MEDSURG CH.64
The nurse is teaching a patient with diabetes about proper foot care. Which statement by the patient indicates that teaching was effective? "I should go barefoot in my house so that my feet are exposed to air." "I must inspect my shoes for foreign objects before putting them on." "I will soak my feet in warm water to soften calluses before trying to remove them." "I must wear canvas shoes as much as possible to decrease pressure on my feet."
"I must inspect my shoes for foreign objects before putting them on." To avoid injury or trauma to the feet, shoes should be inspected for foreign objects before they are put on. Diabetic patients should not go barefoot because foot injuries can occur. To avoid injury or trauma, a callus should be removed by a podiatrist, not by the patient. The diabetic patient must wear firm support shoes to prevent injury.
The nurse is teaching a patient about the manifestations and emergency treatment of hypoglycemia. In assessing the patient's knowledge, the nurse asks the patient what he or she should do if feeling hungry and shaky. Which response by the patient indicates a correct understanding of hypoglycemia management? "I should sit down and rest." "I should drink a glass of water." "I should eat three graham crackers." "I should give myself 1 mg of glucagon."
"I should eat three graham crackers." Eating three graham crackers is a correct management strategy for mild hypoglycemia. Water or resting does not remedy hypoglycemia. Glucagon should be administered only in cases of severe hypoglycemia.
The nurse is evaluating teaching that has been provided to a patient who was recently diagnosed with diabetes. What statement indicates a need for further teaching? "I will avoid trans fats." "I will avoid eating fatty fish." "I will limit my cholesterol to less than 200 mg/day." "I will limit my fat intake to about 25% of my daily calories."
"I will avoid eating fatty fish." Patients should be encouraged to have two or more servings of fatty fish per week. Trans fats should be avoided. Limiting cholesterol and fat intake are indicated.
The nurse is providing teaching for a patient newly diagnosed with type 1 diabetes. Which statements by the patient indicate an understanding of the teaching provided about continuous glucose monitoring? Select all that apply. "The continuous monitoring will replace fingersticks." "I will not need to calibrate the continuous glucose monitoring system." "It is important to check fingersticks with continuous glucose monitoring." "I should purchase disposable sensors for the continuous glucose monitor system." "I will give myself an insulin bolus when my monitor shows my blood sugar is elevated."
"It is important to check fingersticks with continuous glucose monitoring." "I should purchase disposable sensors for the continuous glucose monitor system." Patients will still need to check fingersticks with continuous glucose monitoring. It is important to purchase disposable sensors for the continuous glucose monitor system. Continuous monitoring will not replace fingersticks. Continuous blood glucose monitoring systems still need to be calibrated. Boluses should not be given until the fingerstick confirms the blood glucose.
The nurse is caring for a patient who has type 2 diabetes with poorly controlled blood glucose levels. The patient asks the nurse, "When my blood sugar is high, why am I always hungry, even when I constantly eat?" What is the nurse's best response? Select all that apply. "When insulin is not present, increased hunger persists." "Despite eating, insulin is very high and increases hunger." "Despite eating, glucose is not being used at the cellular level." "When cellular glucose is low, cell starvation triggers excessive hunger." "When cellular glucose is high, cell starvation triggers excessive hunger."
"When insulin is not present, increased hunger persists." "Despite eating, glucose is not being used at the cellular level." "When cellular glucose is low, cell starvation triggers excessive hunger." When blood glucose is elevated in a patient with type 2 diabetes, insulin is deficient and cannot help glucose into the cell, resulting in low glucose in the cell. When insulin is not present, increased hunger persists. Despite eating, glucose is not being used at the cellular level. When cellular glucose is low, cell starvation triggers excessive hunger. Insulin levels are not elevated; instead, they are deficient in the patient with type 2 diabetes. Cellular glucose is low, despite high blood glucose, because the cell is unable to receive the glucose without insulin.
The nurse is caring for a patient with diabetes mellitus who tells the nurse, "I sometimes have episodes of seeing double. What causes that?" Which response would the nurse give? "You are likely experiencing diabetic retinopathy." "You are likely experiencing optic nerve atrophy." "You are likely experiencing an episode of low blood sugar when this happens." "You are likely experiencing an episode of high blood sugar when this happens.
"You are likely experiencing an episode of low blood sugar when this happens." An episode of hypoglycemia, low blood sugar, may cause the patient to see double. Diabetic retinopathy and optic nerve atrophy do not present as periodic episodes of seeing double. An episode of hyperglycemia, high blood sugar, may cause the patient to have blurry vision, not double vision.
Consuming which item is appropriate for the patient who becomes hypoglycemic at home? 1 tsp of sugar 1 tbsp of honey 1 oz of skim milk 1 cup of fruit juice
1 tbsp of honey A patient with hypoglycemia can consume 1 tbsp of honey to adjust his or her blood glucose level. The patient should have 8 oz of skim milk, not just 1 oz, to manage hypoglycemia. Half a cup of fruit juice, not a full cup, is generally sufficient to raise the glycemic level. The patient requires at least 4 tsp, not 1 tsp, of sugar to overcome hypoglycemia.
Which patient does the nurse identify as needing screening for type 2 diabetes? A 44-year-old patient with 2 children A 29-year-old patient with a BMI 24 kg/m A 46-year-old patient with no health history A 35-year-old patient with a fasting blood glucose of 90
A 46-year-old patient with no health history A patient over the age of 45 should be screened for type 2 diabetes. The 44-year-old, 29-year-old, and 35-year-old have no indication of a need for screening at this time.
The nurse is assigned the following four patients. Which patient should the nurse see first? A patient diagnosed with hypoglycemia with a blood glucose level of 72 mg/dL A patient diagnosed with diabetic ketoacidosis (DKA) who is now scheduled for subcutaneous insulin A patient diagnosed with new-onset type 1 diabetes who now has positive ketones in his urine A patient diagnosed with hyperglycemic-hyperosmolar state (HHS) who is receiving 0.45% sodium chloride at 100 mL/hr
A patient diagnosed with new-onset type 1 diabetes who now has positive ketones in his urine The priority patient is the one with new-onset type 1 diabetes with ketones in the urine indicating that diabetic ketoacidosis is now present. The patient with hypoglycemia has a stable blood glucose. The patient with DKA scheduled for subcutaneous insulin administration is no longer on IV insulin, which indicates improvement. The patient with HHS is now receiving fluid replacement at a low rate, which indicates improvement of HHS.
A nurse cares for a client with diabetes mellitus who is visually impaired. The client asks, Can I ask my niece to prefill my syringes and then store them for later use when I need them? How should the nurse respond? a. Yes. Prefilled syringes can be stored for 3 weeks in the refrigerator in a vertical position with the needle pointing up. b. Yes. Syringes can be filled with insulin and stored for a month in a location that is protected from light. c. Insulin reacts with plastic, so prefilled syringes are okay, but you will need to use glass syringes. d. No. Insulin syringes cannot be prefilled and stored for any length of time outside of the container.
ANS: A Insulin is relatively stable when stored in a cool, dry place away from light. When refrigerated, prefilled plastic syringes are stable for up to 3 weeks. They should be stored in the refrigerator in the vertical position with the needle pointing up to prevent suspended insulin particles from clogging the needle.
A nurse teaches a client who is prescribed an insulin pump. Which statement should the nurse include in this clients discharge education? a. Test your urine daily for ketones. b. Use only buffered insulin in your pump. c. Store the insulin in the freezer until you need it. d. Change the needle every 3 days.
ANS: D Having the same needle remain in place through the skin for longer than 3 days drastically increases the risk for infection in or through the delivery system. Having an insulin pump does not require the client to test for ketones in the urine. Insulin should not be frozen. Insulin is not buffered.
The nurse is providing education to a patient with a new diagnosis of type 1 diabetes. What action by the patient indicates a need for further teaching? Utilizing only the abdomen for injections Grasping a skin fold and injecting at a 90-degree angle Aspirating for blood return before administering the medication Mixing regular human insulin with isophane insulin NPH for injection
Aspirating for blood return before administering the medication Aspirating for blood return is not indicated with insulin administration. Utilizing the abdomen only for injection (one anatomic site) is preferred to rotation from one area to another to prevent day-to-day changes in absorption. Grasping the skin and injecting at 90 degrees is correct practice. Mixing regular insulin and NPH is acceptable.
A patient newly diagnosed with diabetes is being instructed when to perform blood glucose monitoring. At what times does the nurse instruct the patient to check blood glucose? Select all that apply. After eating Before meals Frequently if you are ill If you are thirsty and urinate frequently One hour after taking a rapid-acting insulin
Before meals Frequently if you are ill If you are thirsty and urinate frequently Assessment of blood glucose levels is very important for the following situations: symptoms of hypoglycemia/hyperglycemia; hypoglycemic unawareness; periods of illness; before and after exercise; gastroparesis; adjustment of antidiabetes drugs; evaluation of other drug therapies (e.g., steroids); preconception planning; and pregnancy. In addition, blood glucose levels should be monitored before meals.
A patient newly diagnosed with diabetes is not ready or willing to learn diabetes control during the hospital stay. Which information is the priority for the nurse to teach the patient and the patient's family? Dietary control Insulin administration Causes and treatment of hypoglycemia Causes and treatment of hyperglycemia
Causes and treatment of hypoglycemia The causes and treatment of hypoglycemia must be understood by the patient and family to manage the patient's diabetes effectively. The causes and treatment of hyperglycemia is a topic for secondary teaching and is not the priority for the patient with diabetes. Dietary control and insulin administration are important, but are not the priority in this situation.
The nurse is caring for a patient with continuous glucose monitoring (CGM) and obtains an elevated reading. Which action would the nurse take first? Administer insulin. Notify the provider. Continue to monitor hourly readings. Confirm the results with a finger stick test.
Confirm the results with a finger stick test. CGM is meant to supplement, not replace, finger stick tests. An elevated reading would be confirmed with a finger stick test. Insulin should be given only after confirming the results of any of the CGM systems. The provider would be notified if the finger stick reading was out of range and the orders indicated that a call was warranted. If the reading on CGM is elevated, continuing to monitor readings without an intervention is considered neglectful behavior and puts the patient at risk.
What symptoms should be assessed for in a patient diagnosed with hypoglycemia? Select all that apply. Ketones Confusion Weakness Dehydration Cool, clammy skin
Confusion Weakness Cool, clammy skin Confusion, weakness, and cool, clammy skin would indicate hypoglycemia and should be assessed for in this patient. Ketones would not be found in hypoglycemia. Dehydration is not found in hypoglycemia.
What teaching should be included for a patient with a new diagnosis of type 1 diabetes? Select all that apply. Sick day rules Avoidance of exercise Daily inspection of feet Reporting any vision changes Weekly blood work for the first year
Daily inspection of feet Reporting any vision changes Sick day rules Patients should be taught about sick day rules, the need to inspect their feet daily, and to report changes in vision. Patients with diabetes do not need to avoid exercise and will not have weekly blood work for the first year.
Which oral medication lowers blood glucose levels by preventing kidney reabsorption of glucose and sodium that was filtered from the blood into the urine, allowing for the filtered glucose to be excreted in the urine rather than moved back into the blood? Alogliptin (Nesina) Exenatide (Byetta) Pramlintide (Symlin) Dapagliflozin (Farxiga)
Dapagliflozin (Farxiga) Dapagliflozin (Farxiga) is a sodium-glucose cotransport inhibitor that works by preventing kidney reabsorption of glucose and sodium that was filtered from the blood into the urine, allowing for the filtered glucose to be excreted in the urine rather than moved back into the blood. Alogliptin (Nesina) is a DPP-4 inhibitor that works by preventing the enzyme DPP-4 from breaking down the natural gut hormones (GLP-1 and GIP), which then allows these natural substances to work with insulin to lower glucagon secretion from the pancreas. Pramlintide (Symlin) is an amilyn analog that works by decreasing endogenous glucagon, delaying gastric emptying, and triggering satiety. Exenatide (Byetta) is an incretin mimetics (GLP-1 agonist) that works with insulin to lower blood glucose levels by reducing pancreatic glucagon secretion; reducing liver glucose production; and delaying gastric emptying, which slows the rate of nutrient absorption into the blood.
What method must the patient with diabetes use with regard to insulin safety? Shake insulin well before administration. Discard any unused insulin after 28 days. Refrigerate unused insulin at 32° F (0° C). Store prefilled syringes in a horizontal position
Discard any unused insulin after 28 days The patient must discard any unused insulin after 28 days because a slight loss in potency may occur after the bottle has been in use for more than 30 days, even when the expiration date has not passed. The bottle or the prefilled syringe may be rolled gently between the hands, but not shaken vigorously before administration, to prevent loss of potency. Prefilled syringes must be stored upright, with the needle pointing upward, to prevent clogging of the needle. Unused insulin must not be exposed to temperatures below 36° F (2.2° C) to prevent loss of drug potency.
When providing teaching about nutrition to a patient diagnosed with diabetes, what instruction should the nurse include? It is important to avoid snacks. Decrease calories when exercising. Carbohydrates should be restricted to once a day. Eat consistent amounts of food at consistent times.
Eat consistent amounts of food at consistent times. It is important to have consistent amounts of food at consistent times. Snacks are OK, calories should not be avoided when exercising, and carbohydrates should not be restricted to once a day.
A patient has just been diagnosed with diabetes. Which factor is most important for the nurse to assess in the patient before providing instruction about the disease and its management? Current lifestyle Sexual orientation Current energy level Educational and literacy level
Educational and literacy level A large amount of information must be synthesized; typically written instructions are given. The patient's educational and literacy level are essential information. Although lifestyle should be taken into account, it is not the priority. Sexual orientation will have no bearing on the ability of the patient to provide self-care. Although energy level will influence the ability to exercise, it is not essential.
Which manifestation is associated with hyperglycemia in a patient with diabetes mellitus? Pallor Irritability Diaphoresis Excessive urination
Excessive urination Manifestations of hyperglycemia and diabetes include polydipsia (excessive thirst), polyuria (excessive urination), and polyphagia (excessive eating). Symptoms of hypoglycemia include diaphoresis, pallor, irritability, tremor, anxiety, confusion, hunger, and loss of consciousness.
The nurse is caring for an older adult patient with diabetes mellitus, acute renal failure, history of a thyroid tumor, and periodic angina. Which drug can be safely administered to control the patient's diabetes? Glipizide Liraglutide Metformin Pioglitazone
Glipizide Glipizide can be safely administered to manage diabetes in the patient with kidney and heart dysfunction. Liraglutide should not be used in patients with thyroid tumors, because it can worsen the tumors. Metformin should not be used in patients with kidney diseases due to the risk for lactic acidosis. Due to an increased risk of heart-related deaths, pioglitazone is contraindicated for patients who have angina.
What does a fasting blood glucose of 65 mg/dL indicate? Hypoglycemia Hyperglycemia More information needed Normal result in range for fasting
Hypoglycemia Hypoglycemia is defined as a fasting blood glucose level lower than 74 mg/dL. Hyperglycemia is defined as a fasting blood glucose level greater than 106 mg/dL. These are universal guidelines that are not individualized, so more information is not necessary. The normal range for fasting blood glucose levels is 74 to 106 mg/dL.
What initial electrolyte imbalance can the nurse anticipate in a patient experiencing hyperglycemia? Hypokalemia Hyperkalemia Hyponatremia Hypernatremia
Hypokalemia The initial electrolyte imbalance that the nurse can anticipate for a patient experiencing hyperglycemia is hypokalemia. With the increased fluid loss from hyperglycemia, excessive potassium is excreted in the urine, leading to low serum potassium levels. Hyperkalemia may occur with acidosis because of the shift of the potassium from inside the cells of the blood. An imbalance in sodium is unrelated to the initial changes caused by hyperglycemia.
The nurse is providing education to a patient about the prevention of hypoglycemia. What signs and symptoms of this complication should be included in the teaching? Irritability Vomiting Positive ketones Warm, moist skin
Irritability Irritability is a sign of hypoglycemia. Vomiting, positive ketones, and warm, moist skin are signs of hyperglycemia.
The nurse is providing nutritional education to a patient newly diagnosed with diabetes. What should be considered for optimal adherence to the plan? Select all that apply. Lifestyle Family history Financial status Cultural background Mental health history
Lifestyle Financial status Cultural background It is important to include the patient's lifestyle, financial status, and cultural background when making a nutritional plan. Family history and mental health history are not important when determining nutritional plans.
Which medication taken by a patient with diabetes mellitus will protect the kidneys and help prevent diabetic nephropathy? Digoxin Lisinopril Propranolol Metoclopramide
Lisinopril Drugs that protect the kidneys are the angiotensin-converting enzyme (ACE) inhibitors and the angiotensin receptor blockers (ARBs); lisinopril is an ACE inhibitor. Propranolol is a beta-adrenergic blocking agent, which can be used for hypertension, but does not possess protective effects for the kidneys. Metoclopramide is used to promote gastric emptying for diabetic patients with gastroparesis. Digoxin is a glycoside to slow and/or strengthen the force of cardiac contraction in patients with atrial fibrillation or heart failure; it does not protect the kidneys from diabetic nephropathy.
Which medication lowers blood glucose levels by inhibiting liver glucose production, decreasing intestinal absorption of glucose, and increasing insulin sensitivity? Pioglitazine (Actos) Glipizide (Glucotrol) Glimepiride (Amaryl) Metformin (Glucophage)
Metformin (Glucophage) Metformin (Glucophage) is a biguanide medication that lowers blood glucose levels by inhibiting liver glucose production, decreasing intestinal absorption of glucose, and increasing insulin sensitivity. Pioglitzone (Actos) is a thiazolidinedione that lowers blood glucose levels by decreasing liver glucose production and improving the sensitivity of insulin. Glipizide (Glucotrol) and glimepiride (Amaryl) are second-generation sulfonylurea agents that lower blood glucose levels by triggering the release of preformed insulin from beta cells.
The nurse is providing screening for patients about diabetes mellitus. What diagnoses does the nurse recognize as triggers for development of type 1 diabetes mellitus? Select all that apply. Mumps Coxsackievirus Acute renal failure Gastroesophageal reflux End stage renal disease (ESRD
Mumps Coxsackievirus Mumps and coxsackievirus are both viral infections that may trigger diabetes mellitus type 1. Acute renal failure, gastroesophageal reflux, and ESRD do not trigger diabetes mellitus.
The nurse is providing teaching to a patient with visual impairment about safe insulin administration. Which action by the patient indicates effective teaching? Avoids moving plunger in and out Has home health aides administer insulin Places rubber band around fast-acting insulin Places the bottle on a flat surface while withdrawing insulin
Places rubber band around fast-acting insulin Placing a rubber band around fast-acting insulin will differentiate short-acting insulin from long-acting insulin. Moving the plunger in and out can help avoid air bubbles. Having the home health aide administer insulin does not help the patient understand self-administration. The insulin bottle should not be placed on a flat surface when measuring insulin; it should be held up to reduce air bubbles.
What measure should the caregiver of a patient with diabetes take to treat moderate hypoglycemia? Provide half a cup of fruit juice. Offer 4 cubes, or teaspoons, of sugar. Subcutaneously inject 1 mg of glucagon. Provide 15 g of carbohydrate and cheese.
Provide 15 g of carbohydrate and cheese. When treating moderate hypoglycemia, the patient must be given 15 to 30 g of rapidly absorbed carbohydrate, followed by low-fat milk or cheese after 10 to 15 minutes. The patient with mild hypoglycemia usually has a blood glucose level of less than 60 mg/dL. It may be treated by offering the patient half a cup of fruit juice, or 4 cubes or teaspoons of sugar. In severe hypoglycemia, blood glucose is usually less than 20 mg/dL. The patient may be unconscious or unable to swallow; the patient should be administered 1 mg of glucagon as a subcutaneous or intramuscular injection.
Which measure helps the patient with type 1 diabetes mellitus (DM) who uses an insulin pump to appropriately manage blood glucose levels? Managing hyperglycemia by increasing insulin dosage Avoiding additional carbohydrates after unplanned exercise Consuming additional carbohydrates after planned exercise Reducing the insulin dosage before planned physical exercise
Reducing the insulin dosage before planned physical exercise The patient with type 1 DM using an insulin pump must reduce the insulin dosage before planned physical exercise to avoid hypoglycemia. The patient with type 1 DM has a tendency to gain weight by managing hyperglycemia with increased insulin dosage rather than restricting calories. If the insulin dosage is reduced before planned physical exercise, the patient does not need to adjust carbohydrate intake, either by avoiding or consuming additional amounts to prevent alterations in blood glucose levels.
The nurse is providing preoperative instructions to a patient with diabetes. What instructions should the nurse include? Sulfonylureas should be discontinued one day before surgery. Opioid analgesics are contraindicated in patients with diabetes. It is common to have an increased length of stay of 2 to 3 days. The goal is to keep preoperative blood glucose to less than 250 mg/dL
Sulfonylureas should be discontinued one day before surgery. Sulfonylureas should be discontinued one day before surgery. Preoperative blood glucose should be less than 200 mg/dL. Patients do not normally have an increased length of stay; they do sometimes get admitted early. Opiate analgesics are not avoided after surgery.
Which explanation best assists a patient in differentiating type 1 diabetes from type 2 diabetes? People with type 1 diabetes are often obese. Most patients with type 1 diabetes are born with it. Those with type 2 diabetes make insulin, but in inadequate amounts. People with type 2 diabetes do not develop typical diabetic complications.
Those with type 2 diabetes make insulin, but in inadequate amounts People with type 2 diabetes make some insulin but in inadequate amounts, or they have resistance to existing insulin. Although type 1 diabetes may occur early in life, it may be caused by immune responses. Obesity is typically associated with type 2 diabetes. People with type 2 diabetes are at risk for complications, especially cardiovascular complications.
What intervention is most important to prevent complications for the patient diagnosed with diabetes? Low-calorie diet Tight glucose control Annual vision exams Daily foot inspection
Tight glucose control Tight glucose control is the most important intervention that can prevent complications from diabetes. A low-calorie diet is not indicated for diabetic patients. Annual vision exams and daily foot inspections are important, but glucose control is priority.
A patient recently admitted with new-onset type 2 diabetes will be discharged with a self-monitoring blood glucose machine. When is the best time for the nurse to explain to the patient the proper use of the machine? On admission Day of discharge When the patient states readiness While performing the test in the hospital
While performing the test in the hospital Teaching the patient about the operation of the machine while performing the test in the hospital is the best way for the patient to learn. The teaching can be reinforced before discharge. Instructing the patient on the day of admission or the day of discharge would be overwhelming to the patient because of all of the other activities taking place that day. The patient may never feel ready to learn this daunting task; the nurse must be more proactive.
What are the distinguishing characteristics of type 1 diabetes mellitus (DM) that the nurse should remember? Select all that apply. Resistance to insulin Autoimmune disorder Beta cells are destroyed Triggered by viral infections Decreased secretion of insulin
Autoimmune disorder Beta cells are destroyed Triggered by viral infections Type 1 DM is an autoimmune disorder in which beta cells are destroyed in a genetically susceptible person. The immune system fails to recognize normal body cells as "self" and takes destructive actions against them. Certain viral infections, such as mumps and coxsackie virus infection, appear to trigger the autoimmune destruction of pancreatic beta cells. Type 2 DM is a progressive disorder in which the person has a combination of insulin resistance and decreased secretion of insulin by pancreatic beta cells. Insulin resistance develops from obesity and physical inactivity in a genetically susceptible person.
After teaching a young adult client who is newly diagnosed with type 1 diabetes mellitus, the nurse assesses the clients understanding. Which statement made by the client indicates a correct understanding of the need for eye examinations? a. At my age, I should continue seeing the ophthalmologist as I usually do. b. I will see the eye doctor when I have a vision problem and yearly after age 40. c. My vision will change quickly. I should see the ophthalmologist twice a year. d. Diabetes can cause blindness, so I should see the ophthalmologist yearly.
ANS: D Diabetic retinopathy is a leading cause of blindness in North America. All clients with diabetes, regardless of age, should be examined by an ophthalmologist (rather than an optometrist or optician) at diagnosis and at least yearly thereafter.
A nurse cares for a client who has a family history of diabetes mellitus. The client states, My father has type 1 diabetes mellitus. Will I develop this disease as well? How should the nurse respond? a. Your risk of diabetes is higher than the general population, but it may not occur. b. No genetic risk is associated with the development of type 1 diabetes mellitus. c. The risk for becoming a diabetic is 50% because of how it is inherited. d. Female children do not inherit diabetes mellitus, but male children will.
ANS: A Risk for type 1 diabetes is determined by inheritance of genes coding for HLA-DR and HLA-DQ tissue types. Clients who have one parent with type 1 diabetes are at increased risk for its development. Diabetes (type 1) seems to require interaction between inherited risk and environmental factors, so not everyone with these genes develops diabetes. The other statements are not accurate.
A nurse assesses a client who has diabetes mellitus and notes the client is awake and alert, but shaky, diaphoretic, and weak. Five minutes after administering a half-cup of orange juice, the clients clinical manifestations have not changed. Which action should the nurse take next? a. Administer another half-cup of orange juice. b. Administer a half-ampule of dextrose 50% intravenously. NURSINGTB.COM c. Administer 10 units of regular insulin subcutaneously. d. Administer 1 mg of glucagon intramuscularly.
ANS: A This client is experiencing mild hypoglycemia. For mild hypoglycemic manifestations, the nurse should administer oral glucose in the form of orange juice. If the symptoms do not resolve immediately, the treatment should be repeated. The client does not need intravenous dextrose, insulin, or glucagon.
A nurse collaborates with the interdisciplinary team to develop a plan of care for a client who is newly diagnosed with diabetes mellitus. Which team members should the nurse include in this interdisciplinary team meeting? (Select all that apply.) a. Registered dietitian b. Clinical pharmacist c. Occupational therapist d. Health care provider e. Speech-language pathologist
ANS: A, B, D When planning care for a client newly diagnosed with diabetes mellitus, the nurse should collaborate with a registered dietitian, clinical pharmacist, and health care provider. The focus of treatment for a newly diagnosed client would be nutrition, medication therapy, and education. The nurse could also consult with a diabetic educator. There is no need for occupational therapy or speech therapy at this time.
1.A nurse assesses clients at a health fair. Which clients should the nurse counsel to be tested for diabetes? (Select all that apply.) a. 56-year-old African-American male b. Female with a 30-pound weight gain during pregnancy c. Male with a history of pancreatic trauma d. 48-year-old woman with a sedentary lifestyle e. Male with a body mass index greater than 25 kg/m2 f. 28-year-old female who gave birth to a baby weighing 9.2 pounds
ANS: A, D, E, F Risk factors for type 2 diabetes include certain ethnic/racial groups (African Americans, American Indians, Hispanics), obesity and physical inactivity, and giving birth to large babies. Pancreatic trauma and a 30-pound gestational weight gain are not risk factors.
.A nurse is teaching a client with diabetes mellitus who asks, Why is it necessary to maintain my blood glucose levels no lower than about 60 mg/dL? How should the nurse respond? A. Glucose is the only fuel used by the body to produce the energy that it needs. B. Your brain needs a constant supply of glucose because it cannot store it. C. Without a minimum level of glucose, your body does not make red blood cells. D. Glucose in the blood prevents the formation of lactic acid and prevents acidosis.
ANS: B Because the brain cannot synthesize or store significant amounts of glucose, a continuous supply from the bodys circulation is needed to meet the fuel demands of the central nervous system. The nurse would want to educate the client to prevent hypoglycemia. The body can use other sources of fuel, including fat and protein, and glucose is not involved in the production of red blood cells. Glucose in the blood will encourage glucose metabolism but is not directly responsible for lactic acid formation.
.A nurse assesses a client with diabetes mellitus. Which clinical manifestation should alert the nurse to decreased kidney function in this client? a. Urine specific gravity of 1.033 b. Presence of protein in the urine c. Elevated capillary blood glucose level d. Presence of ketone bodies in the urine
ANS: B Renal dysfunction often occurs in the client with diabetes. Proteinuria is a result of renal dysfunction. Specific gravity is elevated with dehydration. Elevated capillary blood glucose levels and ketones in the urine are consistent with diabetes mellitus but are not specific to renal function.
A nurse teaches a client with diabetes mellitus about sick day management. Which statement should the nurse include in this clients teaching? a. When ill, avoid eating or drinking to reduce vomiting and diarrhea. b. Monitor your blood glucose levels at least every 4 hours while sick. c. If vomiting, do not use insulin or take your oral antidiabetic agent. d. Try to continue your prescribed exercise regimen even if you are sick.
ANS: B When ill, the client should monitor his or her blood glucose at least every 4 hours. The client should continue taking the medication regimen while ill. The client should continue to eat and drink as tolerated but should not exercise while sick.
A nurse assesses clients who are at risk for diabetes mellitus. Which client is at greatest risk? a. A 29-year-old Caucasian b. A 32-year-old African- American c. A 44-year-old Asian d. A 48-year-old American Indian
ANS: D Diabetes is a particular problem among African Americans, Hispanics, and American Indians. The incidence of diabetes increases in all races and ethnic groups with age. Being both an American Indian and middle-aged places this client at highest risk.
A patient has 0700 fingerstick blood glucose readings of 353-286 for 3 mornings in a row, and the nurse is concerned the patient may have dawn phenomenon. Which finding is consistent with this phenomenon? Postprandial glucose elevations Early morning glucose elevations Bedtime hypoglycemia unless a snack is eaten Morning glucose elevations preceded by hypoglycemia during the night
Early morning glucose elevations Dawn phenomenon results from a nighttime release of growth hormone causing blood glucose elevations around 5-6 AM. This is resolved by administering more insulin for the overnight period. All individuals have some degree of postprandial glucose elevation; release of insulin from the pancreas or exogenous insulin resolves this issue. Somogyi phenomenon is early morning hyperglycemia secondary to nighttime hypoglycemia. A patient may develop hypoglycemia at bedtime if sufficient calories are not consumed relative to the dinner/evening insulin prescription.
The nurse is providing screening for diabetes. What findings are consistent with both type 1 and type 2 diabetes diagnosis? Select all that apply. Fatigue Polyuria Polydipsia Weight loss Hypertension
Fatigue Polyuria Polydipsia Fatigue, polyuria, and polydipsia are all findings consistent with both type 1 and type 2 diabetes. Weight loss is consistent with type 1 diabetes. Hypertension is not directly related to either diagnosis.
A patient with chronic renal insufficiency was recently diagnosed with type 2 diabetes. The nurse should contact the health care provider and hold which medication? Acarbose Glipizide Metformin Pioglitazone
Metformin Metformin is contraindicated in patients with renal disease. The medication should be held, and the health care provider should be contacted. Acarbose, glipizide, and pioglitazone are not contraindicated in this patient.
The nurse has just received a change-of-shift report on the endocrine unit. Which patient does the nurse see first? Newly diagnosed patient with type 1 diabetes who is reporting thirst Patient with type 2 diabetes who has a blood glucose of 150 mg/dL Patient with type 2 diabetes with a blood pressure of 150/90 mm Hg Patient with type 1 diabetes whose insulin pump is beeping "occlusion"
Patient with type 1 diabetes whose insulin pump is beeping "occlusion" Because glucose levels will increase quickly in patients who use continuous insulin pumps, the nurse should assess this patient and the insulin pump first to avoid diabetic ketoacidosis (DKA). Thirst is a symptom of hyperglycemia and although important, is not a priority; the nurse could delegate a finger stick blood glucose to unlicensed assistive personnel while assessing the patient whose insulin pump is beeping. Although a blood glucose reading of 150 mg/dL is mildly elevated, this is not an emergency. Mild hypertension is also not an emergency.
Which action is correct when drawing up a single dose of insulin? Wash hands thoroughly and don sterile gloves. Shake the bottle of insulin vigorously to mix the insulin. Recap the needle and save the syringe for the next dose of insulin. Pull back plunger to draw air into the syringe equal to the insulin dose.
Pull back plunger to draw air into the syringe equal to the insulin dose The plunger is pulled back to draw an amount of air into the syringe that is equal to the insulin dose. The air is then injected into the insulin bottle before withdrawing the insulin dose. Although handwashing is important before any medication administration, sterile gloves are not required. The bottle of insulin should be rolled gently in the palms of the hands to mix the insulin, not shaken. Insulin syringes are never recapped or reused; the syringe and needle should be disposed of (without recapping) in a puncture-proof container.
The nurse is providing education to a patient with diabetes mellitus who has manifestations of cardiovascular disease. What is the nurse's priority action? Reverse disease processes Reduce modifiable risk factors Determine the severity of disease Identify non-modifiable risk factors
Reduce modifiable risk factors Priority nursing actions focus on interventions to reduce modifiable risk factors associated with CVD, such as smoking cessation, diet, exercise, blood pressure control, maintaining prescribed aspirin use, and maintaining prescribed lipid lowering drug therapy. Reversing the disease process will not occur and is not a priority nursing action. Determining the severity of the disease and identifying non-modifiable risk factors are not the priority nursing actions.
What is an important feature of the glycosylated hemoglobin A 1c (HbA 1c) test? The results are not altered by eating habits 24 hours before the test. The patient must drink a 75 g glucose load an hour before the test. It determines the average blood glucose levels of the previous 14 days. The patient must not have any caloric intake for at least 8 hours before the test
The results are not altered by eating habits 24 hours before the test. Glycosylated hemoglobin A 1c (HbA 1c) test results are not altered by eating habits the day before the test. Glucose binds to hemoglobin through a process called glycosylation. The glycosylated hemoglobin A 1c (HbA 1c) test is a good indicator of the average blood glucose level during the previous 120 days—the life span of red blood cells. Glycosylated serum albumin (GSA), glycosylated serum protein (GSP), and fructosamine determine blood glucose levels during the previous 14 days. The diagnosis of gestational diabetes mellitus is based on the oral glucose tolerance test, in which the patient must drink a 75 g glucose load an hour before the test. The patient must not have any caloric intake for at least 8 hours before the fasting plasma glucose test to prevent falsely elevated values.
Which statements about the etiology and genetic risk for diabetes mellitus are correct? Select all that apply. Type 1 diabetes results from genetic susceptibility. Pancreatic beta cells are destroyed in type 2 diabetes. Viral infections may act as a trigger for type 1 diabetes. Metabolic syndrome is a known cause for type 1 diabetes. Type 2 diabetes results from genetic susceptibility in addition to controllable risk factors
Type 1 diabetes results from genetic susceptibility. Viral infections may act as a trigger for type 1 diabetes. Type 2 diabetes results from genetic susceptibility in addition to controllable risk factors. Type 2 diabetes results from genetic susceptibility in addition to controllable risk factors. Type 1 diabetes results from genetic susceptibility that may be triggered by a viral infection. Metabolic syndrome is the presence of metabolic factors known to increase risk for type 2 diabetes and cardiovascular disease. Pancreatic beta cells are destroyed in type 1 diabetes, but may be dysfunctional in type 2 diabetes.
