MEDSURG Diabetes Mellitus

An external insulin pump is prescribed for a client with DM. The client asks the nurse about the functioning of the pump. The nurse bases the response on the information that the pump: a. Gives small continuous dose of regular insulin subcutaneously, and the client can self-administer a bolus with an additional dosage from the pump before each meal. b. Is timed to release programmed doses of regular or NPH insulin into the bloodstream at specific intervals. c. Is surgically attached to the pancreas and infuses regular insulin into the pancreas, which in turn releases the insulin into the bloodstream. d. Continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels

A (An insulin pump provides a small continuous dose of regular insulin subcutaneously throughout the day and night, and the client can self-administer a bolus with additional dosage from the pump before each meal as needed. Regular insulin is used in an insulin pump. An external pump is not attached surgically to the pancreas.)

What will the nurse teach the client with diabetes regarding exercise in his or her treatment program? A. During exercise the body will use carbohydrates for energy production, which in turn will decrease the need for insulin. B. With an increase in activity, the body will use more carbohydrates; therefore more insulin will be required. C. The increase in activity results in an increase in the use of insulin;therefore the client should decrease his or her carbohydrate intake. D. Exercise will improve pancreatic circulation and stimulate the islets of Langerhans to increase the production of intrinsic insulin.

A (As carbohydrates are used for energy, insulin needs decrease.Therefore during exercise, carbohydrate intake should be increased to cover the increased energy requirements. The beneficial effects of regular exercise may result in a decreased need for diabetic medications in order to reach target blood glucose levels. Furthermore, it may help to reduce triglycerides, LDL cholesterol levels, increase HDLs, reduce blood pressure, and improvecirculation.)

A client is diagnosed with DKA. The client reports frequent urination, thirst, and weakness. The nurse assesses a temperature of 102 F, fruity breath, labored respirations with a rate of 30/ minute and dry mucus membranes. What is the priority nursing diagnosis at this time? A. Deficient fluid volume related to osmotic diuresis B. Imbalanced nutrition, less than body requirements related to inability to metabolize glucose C. Ineffective breathing pattern related to the presence of metabolic acidosis D. Ineffective health maintenance related to the inability to manage DM during illness

A (Deficient fluid volume related to osmotic diuresis secondary to hyperglycemia as evidenced by dry MM and client report of frequent urination, thirst, and weakness is the priority ND.)

The nurse is teaching a group of clients diagnosed with diabetes mellitus. Which lesson regarding foot care should be included. SATA. A. Cut toenails straight across and fie along the curves of the toes. B. Rub feet vigorously with a towel after bathing to ensure dryness C. Use a mild foot powder on perspiring feet D. Use cotton or lamb's wool to separate overlapping tools E. Use an OTC corn removal kit to remove corns or calluses

A, C, D (Wash feet daily with warm water and mild soap. Test water temperature with thermometer beforehand. Gently pat feet dry particularly between the toes. Use lanolin to prevent dry and cracked skin but do not apply between the toes. Inspect for abrasions, cuts, and sores. Have others inspect feet if eyesight is poor Use mild foor powder to absorb perspiration and wear clean, absorbent socks with seams aligned. Avoid OTC products such as iodine and alcohol on cuts or abrasions To improve circulation do not sit with legs crossed for extended periods of time)

Which information should the nurse include when developing a teaching plan for a client newly diagnosed with type 2 diabetes mellitus? SATA A. A major risk factor for complications is obesity and central abdominal obesity B. Supplemental insulin is mandatory for controlling the disease C. Exercise increases insulin resistance D. The primary nutritional source requiring monitoring in the diet is carbohydrates. E. Annual eye and foot examinations are recommended by the ADA.

A, E

When no changes are made to the diet or prescribed insulin, which client with type 1 DM does the nurse anticipate having the highest risk of developing hypoglycemia? A. 29 year old with new onset of influenza B. 40 year old experienced cyclist who rides an extra 10 miles C. 65 year old with cellulitis of the leg D. 72 year old with emphysema who is taking prednisone

B (Hypogylcemia occurs when the proportion of insulin exceeds the glucose in the blood. Counterregulatory hormones such as epinephrine are then released and autonomic nervous system is activated causing symptoms of hypoglycemia such as sweating, tremor and hunger. Aerobic exercise lowers blood glucose levels. As muscles use up glucose, the liver is unable to produce enough glucose to keep up with the demand. Regardless of the experience level, the client should check BS levels before, during and after exercise and carry a snack in case hypoglycemia were to occur. Clients with acute illness are more likely to experience hyperglycemia. Prednisone associated with hyperglycemia)

A patient with newly diagnosed type 2 diabetes mellitus asks the nurse what "type 2" means in relation to diabetes. The nurse explains to the patient that type 2 diabetes differs from type 1 diabetes primarily in that with type 2 diabetes? A. The patient is totally dependent on an outside source of insulin B. There is decreased insulin secretion and cellular resistance to insulin that is produced C. The immune system destroys the pancreatic insulin-producing cells D. The insulin precursor that is secreted by the pancreas is not activated by the liver

B (Rationale: In type 2 diabetes, the pancreas produces insulin, but the insulin is insufficient for the body's needs or the cells do not respond to the insulin appropriately. The other information describes the physiology of type 1 diabetes)

A diabetic patient has a serum glucose level of 824 mg/dL (45.7 mmol/L) and is unresponsive. Following assessment of the patient, the nurse suspects diabetic ketoacidosis rather than hyperosmolar hyperglycemic syndrome based on the finding of: A. polyuria B. severe dehydration C. rapid, deep respirations D. decreased serum potassium

C (Signs and symptoms of DKA include manifestations of dehydration such as poor skin turgor, dry mucous membranes, tachycardia, and orthostatic hypotension. Early symptoms may include lethargy and weakness. As the patient becomes severely dehydrated, the skin becomes dry and loose, and the eyeballs become soft and sunken. Abdominal pain is another symptom of DKA that may be accompanied by anorexia and vomiting. Kussmaul respirations (i.e., rapid, deep breathing associated with dyspnea) are the body's attempt to reverse metabolic acidosis through the exhalation of excess carbon dioxide. Acetone is identified on the breath as a sweet, fruity odor. Laboratory findings include a blood glucose level greater than 250 mg/dL, arterial blood pH less than 7.30, serum bicarbonate level less than 15 mEq/L, and moderate to large ketone levels in the urine or blood ketones.)

A client with DM I is brought to the ED by his wife. The client has fruity breath, rapid, deep respirations at 36 bpm, reports abdominal pain and appears weak. The nurse should anticipate implementation of which prescriptions. SATA. A. Administer dextrose 50 mg IVP B. Instruct client to breathe into a paper bag to treat hyperventilation C. Perform fingerstick and serum blood glucose test D. Prepare to administer IV infusion of regular insulin. E. Start an IV line and administer a bolus of normal saline

C, D, E Kussmaul respiration are a compensatory mechanism that results in a lowered PaCO2 in an attempt to restore the body's normal pH level and SHOULD not be reversed.

A client is brought to the emergency department in an unresponsive state, and a diagnosis of hyperglycemic hyperosmolar nonketotic syndrome is made. The nurse would immediately prepare to initiate which of the following anticipated physician's prescriptions? A. Endotracheal intubation B. 100 units of NPH insulin C. Intravenous infusion of normal saline D. Intravenous infusion of sodium bicarbonate

C. (Intravenous infusion of normal saline Rationale: The primary goal of treatment is hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is to rehydrate the client to restore the fluid volume and to correct electrolyte deficiency. Intravenous fluid replacement is similar to that administered in diabetic keto acidosis (DKA) and begins with IV infusion of normal saline. Regular insulin, not NPH insulin, would be administered. The use of sodium bicarbonate to correct acidosis is avoided because it can precipitate a further drop in serum potassium levels. Intubation and mechanical ventilation are not required to treat HHNS)

The nurse cares for a client diagnosed with DKA in the emergency department. After checking the blood glucose, which prescription should the nurse implement first? A. Insert indwelling catheter for accurate I/Os B. Obtain serum potassium level results and report to the HCP C. Prepare an insulin drip for IV insulin as prescribed D. Start an IV line and infuse normal saline as prescribed

D (DKA is a life threatening complication of DM I that results in ketosis, a metabolic acidosis. Glucose cannot be taken out of the bloodstream and used for energy without insulin. The body begins to break down fat stores into ketones, as it does in a state of starvation, causing a metabolic acidosis (low pH and low HCO3). The lack of insulin results in increased glucose production in the liver, worsening the hyperglycemia. Hyperglycemia causes osmotic diuresis causing clients to be severely dehydrated. The cardinal signs of dehydration are poor skin turgor, dry mucus membranes, tachycardia, orthostatic hypotension, weakness and lethargy. Iv fluids should begin prior to insulin because insulin causes water, potassium, and glucose to enter the cells which worsens dehydration and electrolyte imbalanaces.)

A client with DKA is being treated in the ED. What would the nurse suspect? A. Comatose state B. Decreased Urine Output C. Increased respirations and an increase in pH. D. Elevated blood glucose level and low plasma bicarbonate level.

D (Rationale: In DKA the arteriole pH is lower than 7.35, plasma bicarbonate is lower than 15 mEq/L, the blood glucose is higher than 250, and ketones are present in the blood and urine. The client would be experiencing polyuria and Kussmauls respirations would be present. A comatose state may occur if DKA is not treated.)

The nurse should call the HCP to obtain a new prescription prior to administering which medication to a client with type I DM? A. 10 units regular insulin IVP for blood glucose greater than 250 mg/dl B. 14 units glargine insulin subcutaneous injection every night at 8 pm C. 18 units aspart insulin subcutaneous injection 15 minutes before breakfast D. 20 units NPH insulin IVP administered every morning at 7 am

D (Subcutaneous injection is the indicated route for NPH insulin administration; NEVER IVP REGULAR ONLY TYPE TO BE IVP Basal long acting insulin such as glargine or detemir once daily Basal intermediate acting such as NPH twice daily Post prandial short acting insulin such as regular insulin—peak 2-5 hours lispro, glulisine, aspart---peak (0.5-3 hours) best option for postmeal hypergylcemia)

The nurse is teaching a community class to people with Type 2 diabetes mellitus. Which explanation would explain the development of Type 2 diabetes? A. The islet cells in the pancreas stop producing insulin. B. The client eats too many foods that are high in sugar. C. The pituitary gland does not produce vasopressin. D. The cells become resistant to the circulating insulin.

D. (Normally insulin binds to special receptor sites on the cells and initiates a series of reactions involved in metabolism. In Type 2 diabetes these reactions are diminished primarily as a result of obesity and aging)

The nurse is assessing the client's understanding of the use of mediations. Which medications may cause a complication with the treatment plan of a client with diabetes? A. Aspirin B. Steroids C. Sulfonylureas D. Angiotensin-Converting Enzyme (ACE) Inhibitors

B

The nurse should teach the diabetic client that which symptom is MOST indicative of hypoglycemia? A. Nervousness B. Anorexia C. Kussmaul's respirations D. Bradycardia

A

The nurse is caring for a patient whose blood glucose level is 55mg/dL. What is the likely nursing response? A. Administer a glucagon injection B. Give a small meal C. Administer 10-15 g of a simple carbohydrate D. Give a small snack of high protein food

C (The client has low hypoglycemia. This is generally treated with a small snack.)

Which of the following diabetes drugs acts by decreasing the amount of glucose produced by the liver? a. Sulfonylureas b. Meglitinides c. Biguanides d. Alpha-glucosidase inhibitors

c. (Biguanides, such as metformin, lower blood glucose by reducing the amount of glucose produced by the liver. Sulfonylureas and Meglitinides stimulate the beta cells of the pancreas to produce more insulin. Alpha-glucosidase inhibitors block the breakdown of starches and some sugars, which helps to reduce blood glucose levels)

The nurse teaches disease management to a group of clients with DM II. Which of the following should the nurse teach as signs or symptoms associated with hypoglycemia A. Diaphoresis B. Flushing C. Pallor D. Polyuria E. Trembling

A, C, E (Epinephrine is one of the major hormones released during a hypoglycemic reaction and may cause early symptoms such as trembling, palpitations, anxiety/arousal, and restlessness. Diaphoresis and pallor are present on examination. When the brain is deprived of glucose due to prolonged and severe hypoglycemia, neuroglycopenic symptoms (confusion, seizures, coma) develop)

The nurse caring for a 54-year-old patient hospitalized with diabetes mellitus would look for which of the following laboratory test results to obtain information on the patient's past glucose control? a. prealbumin level b. urine ketone level c. fasting glucose level d. glycosylated hemoglobin level

D (A glycosylated hemoglobin level detects the amount of glucose that is bound to red blood cells (RBCs). When circulating glucose levels are high, glucose attaches to the RBCs and remains there for the life of the blood cell, which is approximately 120 days. Thus the test can give an indication of glycemic control over approximately 2 to 3 months.)