NU473 Week 5: PrepU Assessment and Management of Patients With Diabetes (Chapter 51)

A health care provider prescribes short-acting insulin for a patient, instructing the patient to take the insulin 20 to 30 minutes before a meal. The nurse explains to the patient that Humulin-R taken at 6:30 AM will reach peak effectiveness by: o 12:30 PM. o 8:30 AM. o 10:30 AM. o 2:30 PM.

o 8:30 AM. · Short-acting insulin reaches its peak effectiveness 2 to 3 hours after administration. See Table 30-3 in the text.

The nurse is preparing to administer intermediate-acting insulin to a patient with diabetes. Which insulin will the nurse administer? o Iletin II o NPH o Lispro (Humalog) o Glargine (Lantus)

o NPH · Intermediate-acting insulins are called NPH insulin (neutral protamine Hagedorn) or Lente insulin. Lispro (Humalog) is rapid acting, Iletin II is short acting, and glargine (Lantus) is very long acting.

Which instruction about insulin administration should a nurse give to a client? o "Shake the vials before withdrawing the insulin." o "Store unopened vials of insulin in the freezer at temperatures well below freezing." o "Discard the intermediate-acting insulin if it appears cloudy." o "Always follow the same order when drawing the different insulins into the syringe."

o "Always follow the same order when drawing the different insulins into the syringe." · The nurse should instruct the client to always follow the same order when drawing the different insulins into the syringe. Insulin should never be shaken because the resulting froth prevents withdrawal of an accurate dose and may damage the insulin protein molecules. Insulin should never be frozen because the insulin protein molecules may be damaged. The client doesn't need to discard intermediate-acting insulin if it's cloudy; this finding is normal.

A controlled type 2 diabetic client states, "The doctor said if my blood sugars remain stable, I may not need to take any medication." Which response by the nurse is most appropriate? o "Diet, exercise, and weight loss can eliminate the need for medication." o "You misunderstood the doctor. Let's ask for clarification." o "Some doctors do not treat blood sugar elevation until symptoms appear." o "You will be placed on a strict low-sugar diet for better control."

o "Diet, exercise, and weight loss can eliminate the need for medication." · Dieting, exercise, and weight loss can control and/or delay the need for medication to treat type 2 diabetes mellitus in some clients. Because the client is controlling blood sugars, changing the diet is not indicated. Controlling blood glucose levels will prevent multisystem complications and should be the mainstay of treatment for diabetes mellitus. Although clarification is appropriate, stating the client misunderstood can close the line of communication between client and nurse.

A client is taking glyburide (DiaBeta), 1.25 mg P.O. daily, to treat type 2 diabetes. Which statement indicates the need for further client teaching about managing this disease? o "I avoid exposure to the sun as much as possible." o "I always wear my medical identification bracelet." o "I skip lunch when I don't feel hungry." o "I always carry hard candy to eat in case my blood sugar level drops."

o "I skip lunch when I don't feel hungry." · The client requires further teaching if he states that he skips meals. A client who is receiving an oral antidiabetic agent should eat meals on a regular schedule because skipping a meal increases the risk of hypoglycemia. Carrying hard candy, avoiding exposure to the sun, and always wearing a medical identification bracelet indicate effective teaching.

A nurse is preparing to administer insulin to a child who's just been diagnosed with type 1 diabetes. When the child's mother stops the nurse in the hall, she's crying and anxious to talk about her son's condition. The nurse's best response is: o "I'm going to give your son some insulin. Then I'll be happy to talk with you." o "Everything will be just fine. I'll be back in a minute and then we can talk." o "I can't talk now. I have to give your son his insulin as soon as possible." o "If you'll wait in your son's room, the physician will talk with you as soon as he's free."

o "I'm going to give your son some insulin. Then I'll be happy to talk with you." · Attending to the mother's needs is a critical part of caring for a sick child. In this case however, administering insulin in a prompt manner supersedes the mother's needs. By informing the mother that she's going to administer the insulin and will then make time to talk with her, the nurse recognizes the mother's needs as legitimate. She provides a reasonable response while attending to the priority of administering insulin as soon as possible. Telling the mother that she can't talk with her or telling her to wait for the physician could increase the mother's fear and anxiety. The nurse shouldn't tell the mother that everything will be fine; the nurse doesn't know that everything will be fine.

A client is evaluated for type 1 diabetes. Which client comment correlates best with this disorder? o "I'm thirsty all the time. I just can't get enough to drink." o "It seems like I have no appetite. I have to make myself eat." o "I have a cough and cold that just won't go away." o "I notice pain when I urinate."

o "I'm thirsty all the time. I just can't get enough to drink." · Classic signs and symptoms of diabetes mellitus are polydipsia (excessive thirst), polyuria (excessive urination), and polyphagia (excessive appetite). Decreased appetite, lingering cough and cold, and pain on urination aren't related to diabetes. Decreased appetite reflects a GI disorder; cough and cold indicate an upper respiratory problem; and pain on urination suggests a urinary tract infection.

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? o "Ketones will tell us if your body is using other tissues for energy." o "Ketones help the physician determine how serious your diabetes is." o "The spleen releases ketones when your body can't use glucose." o "Ketones can damage your kidneys and eyes."

o "Ketones will tell us if your body is using other tissues for energy." · The nurse should tell the client that ketones are a byproduct of fat metabolism and that ketone testing can determine whether the body is breaking down fat to use for energy. The spleen doesn't release ketones when the body can't use glucose. Although ketones can damage the eyes and kidneys and help the physician evaluate the severity of a client's diabetes, these responses by the nurse are incomplete.

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? o "Inject insulin into healthy tissue with large blood vessels and nerves." o "Administer insulin into areas of scar tissue or hypertrophy whenever possible." o "Rotate injection sites within the same anatomic region, not among different regions." o "Administer insulin into sites above muscles that you plan to exercise heavily later that day."

o "Rotate injection sites within the same anatomic region, not among different regions." · The nurse should instruct the client to rotate injection sites within the same anatomic region. Rotating sites among different regions may cause excessive day-to-day variations in the blood glucose level; also, insulin absorption differs from one region to the next. Insulin should be injected only into healthy tissue lacking large blood vessels, nerves, or scar tissue or other deviations. Injecting insulin into areas of hypertrophy may delay absorption. The client shouldn't inject insulin into areas of lipodystrophy (such as hypertrophy or atrophy); to prevent lipodystrophy, the client should rotate injection sites systematically. Exercise speeds drug absorption, so the client shouldn't inject insulin into sites above muscles that will be exercised heavily.

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

o "Test your blood glucose every 4 hours." · The nurse should instruct a client with diabetes mellitus to check his blood glucose levels every 3 to 4 hours and take insulin or an oral antidiabetic agent as usual, even when he's sick. If the client's blood glucose level rises above 300 mg/dl, he should call his physician immediately. If the client is unable to follow the regular meal plan because of nausea, he should substitute soft foods, such as gelatin, soup, and custard.

A client has just been diagnosed with type 1 diabetes. When teaching the client and family how diet and exercise affect insulin requirements, the nurse should include which guideline? o "You'll need less insulin when you increase your food intake." o "You'll need less insulin when you exercise or reduce your food intake." o "You'll need more insulin when you exercise or increase your food intake." o "You'll need more insulin when you exercise or decrease your food intake."

o "You'll need less insulin when you exercise or reduce your food intake." · The nurse should advise the client that exercise, reduced food intake, hypothyroidism, and certain medications decrease insulin requirements. Growth, pregnancy, greater food intake, stress, surgery, infection, illness, increased insulin antibodies, and certain medications increase insulin requirements.

A 16-year-old client newly diagnosed with type 1 diabetes has a very low body weight despite eating regular meals. The client is upset because friends frequently state, "You look anorexic." Which statement by the nurse would be the best response to help this client understand the cause of weight loss due to this condition? o "I will refer you to a dietician who can help you with your weight." o "Don't worry about what your friends think; the carbohydrates you eat are being quickly digested, increasing your metabolism." o "Your body is using protein and fat for energy instead of glucose." o "You may be having undiagnosed infections, causing you to lose extra weight."

o "Your body is using protein and fat for energy instead of glucose." · Persons with type 1 diabetes, particularly those in poor control of the condition, tend to be thin because when the body cannot effectively utilize glucose for energy (no insulin supply), it begins to break down protein and fat as an alternate energy source. Patients may be underweight at the onset of type 1 diabetes because of rapid weight loss from severe hyperglycemia. The goal initially may be to provide a higher-calorie diet to regain lost weight and blood glucose control.

A physician orders blood glucose levels every 4 hours for a 4-year-old child with brittle type 1 diabetes. The parents are worried that drawing so much blood will traumatize their child. How can the nurse best reassure the parents? o "I'll see if the physician can reduce the number of blood draws." o "Our laboratory technicians use tiny needles and they're really good with children." o "Your child will need less blood work as his glucose levels stabilize." o "Your child is young and will soon forget this experience."

o "Your child will need less blood work as his glucose levels stabilize." · Telling the parents that the number of blood draws will decrease as their child's glucose levels stabilize engages them in the learning process and gives them hope that the present discomfort will end as the child's condition improves. Telling the parents that their child won't remember the experience disregards their concerns and anxiety. The nurse shouldn't offer to ask the physician if he can reduce the number of blood draws; the physician needs the laboratory results to monitor the child's condition properly. Although telling the parents that the laboratory technicians are gentle and use tiny needles may be reassuring, it isn't the most appropriate response.

A client with diabetes mellitus has a blood glucose level of 40 mg/dL. Which rapidly absorbed carbohydrate would be most effective? o three to six LifeSavers candies o 1/2 cup fruit juice or regular soft drink o 1/2 tbsp honey or syrup o 4 oz of skim milk

o 1/2 cup fruit juice or regular soft drink · In a client with hypoglycemia, the nurse uses the rule of 15: give 15 g of rapidly absorbed carbohydrate, wait 15 minutes, recheck the blood sugar, and administer another 15 g of glucose if the blood sugar is not above 70 mg/dL. One-half cup fruit juice or regular soft drink is equivalent to the recommended 15 g of rapidly absorbed carbohydrate. Eight ounces of skim milk is equivalent to the recommended 15 g of rapidly absorbed carbohydrate. One tablespoon of honey or syrup is equivalent to the recommended 15 g of rapidly absorbed carbohydrate. Six to eight LifeSavers candies is equivalent to the recommended 15 g of rapidly absorbed carbohydrate.

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: o 10 to 15 g of a simple carbohydrate. o 2 to 5 g of a simple carbohydrate. o 18 to 20 g of a simple carbohydrate. o 25 to 30 g of a simple carbohydrate.

o 10 to 15 g of a simple carbohydrate. · To reverse hypoglycemia, the American Diabetes Association recommends ingesting 10 to 15 g of a simple carbohydrate, such as three to five pieces of hard candy, two to three packets of sugar (4 to 6 tsp), or 4 oz of fruit juice. Then the client should check his blood glucose after 15 minutes. If necessary, this treatment may be repeated in 15 minutes. Ingesting only 2 to 5 g of a simple carbohydrate may not raise the blood glucose level sufficiently. Ingesting more than 15 g may raise it above normal, causing hyperglycemia.

The nurse is administering lispro insulin. Based on the onset of action, how long before breakfast should the nurse administer the injection? o 10 to 15 minutes o 30 to 40 minutes o 1 to 2 hours o 3 hours

o 10 to 15 minutes · The onset of action of rapid-acting lispro insulin is within 10 to 15 minutes. It is used to rapidly reduce the glucose level.

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: o 80 mg/dL, 1 hour postprandial. o 90 mg/dL before meals. o 120 mg/dL, 1 hour postprandial. o 138 mg/dL, 2 hours postprandial.

o 138 mg/dL, 2 hours postprandial. · The goals for a 2-hour, postprandial blood glucose level are less than 120 mg/dL in a patient who might develop gestational diabetes.

A nurse is caring for a client with type 1 diabetes who exhibits confusion, light-headedness, and aberrant behavior. The client is conscious. The nurse should first administer: o 10 units of fast-acting insulin. o I.M. or subcutaneous glucagon. o I.V. bolus of dextrose 50%. o 15 to 20 g of a fast-acting carbohydrate such as orange juice.

o 15 to 20 g of a fast-acting carbohydrate such as orange juice. · This client is experiencing hypoglycemia. Because the client is conscious, the nurse should first administer a fast-acting carbohydrate, such as orange juice, hard candy, or honey. If the client has lost consciousness, the nurse should administer I.M. or subcutaneous glucagon or an I.V. bolus of dextrose 50%. The nurse shouldn't administer insulin to a client who's hypoglycemic; this action will further compromise the client's condition.

What is the duration of regular insulin? o 12 to 16 hours o 24 hours o 4 to 6 hours o 3 to 5 hours

o 4 to 6 hours · The duration of regular insulin is 4 to 6 hours; 3 to 5 hours is the duration for rapid-acting insulin such as Novolog. The duration of NPH insulin is 12 to 16 hours. The duration of Lantus insulin is 24 hours.

The nurse expects that a type 1 diabetic patient may receive what percentage of his or her usual morning dose of insulin preoperatively? o 50% to 60% o 85% to 90% o 10% to 20% o 25% to 40%

o 50% to 60% · One half to two thirds of the patient's usual morning dose of insulin (either intermediate-acting insulin alone or both short- and intermediate-acting insulins) is administered subcutaneously in the morning before surgery. The remainder is then administered after surgery.

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? o 6.5% o 8.5% o 7.5 % o 8.0%

o 6.5% · Normally the level of glycosylated hemoglobin is less than 7%. Thus a level of 6.5% would indicate that the client's blood glucose level is well-controlled. According to the American Diabetes Association, a glycosylated hemoglobin of 7% is equivalent to an average blood glucose level of 150 mg/dL. Thus, a level of 7.5% would indicate less control. Amount of 8% or greater indicate that control of the client's blood glucose level has been inadequate during the previous 2 to 3 months.

A client is receiving insulin lispro at 7:30 AM. The nurse ensures that the client has breakfast by which time? o 8:30 AM o 8:00 AM o 8:15 AM o 7:45 AM

o 7:45 AM · Insulin lispro has an onset of 5 to 15 minutes. Therefore, the nurse would need to ensure that the client has his breakfast by 7:45 AM at the latest. Otherwise, the client may experience hypoglycemia.

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

o A glucose challenge test should be performed between 24 and 28 weeks. · A glucose challenge test should be performed between 24 and 28 weeks in women at average risk. It occurs in less than 10% of all pregnancies. Onset usually occurs in the second or third trimester. There is an above-normal risk for perinatal complications.

When administering insulin to a client with type 1 diabetes, which of the following would be most important for the nurse to keep in mind? o Area for insulin injection o Duration of the insulin o Technique for injecting o Accuracy of the dosage

o Accuracy of the dosage · The measurement of insulin is most important and must be accurate because clients may be sensitive to minute dose changes. The duration, area, and technique for injecting should also to be noted.

When administering insulin to a client with type 1 diabetes, which of the following would be most important for the nurse to keep in mind? o Technique for injecting o Area for insulin injection o Duration of the insulin o Accuracy of the dosage

o Accuracy of the dosage · The measurement of insulin is most important and must be accurate because clients may be sensitive to minute dose changes. The duration, area, and technique for injecting should also to be noted.

A hospitalized client is found to be comatose and hypoglycemic with a blood sugar of 50 mg/dL. Which of the following would the nurse do first? o Infuse 1000 mL D5W over a 12-hour period. o Encourage the client to drink orange juice with added sugar. o Check the client's urine for the presence of sugar and acetone. o Administer 50% glucose intravenously.

o Administer 50% glucose intravenously. · The unconscious, hypoglycemic client needs immediate treatment with IV glucose. If the client does not respond quickly and the blood glucose level continues to be low, glucagon, a hormone that stimulates the liver to release glycogen, or 20 to 50 mL of 50% glucose is prescribed for IV administration. A dose of 1,000 mL D5W over a 12-hour period indicates a lower strength of glucose and a slow administration rate. Checking the client's urine for the presence of sugar and acetone is incorrect because a blood sample is easier to collect and the blood test is more specific and reliable. An unconscious client cannot be given a drink. In such a case glucose gel may be applied in the buccal cavity of the mouth.

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? o Administering 1 ampule of 50% dextrose solution, per physician's order o Administering a 500-ml bolus of normal saline solution o Inserting a feeding tube and providing tube feedings o Observing the client for 1 hour, then rechecking the fingerstick glucose level

o Administering 1 ampule of 50% dextrose solution, per physician's order · The nurse should administer 50% dextrose solution to restore the client's physiological integrity. Feeding through a feeding tube isn't appropriate for this client. A bolus of normal saline solution doesn't provide the client with the much-needed glucose. Observing the client for 1 hour delays treatment. The client's blood glucose level could drop further during this time, placing him at risk for irreversible brain damage.

A nurse is caring for a diabetic patient with a diagnosis of nephropathy. What would the nurse expect the urinalysis report to indicate? o Red blood cells o Bacteria o Albumin o White blood cells

o Albumin · Nephropathy, or kidney disease secondary to diabetic microvascular changes in the kidney, is a common complication of diabetes. Consistent elevation of blood glucose levels stresses the kidney's filtration mechanism, allowing blood proteins to leak into the urine and thus increasing the pressure in the blood vessels of the kidney. Albumin is one of the most important blood proteins that leak into the urine, and its leakage is among the earliest signs that can be detected. Clinical nephropathy eventually develops in more than 85% of people with microalbuminuria but in fewer than 5% of people without microalbuminuria. The urine should be checked annually for the presence of proteins, which would include microalbumin.

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

o Blood glucose level 1,100 mg/dl · HHNS occurs most frequently in older clients. It can occur in clients with either type 1 or type 2 diabetes mellitus but occurs most commonly in those with type 2. The blood glucose level rises to above 600 mg/dl in response to illness or infection. As the blood glucose level rises, the body attempts to rid itself of the excess glucose by producing urine. Initially, the client produces large quantities of urine. If fluid intake isn't increased at this time, the client becomes dehydrated, causing BUN levels to rise. Arterial pH and plasma bicarbonate levels typically remain within normal limits.

A client with diabetic ketoacidosis was admitted to the intensive care unit 4 hours ago and has these laboratory results: blood glucose level 450 mg/dl, serum potassium level 2.5 mEq/L, serum sodium level 140 mEq/L, and urine specific gravity 1.025. The client has two IV lines in place with normal saline solution infusing through both. Over the past 4 hours, his total urine output has been 50 ml. Which physician order should the nurse question? o Infuse 500 ml of normal saline solution over 1 hour. o Hold insulin infusion for 30 minutes. o Add 40 mEq potassium chloride to an infusion of half normal saline solution and infuse at a rate of 10 mEq/hour. o Change the second IV solution to dextrose 5% in water.

o Change the second IV solution to dextrose 5% in water. · The nurse should question the physician's order to change the second IV solution to dextrose 5% in water. The client should receive normal saline solution through the second IV site until his blood glucose level reaches 250 mg/dl. The client should receive a fluid bolus of 500 ml of normal saline solution. The client's urine output is low and his specific gravity is high, which reveals dehydration. The nurse should expect to hold the insulin infusion for 30 minutes until the potassium replacement has been initiated. Insulin administration causes potassium to enter the cells, which further lowers the serum potassium level. Further lowering the serum potassium level places the client at risk for life-threatening cardiac arrhythmias.

A client's blood glucose level is 45 mg/dl. The nurse should be alert for which signs and symptoms? o Polyuria, polydipsia, hypotension, and hypernatremia o Kussmaul respirations, dry skin, hypotension, and bradycardia o Polyuria, polydipsia, polyphagia, and weight loss o Coma, anxiety, confusion, headache, and cool, moist skin

o Coma, anxiety, confusion, headache, and cool, moist skin · Signs and symptoms of hypoglycemia (indicated by a blood glucose level of 45 mg/dl) include anxiety, restlessness, headache, irritability, confusion, diaphoresis, cool skin, tremors, coma, and seizures. Kussmaul respirations, dry skin, hypotension, and bradycardia are signs of diabetic ketoacidosis. Excessive thirst, hunger, hypotension, and hypernatremia are symptoms of diabetes insipidus. Polyuria, polydipsia, polyphagia, and weight loss are classic signs and symptoms of diabetes mellitus.

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? o Take the antidiabetic drugs regularly. o Eat a high-fiber diet. o Drink plenty of fluids. o Control blood glucose levels.

o Control blood glucose levels. · Controlling blood glucose levels and any hypertension can prevent or delay the development of diabetic nephropathy. Drinking plenty of fluids does not prevent diabetic nephropathy. Taking antidiabetic drugs regularly may help to control blood glucose levels, but it is the control of these levels that is most important. A high-fiber diet is unrelated to the development of diabetic nephropathy.

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? o Psychiatrist o Home health nurse o Dietitian o Social worker

o Dietitian · The client should be referred to a dietitian, who will help him gain better control of his blood glucose levels. The client can care for himself, so a home health agency isn't necessary. The client shows no signs of needing a psychiatric referral, and referring the client to a psychiatrist isn't in the nurse's scope of practice. Social workers help clients with financial concerns; the scenario doesn't indicate that the client has a financial concern warranting a social worker at this time.

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

o Do not mix with other insulins. · Because glargine is in a suspension with a pH of 4, it cannot be mixed with other insulins because this would cause precipitation. Glargine is a "peakless" basal insulin that is absorbed very slowly over a 24-hour period and can be given once a day. When administering glargine insulin it is very important to read the label carefully and to avoid mistaking Lantus insulin for Lente insulin and vice versa.

A nurse is teaching a client with type 1 diabetes how to treat adverse reactions to insulin. To reverse hypoglycemia, the client ideally should ingest an oral carbohydrate. However, this treatment isn't always possible or safe. Therefore, the nurse should advise the client to keep which alternate treatment on hand? o Glucagon o Epinephrine o Hydrocortisone o 50% dextrose

o Glucagon · During a hypoglycemic reaction, a layperson may administer glucagon, an antihypoglycemic agent, to raise the blood glucose level quickly in a client who can't ingest an oral carbohydrate. Epinephrine isn't a treatment for hypoglycemia. Although 50% dextrose is used to treat hypoglycemia, it must be administered I.V. by a skilled health care professional. Hydrocortisone takes a relatively long time to raise the blood glucose level and therefore isn't effective in reversing hypoglycemia.

During a follow-up visit 3 months after a new diagnosis of type 2 diabetes, a client reports exercising and following a reduced-calorie diet. Assessment reveals that the client has only lost 1 pound and did not bring the glucose-monitoring record. Which value should the nurse measure? o Glucose via an oral glucose tolerance test o Glucose via a urine dipstick test o Glycosylated hemoglobin level o Fasting blood glucose level

o Glycosylated hemoglobin level · Glycosylated hemoglobin is a blood test that reflects the average blood glucose concentration over a period of approximately 2 to 3 months. When blood glucose is elevated, glucose molecules attach to hemoglobin in red blood cells. The longer the amount of glucose in the blood remains above normal, the more glucose binds to hemoglobin and the higher the glycosylated hemoglobin level becomes.

A client with diabetes mellitus is receiving an oral antidiabetic agent. The nurse observes for which condition when caring for this client? o Polydipsia o Hypoglycemia o Polyuria o Blurred vision

o Hypoglycemia · The nurse should observe the client receiving an oral antidiabetic agent for signs of hypoglycemia. The time when the reaction might occur is not predictable and could be from 30 to 60 minutes to several hours after the drug is ingested. Polyuria, polydipsia, and blurred vision are symptoms of diabetes mellitus.

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

o Hypokalemia and hypoglycemia · Blood glucose needs to be monitored in clients receiving IV insulin because of the risk of hyperglycemia or hypoglycemia. Hypoglycemia might occur if too much insulin is administered. Hypokalemia, not hyperkalemia, might occur because I.V. insulin forces potassium into cells, thereby lowering the plasma level of potassium. Calcium and sodium levels aren't affected by IV insulin administration.

A 60-year-old client comes to the ED reporting weakness, vision problems, increased thirst, increased urination, and frequent infections that do not seem to heal easily. The physician suspects that the client has diabetes. Which classic symptom should the nurse watch for to confirm the diagnosis of diabetes? o Increased hunger o Fatigue o Dizziness o Numbness

o Increased hunger · The classic symptoms of diabetes are the three Ps: polyuria (increased urination), polydipsia (increased thirst), and polyphagia (increased hunger). Some of the other symptoms include tingling, numbness, and loss of sensation in the extremities and fatigue.

The nurse is preparing to administer intermediate-acting insulin to a patient with diabetes. Which insulin will the nurse administer? o Lispro (Humalog) o NPH o Glargine (Lantus) o Iletin II

o NPH · Intermediate-acting insulins are called NPH insulin (neutral protamine Hagedorn) or Lente insulin. Lispro (Humalog) is rapid acting, Iletin II is short acting, and glargine (Lantus) is very long acting.

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

o Increased urine output · Glucose supplies most of the calories in TPN; if the glucose infusion rate exceeds the client's rate of glucose metabolism, hyperglycemia arises. When the renal threshold for glucose reabsorption is exceeded, osmotic diuresis occurs, causing an increased urine output. A decreased appetite and diaphoresis suggest hypoglycemia, not hyperglycemia. Cheyne-Stokes respirations are characterized by a period of apnea lasting 10 to 60 seconds, followed by gradually increasing depth and frequency of respirations. Cheyne-Stokes respirations typically occur with cerebral depression or heart failure.

The client who is managing diabetes through diet and insulin control asks the nurse why exercise is important. Which is the best response by the nurse to support adding exercise to the daily routine? o Increases ability for glucose to get into the cell and lowers blood sugar o Decreases risk of developing insulin resistance and hyperglycemia o Decreases need for pancreas to produce more cells o Creates an overall feeling of well-being and lowers risk of depression

o Increases ability for glucose to get into the cell and lowers blood sugar · Exercise increases trans membrane glucose transporter levels in the skeletal muscles. This allows the glucose to leave the blood and enter into the cells where it can be used as fuel. Exercise can provide an overall feeling of well-being but is not the primary purpose of including in the daily routine of diabetic clients. Exercise does not stimulate the pancreas to produce more cells. Exercise can promote weight loss and decrease risk of insulin resistance but not the primary reason for adding to daily routine.

A nurse explains to a client that she will administer his first insulin dose in his abdomen. How does absorption at the abdominal site compare with absorption at other sites? o Insulin is absorbed more slowly at abdominal injection sites than at other sites. o Insulin is absorbed more rapidly at abdominal injection sites than at other sites. o Insulin is absorbed unpredictably at all injection sites. o Insulin is absorbed rapidly regardless of the injection site.

o Insulin is absorbed more rapidly at abdominal injection sites than at other sites. · Subcutaneous insulin is absorbed most rapidly at abdominal injection sites, more slowly at sites on the arms, and slowest at sites on the anterior thigh. Absorption after injection in the buttocks is less predictable.

The nurse is preparing a presentation for a group of adults at a local community center about diabetes. Which of the following would the nurse include as associated with type 2 diabetes? o Little to no relation to pre-diabetes o Onset most common during adolescence o Less common than type 1 diabetes o Insulin production insufficient

o Insulin production insufficient · Type 2 diabetes is characterized by insulin resistance or insufficient insulin production. It is more common in aging adults, and now accounts for 20% of all newly diagnosed cases. Type 1 diabetes is more likely in childhood and adolescence although it can occur at any age. It accounts for approximately 5% to 10% of all diagnosed cases of diabetes. Pre-diabetes can lead to type 2 diabetes.

NPH is an example of which type of insulin? o Intermediate-acting o Rapid-acting o Short-acting o Long-acting

o Intermediate-acting · NPH is an intermediate-acting insulin.

Which statement is correct regarding glargine insulin? o Its peak action occurs in 2 to 3 hours. o It cannot be mixed with any other type of insulin. o It is given twice daily. o It is absorbed rapidly.

o It cannot be mixed with any other type of insulin. · Because this insulin is in a suspension with a pH of 4, it cannot be mixed with other insulins because this would cause precipitation. There is no peak in action. It is approved to give once daily.

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? o It enhances the transport of glucose across the cell membrane. o It stimulates the pancreatic beta cells. o It decreases the intestinal absorption of glucose. o It aids in the process of gluconeogenesis.

o It enhances the transport of glucose across the cell membrane. · Insulin carries glucose into body cells as their preferred source of energy. Besides, it promotes the liver's storage of glucose as glycogen and inhibits the breakdown of glycogen back into glucose. Insulin does not aid in gluconeogenesis but inhibits the breakdown of glycogen back into glucose.

Which is a by-product of fat breakdown in the absence of insulin and accumulates in the blood and urine? o Creatinine o Cholesterol o Hemoglobin o Ketones

o Ketones · Ketones are by-products of fat breakdown in the absence of insulin, and they accumulate in the blood and urine. Creatinine, hemoglobin, and cholesterol are not by-products of fat breakdown.

Which type of insulin acts most quickly? o NPH o Regular o Lispro Glargine

o Lispro · The onset of action of rapid-acting lispro is within 10 to 15 minutes. The onset of action of short-acting regular insulin is 30 minutes to 1 hour. The onset of action of intermediate-acting NPH insulin is 3 to 4 hours. The onset of action of very long-acting glargine is ~6 hours.

A patient with a diagnosis of type 2 diabetes has been vigilant about glycemic control since being diagnosed and has committed to increasing her knowledge about the disease. To reduce her risk of developing diabetic nephropathy in the future, this patient should combine glycemic control with what other preventative measure? o Maintenance of healthy blood pressure and prompt treatment of hypertension o Vigorous physical activity at least three times weekly o Subcutaneous injection of 5,000 units of heparin twice daily o Maintenance of a low-sodium, low-protein diet

o Maintenance of healthy blood pressure and prompt treatment of hypertension · Hypertension significantly increases a diabetic patient's risk of nephropathy. A low-sodium, low-protein diet does not appreciably reduce this risk. Exercise is of benefit, but hypertension is a greater risk than inactivity. Heparin is not a relevant intervention.

A client with diabetes is receiving an oral antidiabetic agent that acts to help the tissues use available insulin more efficiently. Which of the following agents would the nurse expect to administer? o Glyburide o Repaglinide o Metformin o Glipizide

o Metformin · Metformin is a biguanide and along with the thiazolidinediones (rosiglitazone and pioglitazone) are categorized as insulin sensitizers; they help tissues use available insulin more efficiently. Glyburide and glipizide which are sulfonylureas, and repaglinide, a meglitinide, are described as being insulin releasers because they stimulate the pancreas to secrete more insulin.

A nurse expects to find which signs and symptoms in a client experiencing hypoglycemia? o Polyuria, headache, and fatigue o Polyphagia and flushed, dry skin o Polydipsia, pallor, and irritability o Nervousness, diaphoresis, and confusion

o Polydipsia, pallor, and irritability o Nervousness, diaphoresis, and confusion · Signs and symptoms associated with hypoglycemia include nervousness, diaphoresis, weakness, light-headedness, confusion, paresthesia, irritability, headache, hunger, tachycardia, and changes in speech, hearing, or vision. If untreated, signs and symptoms may progress to unconsciousness, seizures, coma, and death. Polydipsia, polyuria, and polyphagia are symptoms associated with hyperglycemia.

A nurse is teaching a diabetic support group about the causes of type 1 diabetes. The teaching is determined to be effective when the group is able to attribute which factor as a cause of type 1 diabetes? o Obesity o Altered glucose metabolism o Presence of autoantibodies against islet cells o Rare ketosis

o Presence of autoantibodies against islet cells · There is evidence of an autoimmune response in type 1 diabetes. This is an abnormal response in which antibodies are directed against normal tissues of the body, responding to these tissues as if they were foreign. Autoantibodies against islet cells and against endogenous (internal) insulin have been detected in people at the time of diagnosis and even several years before the development of clinical signs of type 1 diabetes.

A client is admitted to the unit with diabetic ketoacidosis (DKA). Which insulin would the nurse expect to administer intravenously? o Regular o NPH o Lente o Glargine

o Regular · Regular insulin is administered intravenously to treat DKA. It is added to an IV solution and infused continuously. Glargine, NPH, and Lente are only administered subcutaneously.

The client with diabetes asks the nurse why shoes and socks are removed at each office visit.The nurse gives which assessment finding as the explanation for the inspection of feet? o Sensory neuropathy o Autonomic neuropathy o Nephropathy o Retinopathy

o Sensory neuropathy · Neuropathy results from poor glucose control and decreased circulation to nerve tissues. Neuropathy involving sensory nerves located in the periphery can lead to lack of sensitivity, which increases the potential for soft tissue injury without client awareness. The client's feet are inspected on each visit to ensure no injury or pressure has occurred. Autonomic neuropathy, retinopathy, and nephropathy affect nerves to organs other than feet.

A client with diabetes mellitus has a prescription for 5 units of U-100 regular insulin and 25 units of U-100 isophane insulin suspension (NPH) to be taken before breakfast. At about 4:30 p.m., the client experiences headache, sweating, tremor, pallor, and nervousness. What is the most probable cause of these signs and symptoms? o Serum calcium level of 8.9 mg/dl o Serum glucose level of 450 mg/dl o Serum calcium level of 10.2 mg/dl o Serum glucose level of 52 mg/dl

o Serum glucose level of 52 mg/dl · Headache, sweating, tremor, pallor, and nervousness typically result from hypoglycemia, an insulin reaction in which serum glucose level drops below 70 mg/dl. Hypoglycemia may occur 4 to 18 hours after administration of isophane insulin suspension or insulin zinc suspension (Lente), which are intermediate-acting insulins. Although hypoglycemia may occur at any time, it usually precedes meals. Hyperglycemia, in which serum glucose level is above 180 mg/dl, causes such early manifestations as fatigue, malaise, drowsiness, polyuria, and polydipsia. A serum calcium level of 8.9 mg/dl or 10.2 mg/dl is within normal range and wouldn't cause the client's symptoms.

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? o Sweating, tremors, and tachycardia o Dry skin, bradycardia, and somnolence o Bradycardia, thirst, and anxiety o Polyuria, polydipsia, and polyphagia

o Sweating, tremors, and tachycardia · Sweating, tremors, and tachycardia, thirst, and anxiety are early signs of hypoglycemia. Dry skin, bradycardia, and somnolence are signs and symptoms associated with hypothyroidism. Polyuria, polydipsia, and polyphagia are signs and symptoms of diabetes mellitus.

After taking glipizide (Glucotrol) for 9 months, a client experiences secondary failure. What should the nurse expect the physician to do? o Initiate insulin therapy. o Order an additional oral antidiabetic agent. o Switch the client to a different oral antidiabetic agent. o Restrict carbohydrate intake to less than 30% of the total caloric intake.

o Switch the client to a different oral antidiabetic agent. · The nurse should anticipate that the physician will order a different oral antidiabetic agent. Many clients (25% to 60%) who take glipizide respond to a different oral antidiabetic agent. Therefore, it wouldn't be appropriate to initiate insulin therapy at this time. However, if a new oral antidiabetic agent is unsuccessful in keeping glucose levels at an acceptable level, insulin may be used in addition to the antidiabetic agent. Restricting carbohydrate intake isn't necessary.

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: o Storage of glucose as glycogen in the liver. o Synthesis of glucose from noncarbohydrate sources. o Transport of potassium. o Release of glucose.

o Synthesis of glucose from noncarbohydrate sources. · Gluconeogenesis refers to the making of glucose from noncarbohydrates. This occurs mainly in the liver. Its purpose is to maintain the glucose level in the blood to meet the body's demands.

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: o The pancreatic hormone glucagon will stimulate the liver to release stored glucose. o Insulin will be released to facilitate the transport of sugar. o Glycogenesis will be decreased by the liver. o The process of gluconeogenesis will be inhibited.

o The pancreatic hormone glucagon will stimulate the liver to release stored glucose. · When sugar levels are low, glucagon promotes hyperglycemia by stimulating the release of stored glucose. Glycogenolysis and gluconeogenesis will both be increased. Insulin secretion would promote hypoglycemia.

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? o The short-acting insulin is withdrawn before the intermediate-acting insulin. o If administered immediately, there is no requirement for withdrawing one type of insulin before another. o Different types of insulin are not to be mixed in the same syringe. o The intermediate-acting insulin is withdrawn before the short-acting insulin.

o The short-acting insulin is withdrawn before the intermediate-acting insulin. · When combining two types of insulin in the same syringe, the short-acting regular insulin is withdrawn into the syringe first and the intermediate-acting insulin is added next. This practice is referred to as "clear to cloudy."

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? o They decrease the need for insulin. o They have no effect. o They increase the need for insulin. o They cause wide fluctuations in the need for insulin.

o They increase the need for insulin. · Insulin requirements increase in response to growth, pregnancy, increased food intake, stress, surgery, infection, illness, increased insulin antibodies, and some medications. Insulin requirements are decreased by hypothyroidism, decreased food intake, exercise, and some medications.

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? o Increased risk for urologic complications o Need for lifelong immunosuppressive therapy o Need for exocrine enzymatic drainage o Underlying problem of insulin resistance

o Underlying problem of insulin resistance · Clients with type 2 diabetes are not offered the option of a pancreas transplant because their problem is insulin resistance, which does not improve with a transplant. Urologic complications or the need for exocrine enzymatic drainage are not reasons for not offering pancreas transplant to clients with type 2 diabetes. Any transplant requires lifelong immunosuppressive drug therapy and is not the factor.

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

o Using sterile technique during the dressing change · The nurse should perform the dressing changes using sterile technique to prevent infection. Applying heat should be avoided in a client with diabetes mellitus because of the risk of injury. Cleaning the wound with povidone-iodine solution and debriding the wound with each dressing change prevents the development of granulation tissue, which is essential in the wound healing process.

The nurse is teaching a client about self-administration of insulin and about mixing regular and neutral protamine Hagedorn (NPH) insulin. Which information is important to include in the teaching plan? o When mixing insulin, the NPH insulin is drawn up into the syringe first. o When mixing insulin, the regular insulin is drawn up into the syringe first. o If two different types of insulin are ordered, they need to be given in separate injections. o There is no need to inject air into the bottle of insulin before withdrawing the insulin.

o When mixing insulin, the regular insulin is drawn up into the syringe first. · When rapid-acting or short-acting insulins are to be given simultaneously with longer-acting insulins, they are usually mixed together in the same syringe; the longer-acting insulins must be mixed thoroughly before being drawn into the syringe. The American Diabetic Association recommends that the regular insulin be drawn up first. The most important issues are that patients (1) are consistent in technique, so the wrong dose is not drawn in error or the wrong type of insulin, and (2) do not inject one type of insulin into the bottle containing a different type of insulin. Injecting cloudy insulin into a vial of clear insulin contaminates the entire vial of clear insulin and alters its action.

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: o at least five times per week. o at least once per week. o every day. o at least three times per week.

o at least three times per week. · Clients with diabetes must exercise at least three times per week to meet the goals of planned exercise — lowering the blood glucose level, reducing or maintaining the proper weight, increasing the serum high-density lipoprotein level, decreasing serum triglyceride levels, reducing blood pressure, and minimizing stress. Exercising once per week wouldn't achieve these goals. Exercising more than three times per week, although beneficial, would exceed the minimum requirement.

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: o serum fructosamine level. o urine glucose level. o fasting blood glucose level. o glycosylated hemoglobin level.

o glycosylated hemoglobin level. · Because some of the glucose in the bloodstream attaches to some of the hemoglobin and stays attached during the 120-day life span of red blood cells, glycosylated hemoglobin levels provide information about blood glucose levels during the previous 3 months. Fasting blood glucose and urine glucose levels give information only about glucose levels at the point in time when they were obtained. Serum fructosamine levels provide information about blood glucose control over the past 2 to 3 weeks.