NU473 Week 5: Evolve Elsevier EAQ Diabetes - 26 Questions

A client with type 2 diabetes has been receiving insulin in the hospital while being treated for sepsis. The client's infection is resolving and the primary health care provider writes a prescription to discontinue the 7:00 AM dose of insulin and to administer glyburide 5 mg twice daily. After administering the glyburide at 8:30 AM, the nurse sees that the insulin had already been administered at 7:00 AM. Which initial action would the nurse take? o Measure the vital signs. o Notify the primary health care provider. o Administer 15 G of fast acting carbohydrates o Check blood glucose for hypoglycemia.

o Check blood glucose for hypoglycemia. · Checking blood glucose level for signs of hypoglycemia is a priority because both these medications can lower the blood sugar. When any medication error is discovered, the first step is assessing the client. Also, before notifying the primary health care provider, it is essential to have as much information as possible; the primary health care provider will need to know the client's blood sugar. In addition, if the blood sugar is low and the client is responsive and alert, the nurse can provide an immediate snack. Not immediately assessing for or not treating symptoms of hypoglycemia delays care of the client. Although measuring the vital signs may be done eventually, it is not the priority because the error was identified before the oral glyburide had time to precipitate an effect. Administering 15 G of fast acting carbohydrates would not be done initially; a blood glucose level would be checked first.

Which sign or symptom would the nurse expect to find on assessment of a client with a blood glucose level of 55 mg/dL? Select all that apply. o Increased thirst o Abdominal pain o Frequent urination o Cold, clammy skin o 3+ glucose in urinalysis

o Cold, clammy skin · A client with a blood glucose level of 55 mg/dL indicates hypoglycemia. Clinical manifestations would include cold, clammy skin; tachycardia; nervousness; and slurred speech. A client with hyperglycemia would present with increased thirst (polydipsia), abdominal pain, increased urination (polyuria), and polyphagia. The client with hyperglycemia would have glycosuria.

A client experiences ineffective control of type 1 diabetes. The client's study results indicate that a sudden decrease in blood glucose level is followed by rebound hyperglycemia. When this event occurs, which action would the nurse take? o Give the client 8 oz (240 mL) of orange juice. o Seek a prescription to increase the insulin dose at bedtime. o Encourage the client to eat smaller, more frequent meals. o Collaborate with the primary healthcare provider to alter the insulin prescription.

o Collaborate with the primary healthcare provider to alter the insulin prescription. · The client is experiencing the Somogyi effect. It is a paradoxical situation in which sudden decreases in blood glucose are followed by rebound hyperglycemia. The body responds to the hypoglycemia by secreting glucagon, epinephrine, growth hormone, and cortisol to counteract the low blood sugar; this results in an excessive increase in the blood glucose level. It most often occurs in response to hypoglycemia when asleep. The primary health care provider may choose to decrease the insulin dose and then reassess the client. Giving the client 8 oz (240 mL) of orange juice will further increase the serum glucose level and is contraindicated. Increasing the insulin dose at bedtime will further worsen the problem. Encouraging the client to eat smaller, more frequent meals will not address the hypoglycemia and rebound hyperglycemia that occurs when sleeping. However, a bedtime snack may help minimize this event.

A client is taught how to recognize signs of a hypoglycemic reaction. Which symptoms identified by the client indicate to the nurse that the teaching was effective? Select all that apply. o Fatigue o Nausea o Weakness o Nervousness o Increased thirst o Increased perspiration

o Fatigue o Weakness o Nervousness o Increased perspiration · Fatigue is related to hypoglycemia. Weakness is related to a decrease in glucose within the central nervous system. Nervousness is caused by increased adrenergic activity and increased secretion of catecholamines. Increased perspiration is related to increased adrenergic activity and increased secretion of catecholamines. Nausea is related to hyperglycemia, not hypoglycemia. Increased thirst with an excessive oral fluid intake (polydipsia) is associated with hyperglycemia and is one of the cardinal signs of diabetes mellitus.

The nurse is caring for a client who reports sweating, tachycardia, and tremors. The laboratory report of the client reveals serum cortisol less than normal and a blood glucose level of 60 mg/dL. Which medication would be administered to this client? o Glucagon o Kayexalate o Hydrocortisone o Insulin with dextrose in normal saline

o Glucagon · A decrease in cortisol levels impairs the glucose metabolism. The client's blood glucose level is 60 mg/dL, which is indicative of hypoglycemia. The nurse should administer glucagon as per the prescription to manage the low glucose levels. Kayexalate is a potassium-binding resin that facilitates potassium excretion and is used to manage hyperkalemia. Intramuscular hydrocortisone is given concomitantly every 12 hours as part of hormone replacement in adrenal insufficiency. Insulin with dextrose in normal saline is given to manage hyperkalemia by causing an intracellular shift of potassium.

The nurse, caring for a client with uncontrolled diabetes, suspects that a client is experiencing hypoglycemia in response to insulin administration. Which clinical manifestations lead the nurse to this conclusion? Select all that apply. o Headache o Confusion o Extreme thirst o Profuse sweating o Increased urination

o Headache o Confusion o Profuse sweating · Neurological responses occur when there is an insufficient supply of glucose to the brain, thus causing clinical manifestations such as headache and confusion. Profuse sweating is a classic sign of hypoglycemia. This is triggered by lack of glucose to the nerve cells. Thirst (polydipsia) is a classic symptom of hyperglycemia. Increased urination (polyuria) is a classic sign of hyperglycemia.

A client with diabetic ketoacidosis who is receiving intravenous fluids and insulin reports tingling and numbness of the fingers and toes, and shortness of breath. The nurse identifies a U wave on the cardiac monitor. Which electrolyte imbalance is causing these clinical findings? o Hypokalemia o Hyponatremia o Hyperglycemia o Hypercalcemia

o Hypokalemia · These are classic signs of hypokalemia that occur when potassium levels are reduced as potassium reenters cells with glucose. Clinical manifestations of hyponatremia include nausea, malaise, and changes in mental status. Clinical manifestations of hyperglycemia include weakness, dry skin, flushing, polyuria, and thirst. Clinical manifestations of hypercalcemia include lethargy, nausea, vomiting, paresthesias, and personality changes.

Which information would the nurse include in a teaching plan when teaching a client with diabetes about the advantages of using an insulin pump? Select all that apply. o It prevents ketoacidosis. o It helps cause weight loss. o It can improve A1c levels. o An insulin pump costs less than subcutaneous injections. o Clients may be able to exercise without eating more carbohydrates.

o It can improve A1c levels. o Clients may be able to exercise without eating more carbohydrates. · Maintaining a consistent acceptable blood glucose level will improve A1c results. Because insulin is administered only as needed, the client will be able to exercise without having to increase the carbohydrate intake. Ketoacidosis may occur if the catheter becomes dislodged and the client does not receive insulin for hours. Insulin pumps can cause weight gain, not loss. An insulin pump is more expensive than subcutaneous insulin injections.

The nurse provides dietary education for a client with newly diagnosed diabetes. The instructions include a food exchange list. The nurse determines that the teaching was effective when the client states that, instead of asparagus, broccoli, and mushrooms, the client plans to eat which food items? o String beans, beets, and carrots o Corn, lima beans, and dried peas o Baked beans, potatoes, and parsnips o Corn muffins, corn chips, and pretzels

o String beans, beets, and carrots · String beans, beets, and carrots are in the vegetable exchange, as are asparagus, broccoli, and mushrooms. Corn, lima beans, dried peas, baked beans, potatoes, and parsnips are starchy vegetables and are listed as bread exchanges. Corn muffins, corn chips, and pretzels are from the bread exchange list.

The nurse provides education related to manifestations of hyperglycemia to a client with type 1 diabetes. Which signs and symptoms, identified by the client, indicate that the teaching was effective? Select all that apply. o Thirst o Headache o Nervousness o Fruity breath odor o Excessive urination

o Thirst o Fruity breath odor o Excessive urination · Thirst (polydipsia) is associated with hyperglycemia. This is in response to the polyuria associated with hyperglycemia. A fruity odor to the breath is acetone on the breath reflective of the presence of ketones; ketones are a byproduct of fat metabolism in an attempt to meet energy needs because the body is unable to convert glucose to glycogen. Excessive urination occurs when fluid is lost along with glucose as it is excreted in the urine. Headache is associated with hypoglycemia because of central nervous irritation secondary to a low blood glucose level. Nervousness is associated with hypoglycemia because of central nervous system irritation.

Which blood glucose levels would the nurse identify as hypoglycemia? o 68 mg/dL (3.8 mmol/L) o 78 mg/dL (4.3 mmol/L) o 88 mg/dL (4.9 mmol/L) o 98 mg/dL (5.4 mmol/L)

o 68 mg/dL (3.8 mmol/L) · Normal blood glucose level for an adult is 72 to 108 mg/dL (4-6 mmol/L). Clients who have blood glucose levels less than 72 mg/dL (4 mmol/L) may experience hypoglycemia; 78 mg/dL (4.3 mmol/L), 88 mg/dL (4.9 mmol/L), and 98 mg/dL (5.4 mmol/L) are normal blood glucose levels.

Which infection control measures would the nurse provide a client regarding blood glucose monitoring? Select all that apply. o Wear gloves. o Reuse lancets. o Perform hand washing. o Clean site before fingerstick. o Share blood glucose monitor.

o Perform hand washing. o Clean site before fingerstick. · The nurse would instruct the client to perform hand washing and to clean the site before the fingerstick. The nurse would wear gloves, not the client. Lancets should not be reused nor should the meter be shared.

Which clinical findings are commonly associated with hyperglycemia? Select all that apply. o Polyuria o Polydipsia o Polyphagia o Polyphrasia o Polydysplasia

o Polyuria o Polydipsia o Polyphagia · Polyuria is excessive urination associated with osmotic diuresis. Polydipsia is excessive thirst associated with hyperglycemia; thirst is the response to osmotic diuresis and glycosuria. Polyphagia is associated with the catabolic state induced by insulin deficiency. Polyphrasia is excessive talking associated with mental illness, not hyperglycemia. Polydysplasia is related to multiple developmental abnormalities and is unrelated to hyperglycemia.

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? o Skim milk o Apple juice o Nonfat yogurt o Fresh orange juice

o Skim milk · 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.

A client is newly diagnosed with diabetes. The nurse would instruct the client to monitor for which indication of hypoglycemia? o Kussmaul respirations o Bradycardia o Confusion o Anorexia

o Confusion · The most common symptoms of hypoglycemia are nervousness, weakness, perspiration, and confusion. Kussmaul respirations are associated with hyperglycemia or ketoacidosis. Tachycardia, not bradycardia, is associated with hypoglycemia. Anorexia is associated with hyperglycemia.

Which instruction would the nurse provide to a 6' 0", 160-pound client newly diagnosed with type 1 diabetes who wants to self-administer injections with an insulin pen? Select all that apply. o Prime the needle with two units. o Use a 29-gauge insulin needle. o Give the injection at 45-degree angle. o Refrain from recapping the needle. o Dial the pen to deliver the unit dose.

o Prime the needle with two units. o Use a 29-gauge insulin needle. o Give the injection at 45-degree angle. o Refrain from recapping the needle. o Dial the pen to deliver the unit dose. · The nurse should instruct the client to prime the needle with two units of insulin to remove air from the needle. Insulin needles range between 28 and 31 gauge, and a 29-gauge insulin needle would be appropriate to use. Thin clients (such as a 6' 0" client who weighs 160 pounds) should be instructed to administer the injection at a 45-degree angle. Clients are advised not to recap needles to prevent accidental needlestick injuries. Clients would dial the pen to deliver the prescribed unit dose.

A client is scheduled for a computed tomography (CT) of the brain with contrast. The nurse reviews the client's medical record before the start of the procedure. The nurse would report which significant finding to the primary healthcare provider before the test is performed? o The client takes metformin daily. o The client consumed a meal 1 hour before the scheduled test. o The client reports an allergy to gadolinium. o The client was not prescribed intravenous (IV) sedation.

o The client takes metformin daily. · A CT often requires a contrast agent to be administered. The contrast agent can cause temporary changes in kidney function. This change in kidney function can cause clients on metformin to have an increased risk of developing a serious side effect called lactic acidosis. Nothing by mouth (NPO) status is not required for a brain CT; however, clients may be instructed to be NPO for a CT of the abdomen or chest. Magnetic resonance imaging contrast contains gadolinium; contrast for CT scans contains iodine. Clients typically do not receive sedation for this diagnostic procedure.o The client takes metformin daily.

Which client is at risk for developing type 2 diabetes mellitus (DM)? Select all that apply. o 15-year-old male who plays video games 6 hours per day o 36-year-old female with a history of gestational diabetes o 47-year-old male who weighs 250 pounds and is 5' 9" tall o 28-year-old female with polycystic ovarian syndrome (POS) o 60-year-old male of Native American descent who abuses alcohol

o 15-year-old male who plays video games 6 hours per day o 36-year-old female with a history of gestational diabetes o 47-year-old male who weighs 250 pounds and is 5' 9" tall o 28-year-old female with polycystic ovarian syndrome (POS) o 60-year-old male of Native American descent who abuses alcohol · A sedentary lifestyle, such as that of a teenage client who plays video games 6 hours per day, can lead to obesity. Obesity increases the risk for type 2 DM. Clients with a history of gestational diabetes and/or a body mass index (BMI) greater than 25 kg/m 2 are at increased risk for type 2 DM. Clients with POS are at increased risk because the condition can affect insulin resistance. Clients of Native American ancestry are already at increased risk because of their ethnicity, and abusing alcohol further increases the risk.

The nurse suspects that a client has diabetes mellitus. Which statements made by the client helped the nurse reach this conclusion? Select all that apply. o "I am 65 years old." o "I quite often feel thirsty." o "I eat food every 2 hours." o "I have excessive sweating." o "I sometimes experience shortness of breath."

o "I am 65 years old." o "I quite often feel thirsty." o "I eat food every 2 hours." · Diabetes mellitus is more common in older clients. Clients with diabetes mellitus may feel excessive thirst due to frequent urination and may also experience excessive hunger. Excessive sweating and respiratory disorders are mostly observed in clients with hyperthyroidism.

Which intervention would the nurse implement for a client who has type 1 diabetes and has an elevated blood glucose? o Administer an oral hypoglycemic. o Institute urine glucose monitoring. o Give supplemental doses of regular insulin. o Decrease the rate of the intravenous infusion.

o Give supplemental doses of regular insulin. · 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.

The nurse is providing instructions about foot care for a client with diabetes mellitus. Which would the nurse include in the instructions? Select all that apply. o Wear shoes when out of bed. o Soak the feet in warm water daily. o Dry between the toes after bathing. o Remove corns as soon as they appear. o Use a heating pad when the feet feel cold.

o Wear shoes when out of bed. o Dry between the toes after bathing. · Wearing shoes protects the feet from trauma; they should fit well and should be worn over clean socks. Drying between the toes after bathing prevents maceration and skin breakdown, thus maintaining skin integrity. Soaking the feet is contraindicated because it can cause macerations and skin breakdown, which allow a portal of entry for pathogenic organisms. Clients should not self-treat corns, calluses, warts, or ingrown toenails because of the potential for trauma and skin breakdown; these conditions should be treated by a podiatrist. Use of a heating pad, hot water bottle, or hot water is contraindicated because of the potential for burns; diabetic neuropathy, if present, does not allow the client to accurately evaluate the extremes of temperature.

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? o 40 to 65 mg/dL (2.2-3.6 mmol/L) of blood o 70 to 105 mg/dL (3.9-5.8 mmol/L) of blood o 110 to 145 mg/dL (6.1-8.0 mmol/L) of blood o 150 to 175 mg/dL (8.3-9.7 mmol/L) of blood

o 70 to 105 mg/dL (3.9-5.8 mmol/L) of blood · 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 hypoglycemia. 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 hyperglycemia.

The nurse is caring for an alert client with diabetes whose blood glucose level is 30 mg/dL (3 mmol/L). Which would the nurse give to the client if the protocol calls for treatment of hypoglycemia with 15 g of a simple carbohydrate? o Provide 12 ounces (360 mL) of nondiet soda. o Give 25 mL dextrose 50% by slow intravenous (IV) push. o Have the client drink 8 ounces (240 mL) of fruit juice. o Ask the client to ingest 1 tube of glucose gel.

o Ask the client to ingest 1 tube of glucose gel. · One tube of glucose gel contains 15 g of carbohydrate and is the most appropriate intervention in this situation. Providing 12 ounces (360 mL) of nondiet soda is too much carbohydrate; 4 to 6 ounces (120-180 mL) is adequate. Administering dextrose by IV push is not appropriate for an alert client who is able to eat and drink. Having the client drink 8 ounces (240 mL) of fruit juice is too much carbohydrate; 4 to 6 ounces (120-180 mL) is adequate.

A client with type 1 diabetes receives Humulin R insulin in the morning. Shortly before lunch the nurse identifies that the client is diaphoretic and trembling. Which intervention is appropriate? o Administer insulin to the client. o Give the client lunch immediately. o Encourage the client to drink fluids. o Assess the client's blood glucose level.

o Assess the client's blood glucose level. · The client needs glucose, not just fluids. The presence of hypoglycemia should be determined before initiating therapy; Humulin R insulin given in the morning peaks within 4 hours or just before lunchtime. After hypoglycemia is verified, the client should be given an immediate source of glucose. Administering insulin is contraindicated; the client is experiencing adaptations of hypoglycemia, and administering insulin will decrease further an already low blood glucose level. Giving the client lunch may be done after hypoglycemia is determined.

The nurse educator is providing information about different insulin types. Which type of insulin can be safely mixed with regular human insulin in the same syringe? o Insulin glargine o Insulin detemir o Insulin lispro mix 75/25 o Isophane insulin neutral protamine hagedorn (NPH)

o Isophane insulin neutral protamine hagedorn (NPH) · Isophane insulin NPH is safe to mix with regular human insulin. No other insulin type should be mixed with insulin glargine, insulin detemir, or insulin lispro mix 75/25.

Before having surgery, a client with type 1 diabetes insulin requirements are elevated but well controlled. Which insulin requirements would the nurse anticipate for this client postoperatively? o Decrease o Fluctuate o Increase sharply o Remain elevated

o Remain elevated · Emotional and physical stress may cause insulin requirements to remain elevated in the postoperative period. Insulin requirements will remain elevated rather than decrease. Fluctuating insulin requirements usually are associated with noncompliance, not surgery. A sharp increase in the client's insulin requirements may indicate sepsis, but this is not expected.