MLQ Ch. 51

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. Deficient knowledge (treatment regimen). B. Health-seeking behaviors (diabetes control). C. Defensive coping. D. Impaired adjustment.

A

A nurse is explaining the action of insulin to a client with diabetes mellitus. During client teaching, the nurse reviews the process of insulin secretion in the body. The nurse is correct when she states that insulin is secreted from the: A. beta cells of the pancreas. B. alpha cells of the pancreas. C. adenohypophysis. D. parafollicular cells of the thyroid.

A

Which of the following is a characteristic of diabetic ketoacidosis (DKA)? Select all that apply. A. More common in type 1 diabetes B. Rapid onset C. Normal arterial pH level D. Absent ketones E. Elevated blood urea nitrogen (BUN) and creatinine

A, B, E

A client who was diagnosed with type 1 diabetes 14 years ago is admitted to the medical-surgical unit with abdominal pain. On admission, the client's blood glucose level is 470 mg/dl. Which finding is most likely to accompany this blood glucose level? A. Rapid, thready pulse B. Slow, shallow respirations C. Cool, moist skin D. Arm and leg trembling

A

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

A

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

A patient is diagnosed with type 1 diabetes. What clinical characteristics does the nurse expect to see in this patient? Select all that apply. A. Little or no endogenous insulin B. Younger than 30 years of age C. Obesity at diagnoses D. Older than 65 years of age E. Ketosis-prone

A, B, E

A client with status asthmaticus requires endotracheal intubation and mechanical ventilation. Twenty-four hours after intubation, the client is started on the insulin infusion protocol. The nurse must monitor the client's blood glucose levels hourly and watch for which early signs and symptoms associated with hypoglycemia? A. Dry skin, bradycardia, and somnolence B. Sweating, tremors, and tachycardia C. Bradycardia, thirst, and anxiety D. Polyuria, polydipsia, and polyphagia

B

A client with type 1 diabetes has a highly elevated glycosylated hemoglobin (Hb) test result. In discussing the result with the client, the nurse is most accurate in stating: A. "It looks like you aren't following the ordered diabetic diet." B. "It tells us about your sugar control for the last 3 months." C. "Your insulin regimen must be altered significantly." D. "The test must be repeated following a 12-hour fast."

B

Which information should be included in the teaching plan for a client receiving glargine, which is "peakless" basal insulin? A. Administer the total daily dosage in 2 doses. B. Do not mix with other insulins. C. Draw up the drug first, then add regular insulin. D. Glargine is rapidly absorbed and has a fast onset of action.

B

Which intervention is essential when performing dressing changes on a client with a diabetic foot ulcer? A. Debriding the wound three times per day B. Using sterile technique during the dressing change C. Applying a heating pad D. Cleaning the wound with a povidone-iodine solution

B

A child is brought into the emergency department with vomiting, drowsiness, and blowing respirations. The father reports that the symptoms have been progressing throughout the day. The nurse suspects diabetic ketoacidosis (DKA). Which action should the nurse take first in the management of DKA? A. Give prescribed antiemetics. B. Administer bicarbonate to correct acidosis. C. Begin fluid replacements. D. Administer prescribed dose of insulin.

C

After teaching a client with type 1 diabetes who is scheduled to undergo an islet cell transplant, which client statement indicates successful teaching? A. "I will receive a whole organ with extra cells to produce insulin." B. "This transplant will provide me with a cure for my diabetes." C. "I might need insulin later on but probably not as much or as often." D. "They'll need to create a connection from the pancreas to allow enzymes to drain."

C

The diabetic client asks the nurse why shoes and socks are removed at each office visit. Which assessment finding is most significant in determining the protocol for inspection of feet? A. Autonomic neuropathy B. Retinopathy C. Sensory neuropathy D. Nephropathy

C

A client with type 1 diabetes presents with a decreased level of consciousness and a fingerstick glucose level of 39 mg/dl. His family reports that he has been skipping meals in an effort to lose weight. Which nursing intervention is most appropriate? A. Administering a 500-ml bolus of normal saline solution B. Observing the client for 1 hour, then rechecking the fingerstick glucose level C. Inserting a feeding tube and providing tube feedings D. Administering 1 ampule of 50% dextrose solution, per physician's order

D

A nurse is preparing a client with type 1 diabetes for discharge. The client can care for himself; however, he's had a problem with unstable blood glucose levels in the past. Based on the client's history, he should be referred to which health care worker? A. Home health nurse B. Psychiatrist C. Social worker D. Dietitian

D

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

D

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

B

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. 140 mg/dL B. 180 mg/dL C. 120 mg/dL D. 160 mg/dL

B

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 five times per week. B. at least three times per week. C. every day. D. at least once per week.

B

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

C

A client with diabetes mellitus develops sinusitis and otitis media accompanied by a temperature of 100.8° F (38.2° C). What effect do these findings have on his need for insulin? A. They have no effect. B. They decrease the need for insulin. C. They cause wide fluctuations in the need for insulin. D. They increase the need for insulin.

D

A nurse is providing education to a client who is newly diagnosed with diabetes mellitus. What are classic symptoms associated with diabetes? A. increased thirst, hunger, and urination B. Loss of appetite, increased urination, and dehydration C. Increased weight loss, dehydration, and fatigue D. Increased weight gain, appetite, and thirst

A

A patient who is 6 months' pregnant was evaluated for gestational diabetes mellitus. The doctor considered prescribing insulin based on the serum glucose result of: A. 138 mg/dL, 2 hours postprandial. B. 120 mg/dL, 1 hour postprandial. C. 80 mg/dL, 1 hour postprandial. D. 90 mg/dL before meals.

A

For a client with hyperglycemia, which assessment finding best supports a nursing diagnosis of Deficient fluid volume? A. Increased urine osmolarity B. Jugular vein distention C. Decreased serum sodium level D. Cool, clammy skin

A

Which clinical characteristic is associated with type 2 diabetes (previously referred to as non-insulin-dependent diabetes mellitus)? A. Blood glucose can be controlled through diet and exercise B. Clients demonstrate islet cell antibodies C. Client is usually thin at diagnosis D. Client is prone to ketosis

A

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

A

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

B

A client with diabetes mellitus must learn how to self-administer insulin. The physician has ordered 10 units of U-100 regular insulin and 35 units of U-100 isophane insulin suspension (NPH) to be taken before breakfast. When teaching the client how to select and rotate insulin injection sites, the nurse should provide which instruction? A. "Administer insulin into sites above muscles that you plan to exercise heavily later that day." B. "Inject insulin into healthy tissue with large blood vessels and nerves." C. "Rotate injection sites within the same anatomic region, not among different regions." D. "Administer insulin into areas of scar tissue or hypertrophy whenever possible."

C

A nurse educates a group of clients with diabetes mellitus on the prevention of diabetic nephropathy. Which of the following suggestions would be most important? A. Take the antidiabetic drugs regularly. B. Drink plenty of fluids. C. Control blood glucose levels. D. Eat a high-fiber diet.

C

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

A nurse is preparing to administer two types of insulin to a client with diabetes mellitus. What is the correct procedure for preparing this medication? A. The short-acting insulin is withdrawn before the intermediate-acting insulin. B. The intermediate-acting insulin is withdrawn before the short-acting insulin. C. Different types of insulin are not to be mixed in the same syringe. D. If administered immediately, there is no requirement for withdrawing one type of insulin before another.

A

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 decreases the intestinal absorption of glucose. C. It stimulates the pancreatic beta cells. D. It aids in the process of gluconeogenesis.

A

What is the duration of regular insulin? A. 4 to 6 hours B. 3 to 5 hours C. 12 to 16 hours D. 24 hours

A

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. 18 to 20 g of a simple carbohydrate. B. 10 to 15 g of a simple carbohydrate. C. 2 to 5 g of a simple carbohydrate. D. 25 to 30 g of a simple carbohydrate.

B

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

B

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 reduce postprandial glucose levels B. Decrease the need for exogenous insulin C. Increase potassium levels D. May improve blood glucose levels E. Help reduce cholesterol levels

B, D, E

A client has been recently diagnosed with type 2 diabetes, and reports continued weight loss despite increased hunger and food consumption. This condition is called: A. polyuria. B. anorexia. C. polyphagia. D. polydipsia.

C

A client newly diagnosed with diabetes mellitus asks why he needs ketone testing when the disease affects his blood glucose levels. How should the nurse respond? A. "Ketones help the physician determine how serious your diabetes is." B. "The spleen releases ketones when your body can't use glucose." C. "Ketones will tell us if your body is using other tissues for energy." D. "Ketones can damage your kidneys and eyes."

C

A client with a history of type 1 diabetes is demonstrating fast, deep, labored breathing and has fruity odored breath. What could be the cause of the client's current serious condition? A. All options are correct. B. hyperosmolar hyperglycemic nonketotic syndrome C. ketoacidosis D. hepatic disorder

C

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

C

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. Elevated triglycerides C. Urinary tract infections D. Lifelong obesity

C

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

C

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

C

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

A client with diabetes comes to the clinic for a follow-up visit. The nurse reviews the client's glycosylated hemoglobin test results. Which result would indicate to the nurse that the client's blood glucose level has been well controlled? A. 7.5% B. 8.5% C. 8.0% D. 6.5%

D

A nurse expects to note an elevated serum glucose level in a client with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which other laboratory finding should the nurse anticipate? A. Serum alkalosis B. Elevated serum acetone level C. Serum ketone bodies D. Below-normal serum potassium level

D

A nurse is assessing a client who is receiving total parenteral nutrition (TPN). Which finding suggests that the client has developed hyperglycemia? A. Cheyne-Stokes respirations B. Decreased appetite C. Diaphoresis D. Increased urine output

D

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

D

The pancreas continues to release a small amount of basal insulin overnight, while a person is sleeping. The nurse knows that if the body needs more sugar: A. Insulin will be released to facilitate the transport of sugar. B. The process of gluconeogenesis will be inhibited. C. Glycogenesis will be decreased by the liver. D. The pancreatic hormone glucagon will stimulate the liver to release stored glucose.

D

A client is admitted with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which laboratory finding should the nurse expect in this client? A. Arterial pH 7.25 B. Plasma bicarbonate 12 mEq/L C. Blood urea nitrogen (BUN) 15 mg/dl D. Blood glucose level 1,100 mg/dl

D

Which combination of adverse effects should a nurse monitor for when administering IV insulin to a client with diabetic ketoacidosis? A. Hypernatremia and hypercalcemia B. Hyperkalemia and hyperglycemia C. Hypocalcemia and hyperkalemia D. Hypokalemia and hypoglycemia

D

Which is a by-product of fat breakdown in the absence of insulin and accumulates in the blood and urine? A. Creatinine B. Hemoglobin C. Cholesterol D. Ketones

D