Diabetes type 1 and 2

A client in the hospital voices concern that the blood glucose monitor may not be working because the blood glucose was 295. After reviewing the medications, the nurse explains which of the following would cause elevated blood glucose? a. quinidine b. prednisone c. atenolol d. sulfamethoxazole-trimethoprim

b. prednisone Prednisone is a glucocorticoid medication used to decrease inflammation. Prednisone has a common side effect of hyperglycemia, especially in diabetic clients.

A nurse is providing instruction with client demonstration on self-administration of insulin. Which of the following Teach Back actions will the nurse observe by the client? Select all that apply. a. pt takes vial and gently shakes rotates it and states "I will ensure the insulin vial is never shaken" b. pt describes where insulin will be stored, "I will never freeze insulin" c. pt looks at the hospital menu then states, " i can give myself more insulin, then eat anything I want" d. pt performs mock injection site selection and states, "I will rotate sites" e. pt states, "on days I am sick and cannot eat or am vomiting, I will skip my insulin so my blood sugar will not get too low"

a, b, c

A client with Type 2 diabetes asks the nurse why insulin injections are necessary after surgery since only oral hypoglycemics are taken while at home. Which statement by the nurse best explains the likely cause for this short-term change in treatment? a. "surgical procedures may alter normal glucose because of stress on the body" b. "once insulin injections occur they might need to continue while at home" c. "insulin must be given because the infusion solutions are heavily concentrated with sugars" d. "it is easier for the staff to manage blood sugars if insulin protocol is followed"

a. "surgical procedures may alter normal glucose because of stress on the body" rationale: A client with Type 2 diabetes who does not normally need insulin injections may need insulin short-term during hospitalization or surgical procedures. The nurse should educate the client about the need for short-term insulin related to the effects of stress on the body altering blood glucose.

The nurse is assessing a diabetic client with frequent exacerbations of chronic obstructive pulmonary disease (COPD) who has been taking prednisone for 6 months. Which of the following indicate an adverse effect of taking prednisone? a. increased blood glucose b. photosensivity c. hair loss d.low blood pressure

a. increased blood glucose rationale: Corticosteroids such as prednisone are used in treatment of acute exacerbations of COPD. Corticosteroids, such as prednisone, elevate blood glucose, especially in the diabetic client.

The nurse is providing diabetic education on Type I diabetes to a newly diagnosed 13-year-old. Which non-pharmacological instruction will most benefit health promotion while living with Type I diabetes? a. perform routine physical exercise b. do not take insulin while ill c. 50% of daily intake should be from protein d. oral hypoglycemic medications may be given in-between insulin

a. perform routine physical exercise rationale: One of the most beneficial non-pharmacological teachings for a teen newly diagnosed with Type I diabetes is encouragement to perform physical exercise.

The nurse instructs a client with Type 2 diabetes on which of the adverse interactions between metformin and cimetidine? a. will result in increased metformin levels and risk of hypoglycemia b. result in decreased levels of metformin and risk of hyperglycemia c. result in lowered ldl d. result in higher levels of ldl

a. will result in increased metformin levels and risk of hypoglycemia rationale: if given with the over-the-counter H2 antagonist, cimetidine, blood levels of metformin can increase, causing a risk of hypoglycemia. Clients should be taught to avoid combining these two medications due to this risk. Other over-the-counter medications for gastroesophageal reflux disease, such as proton pump inhibitors, could be considered since those medications are effective against the gastrointestinal symptoms associated with metformin.

The nurse is alerted that dietary trays are going to be late to client rooms and will arrive at 0800 instead of 0730. The nurse plans to administer insulin aspart at 0800. What time should the nurse provide the morning meal? a. 0750 b 0805 c. 0830 d. 0840

b. 0805 rationale: insulin aspart is an insulin with onset of action of 5 to 15 minutes. meals should be given within 5 minutes so the client will not experience hypoglycemia. Essentially, the meal should be sitting in front of the client when the nurse administers the insulin aspart to assure availability of food. Otherwise, the nurse should provide a snack if the meal is delayed to make sure the client does not experience hypoglycemia.

A nurse is teaching a Type 2 diabetic client about the prescribed once daily detemir insulin injection. Which is the best time of day for the client to take the Levemir insulin? a. midday prior to lunch b. morning with breakfast c. evening or bedtime d. three hours after midday meal

b. morning or bedtime rationale: Detemir insulin is a long-acting insulin that is given once a day or twice a day to treat diabetes mellitus. Once daily detemir insulin injection should be given in the evening or bedtime.

A nurse works in a walk-in clinic. What client is at a greater risk for the development of Type 2 diabetes? Select all that apply. a. client with low blood pressure and heart rate b. native Hawaiian client with family history of diabetes c. client with polycystic ovary syndrome d. client with body mass index of 22 e. client with a high HDL level

b. native Hawaiian client with family history of diabetes c. client with polycystic ovary syndrome rationale: Type 2 diabetes has an ethnic, genetic, familial component, making certain groups more susceptible. Native Hawaiians, clients with polycystic ovary syndrome (PCOS), and clients with a family history are at high risk of developing diabetes.

A client with diabetes informs the nurse of prickling, tingling, and burning sensations to lower extremities at night. The nurse expects to develop a plan of care with a focus on which medical condition? a. albuminuria b. peripheral neuropathy c. raynaud's disease d. hypernatremia

b. peripheral neuropathy rationale: diabetic peripheral neuropathy is a condition in diabetics that causes prickling, tingling, and burning sensations to peripheral extremities. Diabetic peripheral neuropathy is damage that occurs to nerves caused by long-term high blood sugar. * Acute sensory and chronic sensorimotor neuropathies are the most common and prone to night time exacerbation. * Peripheral neuropathy causes the client to be more susceptible to injury since feeling in the extremities (particularly the feet and lower legs) is diminished to completely numb. * Clients can step on nails and never feel it or know it except there is blood coming from their feet. Unfortunately, this can lead to serious infection and amputation.

A client with type 1 diabetes mellitus received an early AM dose of regular insulin per sliding scale. The client ate 20% of breakfast. The nurse returns at 1000 to assess the client. Which sign will the nurse observe for hypoglycemia? a. rash b. shakiness c. polyuria d. fruity acetone odor to breath

b. shakiness rationale: Hypoglycemia is low blood sugar levels. Symptoms include shakiness, nervousness, diaphoresis, irritability, tachycardia, dizziness, and hunger.

The nurse instructs a client on self-administration of NPH insulin and regular insulins through client teach-back and demonstration. The nurse knows the client understands the instruction through demonstration of which action? a. the client withdrew 20 units NPH first then regular insulin next b. the client withdrew 10 units regular first, followed by 20 units NPH insulin c. the client withdrew 20 units NPH insulin in one syringe and 10 units regular insulin in a second syringe d. the client withdrew 30 units glargine insulin and stated glargine is to never be mixed

b. the client withdrew 10 units regular first, followed by 20 units NPH insulin rationale: when 10 Units of regular, clear insulin and 20 Units of NPH, cloudy insulin are ordered to be mixed with these specific steps, this is the correct method: Air is pulled up into the syringe for the 20 Units NPH, cloudy insulin and 20 units of air only placed into the NPH bottle; the needle is withdrawn;"

The nurse is instructing a Type 1 diabetic on "sick day rules" and stresses which key sick day advice? a. "you should perform more vigorous exercises to get well sooner" b. sick day means not to take insulin on days that you are ill c. "the number one rule of thumb is to continue taking your insulin" d. 'limit fluids when ill because fluids will be hypotonic and more harmful"

c. "the number one rule of thumb is to continue taking your insulin" rationale: The first and most important rule regarding sick days for a type 1 diabetic is to continue taking insulin. The amount of insulin taken may vary (more or less) depending on the sickness and the amount of food taken in, but insulin is still taken.

The nurse is caring for a client with Type 1 diabetes. The client is on Sliding Scale Regular insulin subcutaneous before meals and at bedtime. The sliding scale is as follows:-60 mg/dL - 150 mg/dL, give no insulin-151 mg/dL - 200 mg/dL, give 2 units Humulin R-201 mg/dL - 250 mg/dL, give 4 units Humulin R-251 mg/dL - 300 mg/dL, give 6 units Humulin R-over 301 mg/dL, give 8 units Humulin R and notify the physician The bedside blood glucose is 210 mg/dL at 0730. How much insulin would the nurse give? a. 4 units Humulin N subcutaneous b. 2 units Humulin R subcutaneous c. 4 units Humulin R subcutaneous d. 8 units Humulin R subcutaneous

c. 4 units Humulin R subcutaneous rationale: Sliding scale insulin is solely determined by the client's immediate blood glucose. It is not a scheduled insulin, where a client gets a consistent dosage of insulin (unless contraindicated).

The nurse is caring for a client who collapsed and is unresponsive after complaints of sudden lethargy, paleness, and irritability. Bedside blood sugar was 42 mg/dL. A nurse is caring for a client who has developed a hypoglycemic reaction. Which intervention will take priority? a. offer 60cc orange juice after checking that swallowing reflex is present b. order a venous blood sample from the lab to double check the bedside blood sugar monitor c. administer glucagon via parental route as soon as possible d. hang IV of NS and give 500 mL fluid blous as soon as possible

c. administer glucagon via parental route as soon as possible rationale: sleep=stab

A nurse is instructing through Teach Back to a client learning how to perform self-blood glucose monitoring. The nurse evaluates the instruction and identifies the need for additional teaching because of which of the following client statements? a. "I will keep a log of glucose results to monitor for trends." b. "I will try to maintain my blood sugar values around 110 mg/mL" c. "I will always wash my hands prior to puncturing the finger pad" d. "I will puncture my finger in the center of the finger pad"

d. "I will puncture my finger in the center of the finger pad" rationale: This answer is correct because the client does need further teaching since puncturing the finger pad in the center is not appropriate. The client should be taught that testing blood through a puncture to the middle of the finger pad is painful and may not have better blood flow compared to the site off-center. Rotating finger tips is also advised.

The nurse is discussing complications of diabetes with a client. Which condition is the most common microvascular complication associated with diabetes? a. myocardial infarction b. ketoacidosis c. metabolic syndrome d. diabetic retinopathy

d. diabetic retionopathy rationale: Diabetic retinopathy is the most common microvascular complication associated with diabetes. Diabetic retinopathy is a complication of uncontrolled blood glucose levels in the diabetic. Diabetic retinopathy is damage that occurs to the microvascular vessels within the retina.