N172 week 3 evolve quiz DM
Which statement made by a client recently diagnosed with type 1 diabetes indicates that further education is necessary regarding the teaching plan? "I will need to have my eyes and vision examined once a year." "I will need to check my blood sugar at home to evaluate my response to my treatment plan." "I can improve metabolic and cardiac risk factors of this disease if I follow a healthy diet and exercise routine." "Once l get my glucose levels under control, there is a good chance that I will be able to switch from insulin to an oral medication."
"Once l get my glucose levels under control, there is a good chance that I will be able to switch from insulin to an oral medication." Rationale Type 1 diabetes mellitus (DM) is an autoimmune disorder in which beta cells are destroyed. No insulin or very little insulin is produced. A person with type 1 DM will need lifelong insulin injections to control blood sugar. Early detection of changes in the eye permits treatment plan adjustments that can slow or halt progression of retinopathy. Blood glucose monitoring should be done at home to evaluate the treatment plan. Disease risk factors can be improved with a healthy diet and exercise routine.
Which result would the nurse expect to find when assessing the laboratory values of a client with type 2 diabetes? Ketones in the blood but not in the urine Glucose in the urine but not in the blood Urine and blood positive for glucose and ketones Urine negative for ketones and positive glucose in the blood
Urine negative for ketones and positive glucose in the blood Rationale The reason for the lack of ketonuria in type 2 diabetes is unknown. One theory is that extremely high hyperglycemia and hyperosmolarity levels block the formation of ketones, stimulating lipogenesis rather than lipolysis. Ketones in the blood but not in the urine do not occur with type 2 diabetes. Glucose in the urine but not in the blood is impossible; if glycosuria is present, there must first be a level of glucose in the blood exceeding the renal threshold of 160 to 180 mg/dL (8.9-10 mmol/L). Urine and blood positive for glucose and ketones are expected in type 1 diabetes.
Which finding would lead the nurse to recheck the blood glucose level of a diabetic client before administering a mealtime insulin dose? Select all that apply. One, some, or all responses may be correct. Confusion Drowsiness Diaphoresis Nervousness Heart rate 110 beats/min
Confusion Drowsiness Diaphoresis Nervousness Heart rate 110 beats/min Rationale Signs of hypoglycemia include confusion, drowsiness, diaphoresis, nervousness, tachycardia, and headache. The nurse would recheck the blood glucose level of a diabetic client with these symptoms to avoid worsening hypoglycemia caused by administration of additional insulin.
Which factors can predispose a client with type 1 diabetes to a diabetic ketoacidotic coma? Select all that apply. One, some, or all responses may be correct. Taking too much insulin Getting too much exercise Excessive emotional stress Running a fever with the flu Eating fewer calories than prescribed
Excessive emotional stress Running a fever with the flu Rationale Emotional stress stimulates the sympathetic nervous system, which releases glucocorticoids, ultimately increasing the blood glucose level. The stress of an infection increases metabolism and the production of glucocorticoids, resulting in an elevated blood glucose level. Too much insulin will precipitate insulin coma (hypoglycemia). Exercise uses glucose for muscle contraction, decreasing the blood glucose level; this may precipitate insulin coma (hypoglycemia). Not eating enough calories in relation to the amount of insulin received may precipitate insulin coma (hypoglycemia).
Which condition would cause a nontender 5-cm indurated region on the upper arm of a client with type 1 diabetes who says to the nurse, "That is where I give myself insulin shots." ? Callus An allergy An infection Lipodystrophy
Lipodystrophy Rationale Lipodystrophy is a noninflammatory reaction causing localized atrophy or hypertrophy and a localized increase in collagen deposits. Injections of insulin will not cause a horny growth such as a wart or callus. An allergic response will precipitate a localized or systemic inflammatory response. Hyperthermia and localized heat, erythema, and pain are associated with an infection.
The nurse is teaching a client newly diagnosed with type 1 diabetes about self-care. Which is the primary long-term goal? Maintaining normoglycemia Complying with the diabetic diet Adhering to an exercise program Developing a nonstressful lifestyle
Maintaining normoglycemia Rationale Maintaining normoglycemia is a realistic goal because it decreases the risk of complications such as neuropathy, retinopathy, and atherosclerosis. A regimen of insulin, exercise, and diet will help the client achieve this goal. Compliance with a diabetic diet is an objective because it will help achieve the long-term goal; diet alone is insufficient to achieve normoglycemia. Adherence to an exercise program is an objective because it will help achieve the long-term goal; exercise alone is insufficient to achieve normoglycemia. Development of a lower stress lifestyle is a worthwhile goal, but developing a nonstressful lifestyle is not realistic.
Which time range would a nurse teach as the highest risk for hypoglycemia to a client with type 1 diabetes who self-administers neutral protamine Hagedorn (NPH) insulin every morning at 8:00 AM? 9:00 AM to 10:00 AM 10:00 AM to 11:00 AM Noon to 8:00 PM 8:00 PM to midnight
Noon to 8:00 PM Rationale The time of greatest risk for hypoglycemia occurs when the insulin is at its peak. The action of intermediate-acting insulin peaks in 4 to 12 hours. Nine to 10:00 AM and 10:00 AM to 11:00 AM are too soon for NPH to produce a hypoglycemic response. A hypoglycemic response that occurs 45 to 60 minutes after administration is associated with rapid-acting insulins. NPH insulin will have produced a hypoglycemic response before 8:00 PM and after noon.
Metformin 2 g by mouth is prescribed for a client with type 2 diabetes. Each tablet contains 500 mg. How many tablets will the nurse administer? Record your answer using a whole number.
Rationale First, convert the prescribed dose (2 g) to the available dose (mg). 2g x 1000 mg = 2000 mg Then, use the dimensional analysis and/or ratio and proportion methods to determine the appropriate number of tablets to be administered. 2000 mg x 1 tablet/500 mg = 4 tablets.
Which eye problem is the leading cause of blindness in clients with diabetes? Cataracts Glaucoma Retinopathy Astigmatism
Retinopathy Rationale Diabetic retinopathy is a leading cause of blindness in diabetics. Glaucoma and cataracts also are associated with diabetes, but retinopathy is the most common eye problem. Astigmatism is not associated with diabetes.
Which rationale explains why intravenous (IV) potassium is prescribed in addition to regular insulin for clients in diabetic ketosis? Potassium loss occurs rapidly from diaphoresis present during coma. Potassium is carried with glucose to the kidneys to be excreted in the urine in increased amounts. Potassium is quickly used up during the rapid series of catabolic reactions stimulated by insulin and glucose. Serum potassium levels will decrease as potassium ions shift from the extracellular fluid to the intracellular fluid compartment.
Serum potassium levels will decrease as potassium ions shift from the extracellular fluid to the intracellular fluid compartment. Rationale Insulin stimulates cellular uptake of glucose and stimulates the sodium/potassium pump, leading to the influx of potassium into cells. The resulting hypokalemia is offset by parenteral administration of potassium. Potassium is not lost from the body by profuse diaphoresis. Potassium moves from the extracellular to the intracellular compartment rather than being excreted in the urine. Anabolic reactions are stimulated by insulin and glucose administration; potassium is drawn into the intracellular compartment, necessitating a replenishment of extracellular potassium.
The nurse is counseling a client with type 1 diabetes about choosing food items that are low in carbohydrate (CHO) content. Which food selection made by the client indicates effective teaching? Skim milk Apple juice Nonfat yogurt Fresh orange juice
Skim milk Rationale Skim milk contains about 12 g of CHO per cup. There are about 30 g CHO in 1 cup of apple juice. There are about 16 g CHO in 1 cup of nonfat yogurt. There are about 25 g CHO in 1 cup of orange juice.
While hospitalized, a client with diabetes is observed picking at calluses on the feet. Which intervention would the nurse implement immediately? Warn the client of the danger of infection. Suggest that the client wear white cotton socks. Teach the client the importance of effective foot care. Check the client's shoes for their fit in the area of the calluses.
Teach the client the importance of effective foot care. Rationale Inadequate foot care can lead to skin breakdown, poor healing, and subsequent infection, so the nurse should teach the client the importance of effective food care. Warning the client of the danger of infection can increase anxiety and reduce the client's ability to learn. Suggesting that the client wear white cotton socks is only one aspect of effective foot care; synthetic fibers that wick moisture are preferred. Although important, checking the client's shoes for their fit in the area of the calluses is not comprehensive foot care.
Which rationale explains a client's serum glucose level increasing to 240 mg/dL (13.3 mmol/L) six hours after initiation of total parenteral nutrition? The solution is too concentrated. The infusion is flowing too rapidly. The solution is exacerbating preexisting diabetes. The infusion is too slow to meet total nutritional needs.
The infusion is flowing too rapidly. Rationale Rapid infusion of concentrated glucose into the vascular system does not allow time for adequate insulin release to transport glucose to the cells. A hyperconcentrated solution usually results in hypervolemia rather than hyperglycemia. There is no evidence that the client has diabetes mellitus. If the infusion was too slow, the blood glucose level would not increase to 240 mg/aL (13.3 mmol/L).
Which information would the nurse provide a client with diabetes mellitus (DM) regarding alcohol consumption? • Before meals • One drink per week Complete abstinence • With or shortly after meals
With or shortly after meals Rationale A person with DM should only drink alcohol with or shortly after meals to prevent alcohol - induced delayed hypoglycemia. Alcohol should not be consumed before meals. The client with DM does not need to limit to one drink per week nor completely abstain from drinking.
The nurse teaches a client with type 2 diabetes how to provide self-care to prevent infections of the feet. Which statement made by the client shows that teaching was effective? "I should massage my feet and legs with oil or lotion." "I should apply heat intermittently to my feet and legs." "I should eat foods high in protein and carbohydrate kilocalories." "I should control my blood glucose with diet, exercise, and medication."
"I should control my blood glucose with diet, exercise, and medication." Rationale Controlling the diabetes decreases the risk of infection; this is the best prevention. Oil or lotion that is not completely absorbed may provide a warm, moist environment for bacterial growth. Coexisting neuropathy may result in injury from heat application. Protein, carbohydrates, and fats must be in an appropriate balance; high carbohydrate intake can provide too many calories.
The primary health care provider prescribes daily fasting blood glucose levels for a client with diabetes mellitus. Which is the goal of fasting glucose levels for a client with diabetes mellitus? • 40 to 65 mg/dL (2.2-3.6 mmol/L) of blood • 70 to 105 mg/dL (3.9-5.8 mmol/L) of blood • 110 to 145 mg/dL (6.1-8.0 mmol/L) of blood • 150 to 175 mg/dL (8.3-9.7 mmol/L) of blood
70 to 105 mg/dL (3.9-5.8 mmol/L) of blood Rationale The range of 70 to 105 mg/dL (4-6 mmol/L) of blood is the expected range for blood glucose. The range of 40 to 65 mg/dL (2.2-3.6 mmol/L) of blood is indicative of hypog ycemia. The ranges 110 to 145 mg/dL (6.1-8.0 mmol/L) of blood and 150 to 175 mg/dL (8.3-9.7 mmol/L) of blood are indicative of hypoglycemia.
Which laboratory value supports the presence of diabetic ketoacidosis in a client with type 1 diabetes? Decreased serum glucose levels Decreased serum calcium levels Increased blood urea nitrogen levels Increased serum bicarbonate levels
Increased blood urea nitrogen levels Rationale With diabetic ketoacidosis, blood urea nitrogen level generally is increased because of dehydration. With diabetic ketoacidosis, the serum glucose levels are generally greater than 300 mg/dL (16.7 mmol/L). The calcium level is unrelated to diabetic ketoacidosis. Serum bicarbonate levels are less than 15 mEq/L (15 mmol/L).
Which arterial blood gas results are associated with diabetic ketoacidosis? PH: 7.28; Pco 2: 28; HCO 3: 18 pH: 7.30; Pco 2: 54; HCO 3: 28 pH: 7.50; Pco 2: 49; HCO 3: 32 pH: 7.52; Pco 2: 26; HCO 3: 20
PH: 7.28; Pco 2: 28; HCO 3: 18 Rationale Diabetic ketoacidosis would be associated with metabolic acidosis, which is reflected by a low pH and bicarbonate; a low Pco 2 indicates compensatory hyperventilation. A low pH and elevated Pco 2 reflect hypoventilation and respiratory acidosis. An elevated pH and bicarbonate reflect metabolic alkalosis; an elevated Pco 2 indicates compensatory hypoventilation. An elevated pH and low Pco 2 reflect hyperventilation and respiratory alkalosis.
Which is an appropriate teaching goal for a client who is newly diagnosed as having type 2 diabetes? • To perform foot care weekly • To administer insulin as prescribed • To test urine for both sugar and acetone • To identify symptoms of hypoglycemia or hyperglycemia
• To identify symptoms of hypoglycemia or hyperglycemia Rationale Knowledge of the signs and symptoms for hypoglycemia or hyperglycemia is critical to the client's health and well-being and essential for survival. Although performing foot care is important, it should be done daily. The client has type 2 diabetes, which is usually controlled by oral hypoglycemic, not insulin. Self-serum glucose monitoring is more accurate than sugar and acetone urine measurements to identify serum glucose levels.
A client who is 60 pounds (27.2 kg) more than the ideal body weight is admitted to the hospital with a diagnosis of type 1 diabetes. Which concept would the nurse include in teaching about diabetes when discussing strategies to lose weight? Obesity leads to insulin resistance. Surplus fat causes excretion of insulin. Fat cells absorb insulin and prevent its circulation to other cells. Lipids accumulate in the pancreas and interfere with insulin production.
Obesity leads to insulin resistance. Rationale Excess fat alters glucose metabolism, causing cells to become insulin resistant. Fat cells have no relationship to the function of the kidneys. Fat cells do not absorb insulin and therefore do not prevent the circulation of insulin to other cells. Clients with type 1 diabetes do not produce insulin. If lipids should accumulate in the pancreas of a healthy adult, they do not interfere with insulin production.
The nurse is assessing a client admitted with diabetic ketoacidosis. Which statement made by the client indicates a need for further education on sick day management? "I will stop taking my insulin when I am ill because I am not eating." "I will check my urine for ketones when my blood sugar is over 250." "I will alternate drinking Gatorade and water throughout the day while ill." "I will continue all my insulin including my glargine when I am sick."
"I will stop taking my insulin when I am ill because I am not eating." Rationale The diabetic client's metabolic needs will require the same amount of insulin and sometimes more when in a stressed state, including illness. The client checking the urine for ketones when blood sugar is more than 250, alternating water and Gatorade intake, and continuing insulin indicate that the client has an understanding of the basic sick day rules. Alternating the intake of water and Gatorade throughout the day provides noncarbohydrate water and fluids containing glucose and electrolytes while reducing the risk of consuming too much sugar.
Which manifestation would the nurse include when teaching a client about ketoacidosis? Select all that apply. One, some, or all responses may be correct. Confusion Hyperactivity Excessive thirst Fruity-scented breath Decreased urinary output
Confusion Excessive thirst Fruity-scented breath Rationale Diabetic ketoacidosis signs and symptoms often develop quickly, sometimes within 24 hours. Diabetic ketoacidosis is a serious complication of diabetes that occurs when the body produces high levels of ketones (blood acids). Diabetic ketoacidosis develops when the body is unable to produce enough insulin. Without enough insulin, the body begins to break down fat as an alternative fuel. This process produces a buildup of ketones (toxic acids) in the bloodstream, eventually leading to diabetic ketoacidosis if untreated. Signs and symptoms include confusion, excessive thirst, fruity-scented breath, frequent urination, nausea and vomiting, abdominal pain, weakness or fatigue, and shortness of breath. Weakness or fatigue, not hyperactivity, is a symptom. Frequent urination, not decreased urination, is a symptom.
The nurse is formulating a teaching plan for a client recently diagnosed with type 2 diabetes. Which interventions would the nurse include to decrease the risk of complications? Select all that apply. One, some, or all responses may be correct. Examine the feet daily. Wear well-fitting shoes. Perform regular exercise. Powder the feet after showering. Visit the primary health care provider weekly. Test bathwater with the toes before bathing.
Examine the feet daily. Wear well-fitting shoes. Perform regular exercise. Rationale Clients with diabetes often have peripheral neuropathies and are unaware of discomfort or pain in the feet; the feet should be examined every night for signs of trauma. Well-fitting shoes prevent pressure and rubbing that can cause tissue damage and the development of ulcers. Daily exercise increases the uptake of glucose by the muscles and improves insulin use. Powdering the feet after showering may cause a pastelike residue between the toes that may macerate the skin and promote bacterial and fungal growth. Generally, visiting the primary health care provider weekly is unnecessary. Clients with diabetes often have peripheral neuropathy and are unable to accurately evaluate the temperature of bathwater, which can result in burns if the water is too hot.
Which intervention would the nurse implement for a client who has type 1 diabetes and has an elevated blood glucose? Administer an oral hypoglycemic. Institute urine glucose monitoring Give supplemental doses of regular insulin. Decrease the rate of the intravenous infusion.
Give supplemental doses of regular insulin. Rationale The blood glucose level needs to be reduced; regular insulin begins to act in 30 to 60 minutes. The client has type 1, not type 2, diabetes, and an oral hypoglycemic will not be effective. Blood glucose levels are far more accurate than urine glucose levels. The rate may be increased because polyuria often accompanies hyperglycemia.
Which increased risk would the nurse consider when assessing a client with diabetes who is receiving long-term corticosteroid therapy and is admitted with leg ulcers? Weight loss Hypoglycemia Decreased blood pressure Inadequate wound healing
Inadequate wound healing Rationale Because the anti-inflammatory response is depressed as a result of increased cortisol levels, the wounds of clients receiving long-term corticosteroid therapy tend to heal slowly. A common finding associated with long-term corticosteroid use is weight gain, caused not only by fluid retention but also by alterations in fat, carbohydrate, and protein metabolism. Persistent hyperglycemia (steroid diabetes) occurs because of altered glucose metabolism. Hypertension, not hypotension, occurs as a result of sodium and fluid retention.
Which advice will the nurse provide to a client who is taking an oral hypoglycemic daily for type 2 diabetes who develops an infection with anorexia? Select all that apply. One, some, or all responses may be correct. -Avoid solid food. -Continue to take the oral medication. -Drink fluids throughout the day. -Monitor capillary glucose levels. -Do not take medication until tolerating food.
Continue to take the oral medication. Drink fluids throughout the day. Monitor capillary glucose levels. Rationale Physiological stress increases gluconeogenesis, requiring continued pharmacological therapy despite an inability to eat; fluids prevent dehydration; monitoring of glucose levels permits early intervention if necessary. Skipping the oral hypoglycemic agent may precipitate hyperg lycemia. Food intake will be attempted to prevent acidosis. Delaying an oral hypoglycemic agent may precipitate hyperglycemia.
A client's fasting plasma glucose levels are being evaluated. The nurse identifies that the client is considered to be diabetic if the results are within which range? 40 to 60 mg/dL (2.2-3.3 mmol/L) • 80 to 99 mg/dL (4.5-5.5 mmol/L) • 100 to 125 mg/dL (5.6-6.9 mmol/L) 126 to 140 mg/dL (7.0-7.8 mmol/L)
126 to 140 mg/dL (7.0-7.8 mmol/L) Rationale Results in the range 126 to 140 mg/dL (7.0-7.8 mmol/L) indicate diabetes. Results in the range 40 to 60 mg/dL (2.2-3.3 mmol/L) indicate hypoglycemia. Results in the range 80 to 99 mg/dL (4.5-5.5 mmol/L) are considered expected (normal). Results in the range 100 to 125 mg/dL (5.6-6.9 mmol/L) indicate prediabetes according to the American Diabetes Association. Results in the range of 6.1-6.9 mmol/L indicate prediabetes according to the Canadian Diabetes Association Guidelines.
Which statement by a client with type 2 diabetes indicates to the nurse that additional dietary teaching is needed? "| can eat as much dietetic fruit as I want." "I can have a lettuce salad whenever I want it." "I know that half of my diet should be carbohydrates." "I need to reduce the amounts of saturated fats in my diet."
"| can eat as much dietetic fruit as I want." Rationale The client needs further teaching; dietetic fruit is not sugar free and must be calculated in a diabetic individual's diet. Lettuce is considered a free food in the diet of a diabetic person. It is suggested that the caloric intake of a diabetic person's diet should be 50% carbohydrate, 20% protein, and 30% fat. Saturated fats should be limited to 10% of the fat intake; 90% of fat should be unsaturated fats.
Which insulin will the nurse prepare for the emergency treatment of ketoacidosis? Glargine NPH insulin Insulin aspart Insulin detemir
Insulin aspart Rationale Insulin aspart is a rapid-acting insulin (within 10-20 minutes) and is used to meet a client's immediate insulin needs. Glargine is a long-acting insulin, which has an onset of 1.5 hours; for diabetic ketoacidosis, the individual needs rapid-acting insulin. NPH insulin is an intermediate-acting insulin, which has an onset of 1 to 2 hours; for diabetic ketoacidosis, the individual needs rapid-acting insulin. Insulin detemir is a long-acting insulin; for diabetic ketoacidosis, the individual needs rapid-acting insulin.
A client with type 1 diabetes for 25 years states, "I have been really bad for the past 15 years. I have not paid attention to my diet and have done little to control my diabetes." Which common complications of diabetes might the nurse expect to identify when assessing this client? Select all that apply. One, some, or all responses may be correct. Leg ulcers Loss of visual acuity Thick, yellow toenails Increased growth of body hair Decreased sensation in the feet
Leg ulcers Loss of visual acuity command Thick, yellow toenails Decreased sensation in the feet Rationale Leg ulcers are a common response to the microvascular and macrovascular changes associated with diabetes. Retinopathy, damage to the microvascular system of the retina (e.g., edema, exudate, and local hemorrhage), occurs as a result of the occlusion of the small vessels in the eyes, causing microaneurysms in the capillary walls. Thick, yellow toenails result from prolonged inadequate arterial circulation to the feet. Pedal pulses diminish, which can result in gangrene, necessitating amputation. Diabetic neuropathies affect 60% to 70% of people with diabetes. It is theorized that consistent hyperglycemia causes a buildup of sorbitol and fructose in the nerves that results in impairment via an unknown process. Inadequate arterial circulation to hair follicles results in a lack of hair on the feet and ankles. The skin becomes dry and cracks, predisposing it to leg ulcers and infection.
Which manifestation may indicate that the client with type 1 diabetes has insulin-induced hypoglycemia? Select all that apply. One, some, or all responses may be correct. Excessive hunger Weakness Diaphoresis Excessive thirst Deep respirations
Excessive hunger Weakness Diaphoresis Rationale Excessive hunger is associated with hypoglycemia because the body needs glucose for cellular metabolism. Hypoglycemia affects the central nervous system, causing weakness. Hypoglycemia affects the sympathetic nervous system, causing diaphoresis. Excessive thirst is associated with hyperglycemia because fluid shifts, along with the excess glucose being excreted by the kidneys, resulting in polyuria. Deep respirations (Kussmaul respirations) are associated with hyperglycemia because the body is attempting to blow off carbon dioxide to compensate for metabolic acidosis.
Which nursing instruction would the nurse provide to a diabetic client who developed renal disease? Select all that apply. One, some, or all responses may be correct. -Recommend the client drink boiled water -Suggest the client go for morning walks. -Instruct the client to check their blood pressure regularly. -Direct the client to contact their primary health care provider before taking ibuprofen. -Encourage the client to undergo a microalbuminuria test yearly.
-Instruct the client to check their blood pressure regularly. -Direct the client to contact their primary health care provider before taking ibuprofen. -Encourage the client to undergo a microalbuminuria test yearly. Rationale High blood pressure affects normal kidney function. Clients with renal disease must monitor blood pressure because increased blood pressure can damage the vessel walls of the kidneys, thereby causing kidney damage and leading to kidney failure. Clients with renal disease would be encouraged to check their blood pressure regularly. Drugs such as ibuprofen are potent nephrotoxic agents; therefore the client must contact their primary health care provider before ingestion to avoid further complications. Diabetic clients would undertake a microalbuminuria test yearly to determine the risk of developing end-stage kidney disease. Drinking boiled water may reduce the risk of infections; however, this instruction is less beneficial than the other interventions. Going for a walk will improve the overall health of the client, but it is not a specific intervention related to kidney function.
Which cellular process associated with type 1 diabetes mellitus results in increased client fatigue? Increased metabolism at the cellular level Increased glucose absorption from the intestine Decreased production of insulin by the pancreas Decreased glucose secretion into the renal tubules Rationale Insulin facilitates transport of glucose across the cell membrane to meet metabolic needs and prevent fatigue. With diabetes there is decreased cellular metabolism because of the decrease in glucose entering the cells. Glucose is not absorbed from the intestinal tract by the cells; fatigue is caused by decreased, not increased, cellular levels of glucose. Filtration and excretion of glucose by the kidneys do not regulate energy levels; if insulin production is adequate, glucose does not spill into the urine.
Decreased production of insulin by the pancreas Rationale Insulin facilitates transport of glucose across the cell membrane to meet metabolic needs and prevent fatigue. With diabetes there is decreased cellular metabolism because of the decrease in glucose entering the cells. Glucose is not absorbed from the intestinal tract by the cells; fatigue is caused by decreased, not increased, cellular levels of glucose. Filtration and excretion of glucose by the kidneys do not regulate energy levels; if insulin production is adequate, glucose does not spill into the urine.
A client with type 1 diabetes has dry, hot, flushed skin; a fruity odor to the breath; and is having Kussmaul respirations. Which complication does the nurse suspect that the client is experiencing? Ketoacidosis Somogyi phenomenon Hypoglycemic reaction Hyperosmolar nonketotic coma
Ketoacidosis Rationale Ketoacidosis occurs when insulin is lacking and carbohydrates cannot be used for energy; this increases the breakdown of protein and fat, causing deep, rapid respirations (Kussmaul respirations), decreased alertness, decreased circulatory volume, metabolic acidosis, and an acetone breath. The Somogyi phenomenon is a rebound hyperglycemia induced by severe hypoglycemia; there are not enough data to determine whether this occurred. Hypoglycemia is manifested by cool, moist skin, not hot, dry skin; Kussmaul respirations do not occur with hypoglycemia. Hyperosmolar nonketotic coma usually occurs in clients with type 2 diabetes because available insulin prevents the breakdown of fat.
Which information will the nurse include when teaching a client with type 1 diabetes about the use of an insulin pump? Insulin pumps mimic the way a healthy pancreas works. The insulin pump's needle should be changed every day. Pumps are implanted in a subcutaneous pocket near the abdomen. The insulin pump's advantage is that it only requires glucose monitoring once a day.
Insulin pumps mimic the way a healthy pancreas works. Rationale The basal infusion rate mimics the low rate of insulin secretion during fasting, and the bolus before meals mimics the high output after meals. The subcutaneous needle may be left in place for as long as 3 days. Most insulin pumps are external to the body and access the body via a subcutaneous needle. Blood glucose monitoring is done a minimum of four times a day.
When determining the main difference between type 1 and type 2 diabetes, the nurse recognizes which clinical presentation about type 1? Onset of the disease is slow. Excessive weight is a contributing factor. Complications are not present at the time of diagnosis. Treatment involves diet, exercise, and oral medications.
Complications are not present at the time of diagnosis. Rationale Clinical presentation of type 1 diabetes is characterized by acute onset, and there is no time to develop the long-term complications that are common with long-standing disease; 20% of newly diagnosed clients with type 2 diabetes demonstrate complications because the diabetes has gone undetected for an extended period of time. Clinical presentation of type 1 diabetes is rapid, not slow, because pancreatic beta cells are destroyed by an autoimmune process; in type 2 diabetes, the body is still producing some insulin, and the onset of signs and symptoms is slow. In type 1 diabetes, clients are generally lean or have an ideal weight; 80% to 90% of clients with type 2 diabetes are overweight. Type 1 diabetes requires diet control, exercise, and subcutaneous administration of insulin, not oral medications; oral medications are used for type 2 diabetes because some insulin is still being produced.
Which short-term goal is the priority for a client with a new insulin pump who is receiving discharge instructions? Plan daily intake incorporating diabetic diet guidelines. Demonstrate proper subcutaneous insulin injection technique. Demonstrate correct use of the insulin pump. List three self-care activities that help control the diabetes.
Demonstrate correct use of the insulin pump. Rationale Demonstrating correct use of the insulin pump is the short-term, client-oriented goal necessary for the client to manage the pump and avoid hypoglycemia and hyperglycemia; this outcome can be measured by observing a return demonstration by the client. Adhering to the medical regimen is not a short-term goal; it is a plan to obtain glucose control. Planning daily intake around a diabetic diet is important but will not control glucose levels to the extent that using an insulin pump will. Mastering subcutaneous insulin injection technique is not a priority for the client who will be using the insulin pump to deliver insulin except as a backup plan. Although listing three self-care activities that help control the diabetes is a measurable short-term goal, it is not the priority when the client must master use of the insulin pump.
Which instruction about medications would the nurse include when teaching a client with type 1 diabetes who tells the nurse, "I take guaifenesin cough syrup when I have a cold.? "Substitute an elixir for the cough syrup." "Increase fluid intake and use a humidifier to control the cough." "The small amounts of sugar in medications are not a concern with diabetes." "Include the glucose in the cough syrup when calculating daily carbohydrate allowance."
"Include the glucose in the cough syrup when calculating daily carbohydrate allowance." Rationale Cough syrup contains a glucose base; the client should use a glucose-free product or account for the glucose. Elixirs contain natural sweeteners. Although increasing fluid intake and using a room humidifier will also loosen secretions, this does not include important information about the medication. Additional sweeteners, even the amounts in medications, may increase serum glucose levels beyond the desired range; once control is achieved, it is unwise to alter dietary intake or medications without supervision.
How will the nurse respond to a client with a new diagnosis of type 1 diabetes who becomes agitated and says, "I am scared of shots. If that is my only option, I'll just have to go into a coma and die!" when told that lifelong insulin will be needed? "Injections are not the only option available for insulin." "It won't be so bad; you will get used to it if you will only try." • "This is one of those times when you need to act like an adult." • "Clients have the right to refuse treatment, but I need you to sign this form that removes us from liability for your decision."
"Injections are not the only option available for insulin." Rationale An insulin nasal spray was approved by the Food and Drug Administration (FDA) in 2014 and is available for clients who do not want insulin injections. The nurse should use therapeutic communication in interacting with clients. Intimidating the client by suggesting that actions are childlike and suggesting that the client's concerns are not significant are not therapeutic responses. The nurse's primary concern should be for the client's well-being, not protection from liability.
Which action would be taken by the nurse caring for a client with type 1 diabetes mellitus who has a finger-stick glucose level of 258 mg/dL (14.3 mmol/L) at bedtime and a prescription for sliding-scale regular insulin? Call the health care provider. Encourage intake of fluids. Administer the insulin as prescribed. Give the client 4 ounces of orange juice.
Administer the insulin as prescribed. Rationale A value of 258 mg/dL (14.3 mmol/L) is above the expected range of 70 to 100 mg/dL (3.6-5.6 mmol/L); the nurse would administer the regular insulin as prescribed. Calling the health care provider is unnecessary; a prescription for insulin exists and should be implemented. Encouraging the intake of fluids is insufficient to lower a glucose level this high. Giving the client orange juice is contraindicated because this will increase the glucose level further. Orange juice, a complex carbohydrate, and a protein should be given if the glucose level is too low.
