving it. D. Discard any opened vials after a week.

A. Do not mix this insulin with other insulins. Rationale: Glargine is not to be mixed with other insulins. Glargine is usually given in a single dose at bedtime. Insulin should be kept at room temperature; insulin that is administered cold may increase discomfort with the injection. Any vial of insulin that is opened should be discarded after 1 month.

A nurse is making a home visit to a 12-year-old child with type 1 diabetes and is reviewing insulin administration. The nurse determines that the teaching was successful when the child performs which actions? Select all that apply. A. Draws up the short-acting insulin before the intermediate-acting insulin. B. Stores the insulin vial at room temperature. C. Gives the injection at a 45-degree angle. D. Shakes the bottle of intermediate-acting insulin to make sure is it uniform. E. Aspirates for a blood return before injecting the medication.

A. Draws up the short-acting insulin before the intermediate-acting insulin. B. Stores the insulin vial at room temperature. C. Gives the injection at a 45-degree angle. Rationale: The child demonstrates appropriate technique by drawing up the short-acting insulin before the intermediate-acting insulin, stores the insulin at room temperature, and gives the injection at a 45-degree angle. The child should gently roll the bottle of insulin to ensure a uniform mixture and inject the insulin without aspirating.

Which of the following insulins are used for basal dosage? A. Glargine (Lantus) B. NPH (Humulin N) C. Lispro (Humalog) D. Aspart (Novolog)

A. Glargine (Lantus) Rationale: Lantus is used for basal dosage. NPH is an intermediate acting insulin, usually taken after food. Humalog and Novolog are rapid-acting insulins.

Which of the following is a risk factor for the development of diabetes mellitus? Select all that apply. A. Hypertension B. Obesity C. Family history D. Age greater of 45 years or older E. History of gestational diabetes

A. Hypertension B. Obesity C. Family history D. Age greater of 45 years or older E. History of gestational diabetes Rationale: Risk factors for the development of diabetes mellitus include hypertension, obesity, family history, age of 45 years or older, and a history of gestational diabetes.

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

A. Hypoglycemia Rationale: The therapeutic goal for diabetes management is to achieve normal blood glucose levels (euglycemia) without hypoglycemia while maintaining a high quality of life.

Exercise lowers blood glucose levels. Which of the following are the physiologic reasons that explain this statement. Select all that apply. A. Increases lean muscle mass B. Increases resting metabolic rate as muscle size increases C. Decreases the levels of high-density lipoproteins D. Decreases total cholesterol E. Increases glucose uptake by body muscles

A. Increases lean muscle mass B. Increases resting metabolic rate as muscle size increases D. Decreases total cholesterol E. Increases glucose uptake by body muscles Rationale: All of the options are benefits of exercise except the effect of decreasing the levels of HDL. Exercise increases the levels of HDL.

The caregivers of a child just diagnosed with diabetes express concern that they won't remember the different signs and symptoms of hyperglycemia and hypoglycemia. As a result, they are afraid they won't handle an emergency correctly. What is the best initial response by the nurse to help ensure the child's safety? A. Instruct them to treat the reaction as if it's hypoglycemia, which is more likely. B. Repeat the signs and symptoms over and over until they seem to understand. C. Suggest that the child wear an insulin pump for continuous insulin administration. D. Give the caregivers educational pamphlets and videos about diabetes.

A. Instruct them to treat the reaction as if it's hypoglycemia, which is more likely. Rationale: Hypoglycemia is much more likely to occur than hyperglycemia; if there is any doubt as to whether the child is having a hypoglycemic or hyperglycemic reaction, it should be treated as hypoglycemia. While the pump may offer continuous insulin, it does not sense blood glucose level; insulin reactions can still occur. Careful monitoring of blood glucose is still needed. While repeating signs and symptoms may be helpful, caregivers of a recently diagnosed child have lots of information to absorb and the repetition may create more anxiety. Assuming that the caregivers can read and understand them, written materials and videos may be helpful but they should not take the place of an initial teaching session with a nurse.

A diabetic client using insulin reports weight gain. Which response from the nurse explains the most likely cause of the weight increase? A. Insulin is an anabolic hormone. B. Insulin provides more efficient use of glucose. C. Faulty fat metabolism is shut off. D. Weight gain is attributed to fluid retention.

A. Insulin is an anabolic hormone. Rationale: Insulin is an anabolic hormone that is known to cause weight gain. Insulin does lower blood glucose levels by allowing for active transport of glucose into the cells. Faulty fat and protein metabolism will cease once glucose provides the needed the fuel for energy. The restoration of normal metabolism is not the primary cause for weight gain in a client prescribed insulin. Fluid retention is not indicated in this client.

A young adult client with type 1 diabetes does not want to have to self-administer insulin injections several times a day. Which medication approach would the nurse recommend that best controls the condition and meets the client's needs? A. Insulin pump B. 1 injection per day C. 2 injections premixed D. Injection before each meal

A. Insulin pump Rationale: The insulin pump most closely mimics regular pancreas function and increases meal and exercise flexibility. The use of the pump would meet the client's needs of not wanting to self-administer several injections of insulin every day. With one injection per day, there is difficulty controlling fasting blood glucose if the type of insulin does not last. The client could also develop afternoon hypoglycemia if the single dose is increased in order to control the morning fasting glucose level. Two injections per day might meet the client's needs of minimal self-injections; however, for this regimen, there needs to be a fixed schedule of meals and exercise and it is difficult to adjust the dose if premixed insulin is used. Self-administering insulin before each meal will not meet the client's needs since this requires more injections than any other regimen.

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

A. It carries glucose into body cells. Rationale: Insulin carries glucose into body cells as their preferred source of energy. Besides, it promotes the liver's storage of glucose as glycogen and inhibits the breakdown of glycogen back into glucose. Insulin does not aid in gluconeogenesis but inhibits the breakdown of glycogen back into glucose. Insulin does not have an effect on the intestinal absorption of glucose.

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. A. Leakage of fluid or serum (exudates) B. Microaneurysms C. Focal capillary single closure D. Detachment E. Blurred optic discs

A. Leakage of fluid or serum (exudates) B. Microaneurysms C. Focal capillary single closure Rationale: Almost all patients with type 1 diabetes and the majority of patients with type 2 diabetes have some degree of retinopathy after 20 years (ADA, 2013). Changes in the microvasculature include microaneurysms, intraretinal hemorrhage, hard exudates, and focal capillary closure.

The nurse is educating the patient with diabetes about the importance of increasing dietary fiber. What should the nurse explain is the rationale for the increase? Select all that apply. A. May improve blood glucose levels B. Decrease the need for exogenous insulin C. Help reduce cholesterol levels D. May reduce postprandial glucose levels E. Increase potassium levels

A. May improve blood glucose levels B. Decrease the need for exogenous insulin C. Help reduce cholesterol levels Rationale: Increased fiber in the diet may improve blood glucose levels, decrease the need for exogenous insulin, and lower total cholesterol and low-density lipoprotein levels in the blood (ADA, 2008b; Geil, 2008).

The nurse is preparing to administer intermediate-acting insulin to a patient with diabetes. Which insulin will the nurse administer? A. NPH B. Iletin II C. Lispro (Humalog) D. Glargine (Lantus)

A. NPH Rationale: Intermediate-acting insulins are called NPH insulin (neutral protamine Hagedorn) or Lente insulin. Lispro (Humalog) is rapid acting, Iletin II is short acting, and glargine (Lantus) is very long acting.

A hospitalized, insulin-dependent patient with diabetes has been experiencing morning hyperglycemia. The patient will be awakened once or twice during the night to test blood glucose levels. The health care provider suspects that the cause is related to the Somogyi effect. Which of the following indicators support this diagnosis? Select all that apply. A. Normal bedtime blood glucose B. Rise in blood glucose about 11:00 AM C. Increase in blood glucose from 3:00 AM until breakfast D. Decrease in blood sugar to a hypoglycemic level between 2:00 to 3:00 AM E. Elevated blood glucose at bedtime

A. Normal bedtime blood glucose C. Increase in blood glucose from 3:00 AM until breakfast D. Decrease in blood sugar to a hypoglycemic level between 2:00 to 3:00 AM Rationale: The Somogyi effect is nocturnal hypoglycemia followed by rebound hyperglycemia in the morning.

Which of the following factors should the nurse take into consideration when planning meals and selecting the type and dosage of insulin or oral hypoglycemic agent for an elderly patient with diabetes mellitus? A. Patient's eating and sleeping habits B. Patient's ability to self-administer insulin C. Cognitive problems D. Patient's history

A. Patient's eating and sleeping habits Rationale: The eating and sleeping habits of older adults differ from those of young or middle-aged persons. The nurse should take this into consideration when planning meals and selecting the proper type and dosage of insulin or oral hypoglycemic agent. The nurse should evaluate the patient's ability to self-administer insulin before developing a teaching program. Cognitive problems and patient history may not be taken into consideration when planning meals and selecting the proper type and dosage of insulin or oral hypoglycemic agent.

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 factor as a cause of type 1 diabetes? A. Presence of autoantibodies against islet cells B. Obesity C. Rare ketosis D. Altered glucose metabolism

A. Presence of autoantibodies against islet cells Rationale: There is evidence of an autoimmune response in type 1 diabetes. This is an abnormal response in which antibodies are directed against normal tissues of the body, responding to these tissues as if they were foreign. Autoantibodies against islet cells and against endogenous (internal) insulin have been detected in people at the time of diagnosis and even several years before the development of clinical signs of type 1 diabetes.

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

A. Presence of islet cell antibodies Rationale: Individuals with type 1 diabetes often have islet cell antibodies and are usually thin or demonstrate recent weight loss at the time of diagnosis. These individuals are prone to experiencing ketosis when insulin is absent and require exogenous insulin to preserve life.

Lispro (Humalog) is an example of which type of insulin? A. Rapid-acting B. Intermediate-acting C. Short-acting D. Long-acting

A. Rapid-acting Rationale: Humalog is a rapid-acting insulin. NPH is an intermediate-acting insulin. A short-acting insulin is Humulin-R. An example of a long-acting insulin is Glargine (Lantus)

A nurse educator been invited to local seniors center to discuss health-maintaining strategies for older adults. The nurse addresses the subject of diabetes mellitus, its symptoms, and consequences. What should the educator teach the participants about type 1 diabetes? A. The participants are unlikely to develop a new onset of type 1 diabetes. B. New cases of diabetes are highly uncommon in older adults. C. New cases of diabetes will be split roughly evenly between type 1 and type 2. D. Type 1 diabetes always develops before the age of 20.

A. The participants are unlikely to develop a new onset of type 1 diabetes. Rationale: Type 1 diabetes usually (but not always) develops in people younger than 20. In older adults, an onset of type 2 is far more common. A significant number of older adults develops type 2 diabetes.

A nurse is reviewing information about the various types of insulin that are used to treat type 1 diabetes mellitus. Integrating knowledge about the duration of action, place these types in the order from shortest to longest duration. A. aspart B. NPH C. glargine D. regular

A. aspart D. regular B. NPH C. glargine Rationale: Aspart has a duration of action of 3 to 5 hours; regular insulin has a duration of 5 to 8 hours; NPH has a duration of 10 to 16 hours; and glargine has a duration of 12 to 24 hours.

Which is a characteristic of type 2 diabetes? A. insulin resistance B. presence of islet antibodies C. little or no insulin D. ketosis-prone when insulin absent

A. insulin resistance Rationale: Type 2 diabetes is characterized by either a decrease in endogenous insulin or an increase accompanied by insulin resistance. Type 1 diabetes is characterized by production of little or no insulin; the client with type 1 diabetes is ketosis-prone when insulin is absent and often has islet cell antibodies.

An 8-year-old child is seen for moodiness and irritability. The child has begun to develop breast and pubic hair and the parents are concerned that these changes are occurring at too early an age. Which would the nurse suspect? A. precocious puberty B. pseudopuberty C. adrenal hyperplasia D. neurofibromatosis

A. precocious puberty Rationale: The prognosis for a child with precocious puberty depends on the age at diagnosis and immediate treatment. Appropriate treatment can halt, and sometimes even reverse, sexual development and can stop the rapid growth that results in severe short adult stature caused by premature closure of the epiphysis. Treatment for precocious puberty allows the child to achieve the maximum growth potential possible. Mental development in children with precocious puberty is normal, and developmental milestones are not affected; however, the behavior may change to that of a typical adolescent. Girls may have episodes of moodiness and irritability, whereas boys may become more aggressive.

The nurse is assessing a 5-year-old child whose parent reports the child has been vomiting lately, has no appetite, and has had an extreme thirst. Laboratory work for diabetes is being completed. Which symptom would differentiate between type 1 diabetes from type 2 diabetes? A. recent weight loss B. blood pressure of 142/92 mm Hg C. slow healing wounds D. loose stools

A. recent weight loss Rationale: Weight loss is unique to type 1 diabetes, whereas weight gain is associated with type 2. Hypertension is consistent with type 2 diabetes. Both type 1 and type 2 diabetes cause delayed wound healing. The increase in blood glucose in diabetes causes damage to the inner lining of the arteries that cause the arteries to develop plaque and harden. These damages to the blood vessels result in a decrease in the ability of oxygen-rich blood to be transported effectively to the tissues to promote wound healing. Loose stools or repeated loose stools (diarrhea) is a common side effect of the oral medication metformin, which is prescribed for clients with type 2 diabetes. Insulin, the treatment for type 1 diabetes, has constipation as one of the side effects.

The nurse working with the child diagnosed with type 2 diabetes recognizes the disorder can be managed by: A. taking oral hypoglycemic agents. B. increasing carbohydrates in the diet, especially in the evening. C. conserving energy with rest periods during the day. D. decreasing amounts of daily insulin.

A. taking oral hypoglycemic agents. Rationale: Oral hypoglycemic agents, such as metformin, are often effective for controlling blood glucose levels in children diagnosed with type 2 diabetes. Insulin may be used for a child with type 2 diabetes if oral hypoglycemic agents alone are not effective, but "decreasing" the daily insulin would not help treat this disorder. Lifestyle changes such as increased exercise (not conserving energy by resting during the day), and limiting large amounts of carbohydrates are important aspects of treatment for the child.

A nurse is teaching an adolescent with type 1 diabetes about the disease. Which instruction by the nurse about how to prevent hypoglycemia would be most appropriate for the adolescent? A. "Limit participation in planned exercise activities that involve competition." B. "Carry crackers or fruit to eat before or during periods of increased activity." C. "Increase the insulin dosage before planned or unplanned strenuous exercise." D. "Check your blood glucose level before exercising, and eat a protein snack if the level is elevated."

B. "Carry crackers or fruit to eat before or during periods of increased activity." Rationale: Hypoglycemia can usually be prevented if an adolescent with diabetes eats more food before or during exercise. Because exercise with adolescents isn't commonly planned, carrying additional carbohydrate foods is a good preventive measure.

A child and parents are being seen in the office after discharge from the hospital. The child was newly diagnosed with type 2 diabetes. When talking with the child and parents, which statement by the nurse would be most appropriate? A. "You are lucky that you did not have to learn how to give yourself a shot." B. "Young people can usually be managed with an oral agent, meal planning, and exercise." C. "This will rectify itself if you follow all of the doctor's directions." D. "A weight-loss program should be implemented and maintained."

B. "Young people can usually be managed with an oral agent, meal planning, and exercise." Rationale: Treating type 2 diabetes in children may require insulin at the outset if the child is acidotic and acutely ill. More commonly, the child can be managed initially with oral agents, meal planning, and increasing activity. Telling the child that she is lucky she did not have to learn how to give a shot might scare her, so it will inhibit her from seeking future health care. Additionally, insulin may be used if good control is not achieved. The condition will not rectify itself if all orders are followed. A weight-loss program might need to be implemented but that is not always the case.

An agitated, confused client arrives in the emergency department. The client's history includes type 1 diabetes, hypertension, and angina pectoris. Assessment reveals pallor, diaphoresis, headache, and intense hunger. A stat blood glucose sample measures 42 mg/dl, and the client is treated for an acute hypoglycemic reaction. After recovery, the nurse teaches the client to treat hypoglycemia by ingesting: A. 2 to 5 g of a simple carbohydrate. B. 10 to 15 g of a simple carbohydrate. C. 18 to 20 g of a simple carbohydrate. D. 25 to 30 g of a simple carbohydrate.

B. 10 to 15 g of a simple carbohydrate. Rationale: To reverse hypoglycemia, the American Diabetes Association recommends ingesting 10 to 15 g of a simple carbohydrate, such as three to five pieces of hard candy, two to three packets of sugar (4 to 6 tsp), or 4 oz of fruit juice. Then the client should check his blood glucose after 15 minutes. If necessary, this treatment may be repeated in 15 minutes. Ingesting only 2 to 5 g of a simple carbohydrate may not raise the blood glucose level sufficiently. Ingesting more than 15 g may raise it above normal, causing hyperglycemia.

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: A. 10 g of carbohydrates. B. 15 g of carbohydrates. C. 20 g of carbohydrates. D. 25 g of carbohydrates.

B. 15 g of carbohydrates. Rationale: The nurse should instruct the client to administer 1 unit of insulin for every 15 g of carbohydrates.

Glycosylated hemoglobin reflects blood glucose concentrations over which period of time? A. 1 month B. 3 months C. 6 months D. 9 months

B. 3 months Rationale: Glycosylated hemoglobin is a blood test that reflects average blood glucose concentrations over a period of 3 months.

Which statement is true regarding gestational diabetes? A. Onset usually occurs in the first trimester. B. A glucose challenge test should be performed between 24 and 28 weeks. C. There is a low risk for perinatal complications. D. It occurs in most pregnancies.

B. A glucose challenge test should be performed between 24 and 28 weeks. Rationale: A glucose challenge test should be performed between 24 and 28 weeks in women at average risk. It occurs in less than 10% of all pregnancies. Onset usually occurs in the second or third trimester. There is an above-normal risk for perinatal complications.

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? A. Duration of the insulin B. Accuracy of the dosage C. Area for insulin injection D. Technique for injecting

B. Accuracy of the dosage Rationale: The measurement of insulin is most important and must be accurate because clients may be sensitive to minute dose changes. The duration, area, and technique for injecting should also to be noted.

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? A. Epinephrine B. Glucagon C. 50% dextrose D. Hydrocortisone

B. Glucagon Rationale: During a hypoglycemic reaction, a layperson may administer glucagon, an antihypoglycemic agent, to raise the blood glucose level quickly in a client who can't ingest an oral carbohydrate. Epinephrine isn't a treatment for hypoglycemia. Although 50% dextrose is used to treat hypoglycemia, it must be administered I.V. by a skilled health care professional. Hydrocortisone takes a relatively long time to raise the blood glucose level and therefore isn't effective in reversing hypoglycemia.

The nurse is teaching an 11-year-old boy and his family how to manage his diabetes. Which instruction does not focus on glucose management? A. Teaching that 50% of daily calories should be carbohydrates. B. Instructing the child to rotate injection sites. C. Encouraging the child to maintain the proper injection schedule. D. Promoting higher levels of exercise than previously maintained.

B. Instructing the child to rotate injection sites. Rationale: Instructing the child to rotate injection sites to decrease scar formation is important, but does not focus on managing glucose levels. Teaching the child and family to eat a balanced diet, encouraging the child to maintain the proper injection schedule, and promoting a higher level of exercise all focus on regulating glucose control.

Which term refers to the progressive increase in blood glucose from bedtime to morning? A. Somogyi effect B. Insulin waning C. Dawn phenomenon D. Diabetic ketoacidosis (DKA)

B. Insulin waning Rationale: Insulin waning is a progressive rise in blood glucose from bedtime to morning. The dawn phenomenon occurs when blood glucose is relatively normal until about 3 a.m., when the level begins to rise. The Somogyi effect occurs when blood glucose is normal or elevated at bedtime, decreases at 2 to 3 a.m. to hypoglycemia levels, and subsequently increases as a result of the production of counter-regulatory hormones. DKA is caused by an absence or markedly inadequate amount of insulin. This insulin deficit results in disorders in the metabolism of carbohydrates, proteins, and fats. The primary clinical features of DKA are hyperglycemia, ketosis, dehydration, electrolyte loss, and acidosis.

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

B. It cannot be mixed with any other type of insulin. Rationale: Because this insulin is in a suspension with a pH of 4, it cannot be mixed with other insulins because this would cause precipitation. There is no peak in action. It is approved to give once daily.

A client newly diagnosed with type 1 diabetes asks the nurse why injection site rotation is important. What is the nurse's best response? A. Avoid infection. B. Promote absorption. C. Minimize discomfort. D. Prevent muscle destruction.

B. Promote absorption. Rationale: Subcutaneous injection sites require rotation to avoid breakdown and/or buildup of subcutaneous fat, either of which can interfere with insulin absorption in the tissue. Infection and discomfort are risks involved with injection site but not the primary reason for rotation of sites. Insulin is not injected into the muscle.

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

B. Urinary tract infections Rationale: Elevated levels of blood glucose and glycosuria supports bacterial growth and places the diabetic at greater risk for urinary tract, skin, and vaginal infections. Obesity, elevated triglycerides, and high blood pressure are considered symptoms of metabolic syndrome, which can result in type 2 diabetes mellitus.

A nurse should recognize that which laboratory result would be most consistent with a diagnosis of diabetes mellitus? A. proteinuria B. a fasting blood glucose less than 126 mg/dl C. a fasting blood glucose greater than 126 mg/dl D. glucose in the urine

B. a fasting blood glucose less than 126 mg/dl Rationale: A fasting blood glucose greater than 126 mg/dl is diagnostic for diabetes mellitus.

During a class on exercise for clients with diabetes mellitus, a client asks the nurse educator how often to exercise. To meet the goals of planned exercise, the nurse educator should advise the client to exercise: A. at least once per week. B. at least three times per week. C. at least five times per week. D. every day.

B. at least three times per week. Rationale: Clients with diabetes must exercise at least three times per week to meet the goals of planned exercise — lowering the blood glucose level, reducing or maintaining the proper weight, increasing the serum high-density lipoprotein level, decreasing serum triglyceride levels, reducing blood pressure, and minimizing stress. Exercising once per week wouldn't achieve these goals. Exercising more than three times per week, although beneficial, would exceed the minimum requirement.

The nurse is teaching a child with type 1 diabetes mellitus to administer insulin. The child is receiving a combination of short-acting and long-acting insulin. The nurse knows that the child has appropriately learned the technique when the child: A. administers the insulin into a doll at a 30-degree angle. B. draws up the short-acting insulin into the syringe first. C. wipes off the needle with an alcohol swab. D. administers the insulin intramuscularly into rotating sites.

B. draws up the short-acting insulin into the syringe first. Rationale: Drawing up the short-acting insulin first prevents mixing a long-acting form into the vial of short-acting insulin. This maintains the short-acting insulin for an emergency. Insulin is given subcutaneously not intramuscularly. A SQ injection is administered at a 90-degree angle if the person can grasp 2 in (5 cm) of skin. If only 1 in (2.5 cm) of skin can be grasped, then the injection should be given at a 45 degree angle. The needle is sterile. It should not be wiped with an alcohol swab. Only the top of the insulin vial should be wiped with an alcohol swab.

The nurse measures the client's blood glucose level prior to breakfast. The measurement obtained is 130 mg/dl. The orders read to administer 2 units of Humalog insulin for a blood glucose of 100 to 150 mg/dl. How soon should the nurse ensure that the client eats breakfast after receiving insulin? A. within 5 minutes B. within 15 to 30 minutes C. within 60 to 90 minutes D. within 2 hours

B. within 15 to 30 minutes Rationale: Humalog is a rapid-acting insulin. The onset of Humalog insulin is within 15 minutes and the peak level is achieved within 30 to 90 minutes; therefore, the client should eat within 15 to 30 minutes to avoid a hypoglycemic reaction.

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

C. "Test your blood glucose every 4 hours." Rationale: The nurse should instruct a client with diabetes mellitus to check his blood glucose levels every 3 to 4 hours and take insulin or an oral antidiabetic agent as usual, even when he's sick. If the client's blood glucose level rises above 300 mg/dl, he should call his physician immediately. If the client is unable to follow the regular meal plan because of nausea, he should substitute soft foods, such as gelatin, soup, and custard.

Health teaching for a patient with diabetes who is prescribed Humulin N, an intermediate NPH insulin, would include which of the following advice? A. "Your insulin will begin to act in 15 minutes." B. "You should expect your insulin to reach its peak effectiveness by 12 noon if you take it at 8:00 AM." C. "You should take your insulin after you eat breakfast and dinner." D. "Your insulin will last 8 hours, and you will need to take it three times a day."

C. "You should take your insulin after you eat breakfast and dinner." Rationale: NPH (Humulin N) insulin is an intermediate-acting insulin that has an onset of 2 to 4 hours, a peak effectiveness of 6 to 8 hours, and a duration of 12 to 16 hours. See Table 30-3 in the text.

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

C. "Your body is using protein and fat for energy instead of glucose." Rationale: Persons with type 1 diabetes, particularly those in poor control of the condition, tend to be thin because when the body cannot effectively utilize glucose for energy (no insulin supply), it begins to break down protein and fat as an alternate energy source. Patients may be underweight at the onset of type 1 diabetes because of rapid weight loss from severe hyperglycemia. The goal initially may be to provide a higher-calorie diet to regain lost weight and blood glucose control.

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: A. I.M. or subcutaneous glucagon. B. I.V. bolus of dextrose 50%. C. 15 to 20 g of a fast-acting carbohydrate such as orange juice. D. 10 units of fast-acting insulin.

C. 15 to 20 g of a fast-acting carbohydrate such as orange juice. Rationale: This client is experiencing hypoglycemia. Because the client is conscious, the nurse should first administer a fast-acting carbohydrate, such as orange juice, hard candy, or honey. If the client has lost consciousness, the nurse should administer I.M. or subcutaneous glucagon or an I.V. bolus of dextrose 50%. The nurse shouldn't administer insulin to a client who's hypoglycemic; this action will further compromise the client's condition.

A client with type 1 diabetes is to receive a short-acting insulin and an intermediate-acting insulin subcutaneously before breakfast. The nurse would administer the insulin at which site as the preferred site? A. Arms B. Thighs C. Abdomen D. Upper buttock

C. Abdomen Rationale: Although the arms, thighs, and lower back can be used, the preferred site insulin administration is the abdomen which allows more rapid absorption.

A client with long-standing type 1 diabetes is admitted to the hospital with unstable angina pectoris. After the client's condition stabilizes, the nurse evaluates the diabetes management regimen. The nurse learns that the client sees the physician every 4 weeks, injects insulin after breakfast and dinner, and measures blood glucose before breakfast and at bedtime. Consequently, the nurse should formulate a nursing diagnosis of: A. Impaired adjustment. B. Defensive coping. C. Deficient knowledge (treatment regimen). D. Health-seeking behaviors (diabetes control).

C. Deficient knowledge (treatment regimen). Rationale: The client should inject insulin before, not after, breakfast and dinner — 30 minutes before breakfast for the a.m. dose and 30 minutes before dinner for the p.m. dose. Therefore, the client has a knowledge deficit regarding when to administer insulin. By taking insulin, measuring blood glucose levels, and seeing the physician regularly, the client has demonstrated the ability and willingness to modify his lifestyle as needed to manage the disease. This behavior eliminates the nursing diagnoses of Impaired adjustment and Defensive coping. Because the nurse, not the client, questioned the client's health practices related to diabetes management, the nursing diagnosis of Health-seeking behaviors isn't warranted.

The nurse is caring for a client receiving insulin isophane suspension (NPH) at breakfast. What is an important dietary consideration for the nurse to keep in mind? A. Make sure breakfast is not delayed. B. Provide fewest amount of carbohydrates at lunch meal. C. Encourage midday snack. D. Delay dinner meal.

C. Encourage midday snack. Rationale: Because NPH is an intermediate-acting insulin that peaks in approximately 4 to 10 hours, a midday snack should be included in daily calorie intake to avoid hypoglycemia. NPH insulin has no immediate effects. Carbohydrates are distributed throughout the meal plan of diabetics to avoid highs and lows. Delaying dinner meal is not indicated with NPH insulin use.

The nurse is taking the history of a client with diabetes who is experiencing autonomic neuropathy. Which would the nurse expect the client to report? A. Skeletal deformities B. Paresthesias C. Erectile dysfunction D. Soft tissue ulceration

C. Erectile dysfunction Rationale: Autonomic neuropathy affects organ functioning. According the American Diabetes Association, up to 50% of men with diabetes develop erectile dysfunction when nerves that promote erection become impaired. Skeletal deformities and soft tissue ulcers may occur with motor neuropathy. Paresthesias are associated with sensory neuropathy.

During a follow-up visit 3 months after a new diagnosis of type 2 diabetes, a client reports exercising and following a reduced-calorie diet. Assessment reveals that the client has only lost 1 pound and did not bring the glucose-monitoring record. Which value should the nurse measure? A. Fasting blood glucose level B. Glucose via a urine dipstick test C. Glycosylated hemoglobin level D. Glucose via an oral glucose tolerance test

C. Glycosylated hemoglobin level Rationale: Glycosylated hemoglobin is a blood test that reflects the average blood glucose concentration over a period of approximately 2 to 3 months. When blood glucose is elevated, glucose molecules attach to hemoglobin in red blood cells. The longer the amount of glucose in the blood remains above normal, the more glucose binds to hemoglobin and the higher the glycosylated hemoglobin level becomes.

A patient is prescribed Glucophage, an oral antidiabetic agent classified as a biguanide. The nurse knows that a primary action of this drug is its ability to: A. Stimulate the beta cells of the pancreas to secrete insulin. B. Decrease the body's sensitivity to insulin. C. Inhibit the production of glucose by the liver. D. Increase the absorption of carbohydrates in the intestines.

C. Inhibit the production of glucose by the liver. Rationale: The action of the biguanides can be found in Table 30-6 in the text.

NPH is an example of which type of insulin? A. Rapid-acting B. Short-acting C. Intermediate-acting D. Long-acting

C. Intermediate-acting Rationale: NPH is an intermediate-acting insulin.

Rank the different types of insulin based on their duration of action beginning with the shortest to the longest duration. A. Humulin N B. Humulin R C. Lispro D. Lantus

C. Lispro B. Humulin R A. Humulin N D. Lantus Rationale: Lispro is a rapid-acting insulin. Humulin R is a short-acting insulin. Humulin N is an intermediate-acting insulin. Lantus is a long-acting insulin.

Which type of insulin acts most quickly? A. Regular B. NPH C. Lispro D. Glargine

C. Lispro Rationale: The onset of action of rapid-acting lispro is within 10 to 15 minutes. The onset of action of short-acting regular insulin is 30 minutes to 1 hour. The onset of action of intermediate-acting NPH insulin is 3 to 4 hours. The onset of action of very long-acting glargine is ~6 hours.

A group of students are reviewing the various types of drugs that are used to treat diabetes mellitus. The students demonstrate understanding of the material when they identify which of the following as an example of an alpha-glucosidase inhibitor? A. Metformin B. Glyburide C. Miglitol D. Rosiglitazone

C. Miglitol Rationale: Alpha-glucosidase inhibitors include drugs such as miglitol and acarbose. Metformin is a biguanide. Glyburide is a sulfonylurea. Rosiglitazone is a thiazolidinedione.

The nurse suspects that a patient with diabetes has developed proliferative retinopathy. The nurse confirms this by the presence of which of the following diagnostic signs? A. Decreased capillary permeability B. Microaneurysm formation C. Neovascularization into the vitreous humor D. The leakage of capillary wall fragments into surrounding areas

C. Neovascularization into the vitreous humor Rationale: Proliferative retinopathy, an ocular complication of diabetes, occurs because of the abnormal growth of new blood vessels on the retina that bleed into the vitreous and block light. Blood vessels in the vitreous form scar tissue that can pull and detach the retina. Neovascularization into the vitreous humor is considered a diagnostic sign.

The nurse is interviewing the caregivers of a child admitted with a diagnosis of type 1 diabetes mellitus. The caregiver states, "She is hungry all the time and eats everything, but she is losing weight." The caregiver's statement indicates the child most likely has: A. Polyuria B. Pica C. Polyphagia D. Polydipsia

C. Polyphagia Rationale: Symptoms of type 1 diabetes mellitus include polyphagia (increased hunger and food consumption), polyuria (dramatic increase in urinary output, probably with enuresis) and polydipsia (increased thirst). Pica is eating nonfood substances.

The client with diabetes asks the nurse why shoes and socks are removed at each office visit. The nurse gives which assessment finding as the explanation for the inspection of feet? A. Autonomic neuropathy B. Retinopathy C. Sensory neuropathy D. Nephropathy

C. Sensory neuropathy Rationale: Neuropathy results from poor glucose control and decreased circulation to nerve tissues. Neuropathy involving sensory nerves located in the periphery can lead to lack of sensitivity, which increases the potential for soft tissue injury without client awareness. The client's feet are inspected on each visit to ensure no injury or pressure has occurred. Autonomic neuropathy, retinopathy, and nephropathy affect nerves to organs other than feet.

Laboratory studies indicate a client's blood glucose level is 185 mg/dl. Two hours have passed since the client ate breakfast. Which test would yield the most conclusive diagnostic information about the client's glucose use? A. Fasting blood glucose test B. 6-hour glucose tolerance test C. Serum glycosylated hemoglobin (Hb A1c) D. Urine ketones

C. Serum glycosylated hemoglobin (Hb A1c) Rationale: Hb A1c is the most reliable indicator of glucose use because it reflects blood glucose levels for the prior 3 months. Although a fasting blood glucose test and a 6-hour glucose tolerance test yield information about a client's use of glucose, the results are influenced by such factors as whether the client recently ate breakfast. Presence of ketones in the urine also provides information about glucose use but is limited in its diagnostic significance.

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: A. Transport of potassium. B. Release of glucose. C. Synthesis of glucose from noncarbohydrate sources. D. Storage of glucose as glycogen in the liver.

C. Synthesis of glucose from noncarbohydrate sources. Rationale: Gluconeogenesis refers to the making of glucose from noncarbohydrates. This occurs mainly in the liver. Its purpose is to maintain the glucose level in the blood to meet the body's demands.

A child presents to the primary care setting with enuresis, nocturia, increased hunger, weight loss, and increased thirst. What does the nurse suspect? A. Syndrome of inappropriate diuretic hormone B. Diabetes insipidus C. Type 1 diabetes mellitus D. Hypothyroidism

C. Type 1 diabetes mellitus Rationale: Signs and symptoms of type 1 diabetes mellitus include polyuria, polydipsia, polyphagia, enuresis, and weight loss.

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? A. Increased risk for urologic complications B. Need for exocrine enzymatic drainage C. Underlying problem of insulin resistance D. Need for lifelong immunosuppressive therapy

C. Underlying problem of insulin resistance Rationale: Clients with type 2 diabetes are not offered the option of a pancreas transplant because their problem is insulin resistance, which does not improve with a transplant. Urologic complications or the need for exocrine enzymatic drainage are not reasons for not offering pancreas transplant to clients with type 2 diabetes. Any transplant requires lifelong immunosuppressive drug therapy and is not the factor.

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

C. When mixing insulin, the regular insulin is drawn up into the syringe first. Rationale: When rapid-acting or short-acting insulins are to be given simultaneously with longer-acting insulins, they are usually mixed together in the same syringe; the longer-acting insulins must be mixed thoroughly before being drawn into the syringe. The American Diabetic Association recommends that the regular insulin be drawn up first. The most important issues are that patients (1) are consistent in technique, so the wrong dose is not drawn in error or the wrong type of insulin, and (2) do not inject one type of insulin into the bottle containing a different type of insulin. Injecting cloudy insulin into a vial of clear insulin contaminates the entire vial of clear insulin and alters its action.

The nurse is interpreting the negative feedback system that controls endocrine function. What secretion will the nurse correlate as decreasing while blood glucose levels decrease? A. glucagon B. adrenocorticotropic hormone C. insulin D. glycogen

C. insulin Rationale: Feedback is seen in endocrine systems that regulate concentrations of blood components such as glucose. Glucose from the ingested lactose or sucrose is absorbed in the intestine and the level of glucose in blood rises. Elevation of blood glucose concentration stimulates endocrine cells in the pancreas to release insulin. Insulin has the major effect of facilitating entry of glucose into many cells of the body; as a result, blood glucose levels fall. When the level of blood glucose falls sufficiently, the stimulus for insulin release disappears and insulin is no longer secreted. Glycogen is stored in the liver and muscles. It is released to provide energy when the blood glucose levels fall. Glucagon is also produced by the pancreas. Its job is to force the liver to release stored insulin when the body has a need for more insulin. The adrenocorticotropic hormone is produced by the anterior pituitary. Its function is to regulate cortisol. This is needed so the adrenal glands can function properly. It also helps the body respond to stress.

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

C. providing client education at every opportunity. Rationale: The nurse should use routine care responsibilities as teaching opportunities with the intention of preparing the client to understand and eventually manage his disease. Monitoring blood glucose, checking for the presence of ketones, and administering insulin are important when caring for a client with diabetes, but they aren't the priority of care.

A nurse is developing a teaching plan for a client with diabetes mellitus. A client with diabetes mellitus should: A. use commercial preparations to remove corns. B. cut the toenails by rounding edges. C. wash and inspect the feet daily. D. walk barefoot at least once each day.

C. wash and inspect the feet daily. Rationale: A client with diabetes mellitus should wash and inspect his feet daily and should wear nonconstrictive shoes. Corns should be treated by a podiatrist — not with commercial preparations. Nails should be filed straight across. Clients with diabetes mellitus should never walk barefoot.

A nurse who is caring for a 7-year-old is providing client education to the child and caregiver. Which response by the caregiver demonstrates to the nurse that the caregiver understands the diagnosis of type 1 diabetes mellitus? A. "We will just have our child exercise and take medicine to cure this." B. "I will just feed my child healthy foods and sign her up for more sports." C. "Her body fights against the insulin." D. "Her body doesn't have any insulin."

D. "Her body doesn't have any insulin." Rationale: Type 1 diabetes mellitus (DM) is a disorder in which the child's body has a deficiency of insulin; children with type 1 DM cannot produce insulin. Type 2 DM is controlled through diet, medicine, and exercise. Type 2 DM can be prevented through diet and exercise, but type 1 DM cannot. Resistance to insulin is not the primary factor in type 1 DM.

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

D. "I skip lunch when I don't feel hungry." Rationale: The client requires further teaching if he states that he skips meals. A client who is receiving an oral antidiabetic agent should eat meals on a regular schedule because skipping a meal increases the risk of hypoglycemia. Carrying hard candy, avoiding exposure to the sun, and always wearing a medical identification bracelet indicate effective teaching.

Which statement best indicates that a client understands how to administer his own insulin injections? A. "I need to be sure no air bubbles remain." B. "I need to wash my hands before I give myself my injection." C. "If I'm not feeling well, I can get a friend or neighbor to help me." D. "I wrote down the steps in case I forget what to do."

D. "I wrote down the steps in case I forget what to do." Rationale: The fact that the client has written down each step of insulin administration provides the best assurance that he'll follow through with all the proper steps. Awareness of air bubbles and hand washing indicate that the client understands certain aspects of giving an injection, but doesn't confirm he understands all of the steps. Saying that he can ask a friend or neighbor for help indicates a need for further instruction.

The nurse is educating the parents of a client newly diagnosed with type 1 diabetes. Which statement by the parents indicates additional teaching is needed? A. "When our child is sick, we may need to check glucose levels more frequently." B. "Our child should eat three meals and midafternoon and bedtime snacks each day." C. "We and our child need to learn to identify carbohydrate, protein, and fat foods." D. "Our child should not participate in sports or physical activity."

D. "Our child should not participate in sports or physical activity." Rationale: The nurse would provide additional education if the parents state the child should not participate in sports or physical activity. The child with diabetes can, and should, be physically active to maintain proper health and facilitate efficient insulin usage by the body. Glucose levels should be checked more frequently during times of sickness, as well as assessing the urine for ketones. Consistency of intake can help prevent complications and maintain near-normal blood glucose levels. The parents and child should know how to identify foods to adequately monitor the child's nutritional intake. A dietitian with expertise in diabetes education should be consulted for referral as needed.

The nurse is talking with a parent of an adolescent who is newly diagnosed with type 2 diabetes and asks, "How could this happen? No one in our family has diabetes." What response would be appropriate? A. "This is caused by the pancreas not making enough insulin." B. "This disorder usually occurs when inadequate calories are ingested on a regular basis." C. "Because this disorder is genetic, someone in the family will eventually develop the illness." D. "This is caused by insulin resistance from previous pancreatic injury or generalized infection."

D. "This is caused by insulin resistance from previous pancreatic injury or generalized infection." Rationale: Type 2 diabetes is now seen in overweight adolescents as well as those who eat a diet high in fats and carbohydrates and do not exercise regularly. Pancreatic malfunction is not a cause of type 2 diabetes. This disorder is not linked to inadequate ingestion of daily calories. This disorder may have a genetic link, but environmental factors such as obesity, diet, and exercise can influence its development. Type 2 diabetes is a result of insulin resistance in the metabolism of glucose to maintain normal blood glucose levels, but it is not associated with infection or a previous pancreatic injury.

The nurse has told the 14-year-old adolescent with diabetes that the doctor would like to have a hemoglobin A1C test performed. Which comment by the client indicates that she understands what this test is for? A. "That is the test that I take after I have fasted for at least 8 hours." B. "The normal level for my hemoglobin A1C is between 60 to 100 mg/dl." C. "I monitor my own blood glucose every day at home. I don't see why the doctor would want this done." D. "This will tell my doctor what my average blood glucose level has been over the last 2 to 3 months."

D. "This will tell my doctor what my average blood glucose level has been over the last 2 to 3 months." Rationale: Hemoglobin A1C (HgbA1C) provides the physician or nurse practitioner with information regarding the long-term control of glucose levels, as it provides an average of what the blood glucose levels are over a 2 to 3 month period. No fasting is required. Desired levels for children and adolescents 13 to 19 years are less than 7.5%.

A nurse knows to assess a patient with type 1 diabetes for postprandial hyperglycemia. The nurse knows that glycosuria is present when the serum glucose level exceeds: A. 120 mg/dL B. 140 mg/dL C. 160 mg/dL D. 180 mg/dL

D. 180 mg/dL Rationale: Glycosuria occurs when the renal threshold for sugar exceeds 180 mg/dL. Glycosuria leads to an excessive loss of water and electrolytes (osmotic diuresis).

The nurse is preparing an educational session about foot care for clients with diabetes. Which information will the nurse include in the education? Select all that apply. A. Wear binding compression socks daily. B. Shave any calluses with a disposable razor. C. Apply lotion between the toes after bathing. D. Check the inside of shoes before putting them on. E. Check the bottom of the feet with a mirror every day.

D. Check the inside of shoes before putting them on. E. Check the bottom of the feet with a mirror every day. Rationale: The client with diabetes needs to be instructed on foot care in order to prevent the development of wounds. Information about foot care includes checking the inside of shoes before putting them on to ensure that there is nothing inside the shoe. The bottom of the feet should be checked every day and a mirror helps to visualize the bottom of the feet. The client should never go barefoot. Wearing binding compression socks would constrict the feet. The client with diabetes should wear well-fitted shoes. Calluses are not to be shaved as this could cause a wound. A podiatrist should be consulted for any calluses on the feet. Lotion is not to be applied between the toes after bathing since it can promote fungal growth due to moisture.

A client is diagnosed with diabetes mellitus. Which assessment finding best supports a nursing diagnosis of Ineffective coping related to diabetes mellitus? A. Recent weight gain of 20 lb (9.1 kg) B. Failure to monitor blood glucose levels C. Skipping insulin doses during illness D. Crying whenever diabetes is mentioned

D. Crying whenever diabetes is mentioned Rationale: A client who cries whenever diabetes is mentioned is demonstrating ineffective coping. A recent weight gain and failure to monitor blood glucose levels would support a nursing diagnosis of Noncompliance: Failure to adhere to therapeutic regimen. Skipping insulin doses during illness would support a nursing diagnosis of Deficient knowledge related to treatment of diabetes mellitus.

A nurse is reviewing with an 8-year-old how to self-administer insulin. Which of the following is the proper injection technique for insulin injections? A. Place the needle with the bevel facing down before the injection. B. Spread the skin before the injection. C. Aspirate the syringe for blood return before the injection. D. Elevate the subcutaneous tissue before the injection.

D. Elevate the subcutaneous tissue before the injection. Rationale: Insulin injections are always given subcutaneously. Elevating the skin tissue prevents injection into muscles when subcutaneous injections are given. The needle bevel should face upward. The skin is spread in intramuscular, not subcutaneous, injections. It is no longer recommended to aspirate blood for subcutaneous injections.

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? A. Making sure that the patient is aware that quantity of foods will be limited B. Ensuring that the patient understands that some favorite foods may not be allowed on the meal plan and substitutes will need to be found C. Determining whether the patient is on insulin or taking oral antidiabetic medication D. Reviewing the patient's diet history to identify eating habits and lifestyle and cultural eating patterns

D. Reviewing the patient's diet history to identify eating habits and lifestyle and cultural eating patterns Rationale: The first step in preparing a meal plan is a thorough review of the patient's diet history to identify eating habits and lifestyle and cultural eating patterns.

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? A. Between 8:00 and 10:00 a.m. B. Between 4:00 and 6:00 p.m. C. Between 7:00 and 9:00 p.m. D. This insulin has no peak action and does not cause a hypoglycemic reaction.

D. This insulin has no peak action and does not cause a hypoglycemic reaction. Rationale: "Peakless" basal or very long-acting insulins are approved by the U.S. Food and Drug Administration for use as a basal insulin; that is, the insulin is absorbed very slowly over 24 hours and can be given once a day. It has is no peak action.

An elementary school child takes metformin three times each day. Which disorder would the school nurse expect the child to have? A. Type 1 diabetes mellitus B. Gastrointestinal reflux C. Inflammatory bowel disorder D. Type 2 diabetes mellitus

D. Type 2 diabetes mellitus Rationale: Metformin is the common treatment to manage type 2 DM. Insulin, not oral medication, is the treatment of choice for type 1 DM. Metoclopramide is the treatment for GI reflux. Methylprednisolone is used to treat inflammatory bowel disease.

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

D. Use all available injection sites within one area. Rationale: Systematic rotation of injection sites within an anatomic area is recommended to prevent localized changes in fatty tissue. To promote consistency in insulin absorption, the client should be encouraged to use all available injection sites within one area rather than randomly rotating sites from area to area.

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: A. urine glucose level. B. fasting blood glucose level. C. serum fructosamine level. D. glycosylated hemoglobin level.

D. glycosylated hemoglobin level. Rationale: Because some of the glucose in the bloodstream attaches to some of the hemoglobin and stays attached during the 120-day life span of red blood cells, glycosylated hemoglobin levels provide information about blood glucose levels during the previous 3 months. Fasting blood glucose and urine glucose levels give information only about glucose levels at the point in time when they were obtained. Serum fructosamine levels provide information about blood glucose control over the past 2 to 3 weeks.

A nurse is assigned to care for a postoperative client with diabetes mellitus. During the assessment interview, the client reports that he's impotent and says he's concerned about the effect on his marriage. In planning this client's care, the most appropriate intervention would be to: A. encourage the client to ask questions about personal sexuality. B. provide time for privacy. C. provide support for the spouse or significant other. D. suggest referral to a sex counselor or other appropriate professional.

D. suggest referral to a sex counselor or other appropriate professional. Rationale: The nurse should refer this client to a sex counselor or other professional. Making appropriate referrals is a valid part of planning the client's care. The nurse doesn't normally provide sex counseling.