Ch 46 Diabetes

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

"I'm thirsty all the time. I just can't get enough to drink."

A nurse knows to assess a patient with type 1 diabetes for postprandial hyperglycemia. The nurse knows that glycosuria is present when the serum glucose level exceeds: 180 mg/dL 120 mg/dL 140 mg/dL 160 mg/dL

180 mg/dL

When the nurse is caring for a patient with type 1 diabetes, what clinical manifestation would be a priority to closely monitor? Hypoglycemia Ketonuria Hyponatremia Polyphagia

Hypoglycemia

An obese Hispanic client, age 65, is diagnosed with type 2 diabetes. Which statement about diabetes mellitus is true? Nearly two-thirds of clients with diabetes mellitus are older than age 60. Diabetes mellitus is more common in Hispanics and Blacks than in Whites. Approximately one-half of the clients diagnosed with type 2 diabetes are obese. Type 2 diabetes mellitus is less common than type 1 diabetes mellitus.

Diabetes mellitus is more common in Hispanics and Blacks than in Whites.

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

Elevated blood urea nitrogen (BUN) and creatinine Rapid onset More common in type 1 diabetes

Which clinical characteristic is associated with type 1 diabetes (previously referred to as insulin-dependent diabetes mellitus)? Requirement for oral hypoglycemic agents Rare ketosis Obesity Presence of islet cell antibodies

Presence of islet cell antibodies

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? "Our laboratory technicians use tiny needles and they're really good with children." "Your child is young and will soon forget this experience." "I'll see if the physician can reduce the number of blood draws." "Your child will need less blood work as his glucose levels stabilize."

"Your child will need less blood work as his glucose levels stabilize."

A female patient with diabetes who weighs 150 pounds has an ideal body weight of 118 pounds. She can lose 1 pound per week and drop her extra 32 pounds in approximately 8 months. To meet this goal, the nurse advises the patient to decrease her calories by: 3,000 per week. 2,500 per week. 3,500 per week. 2,000 per week.

3,500 per week.

A client with diabetic ketoacidosis has been brought into the ED. Which intervention is not a goal in the initial medical treatment of diabetic ketoacidosis? Administer potassium replacements. Administer isotonic fluid at a high volume. Administer glucose. Monitor serum electrolytes and blood glucose levels.

Administer glucose.

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

Rapid, thready pulse

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? 6.5% 7.5 % 8.0% 8.5%

6.5%

A nurse is assigned to care for a postoperative client with diabetes mellitus. During the assessment interview, the client reports that he's impotent and says he's concerned about the effect on his marriage. In planning this client's care, the most appropriate intervention would be to: encourage the client to ask questions about personal sexuality. provide support for the spouse or significant other. provide time for privacy. suggest referral to a sex counselor or other appropriate professional.

suggest referral to a sex counselor or other appropriate professional.

A nurse is preparing a continuous insulin infusion for a child with diabetic ketoacidosis and a blood glucose level of 800 mg/dl. Which solution is the most appropriate at the beginning of therapy? 100 units of regular insulin in dextrose 5% in water 100 units of NPH insulin in dextrose 5% in water 100 units of regular insulin in normal saline solution 100 units of neutral protamine Hagedorn (NPH) insulin in normal saline solution

100 units of regular insulin in normal saline solution

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

A glucose challenge test should be performed between 24 and 28 weeks.

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

Increased urine output

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

Ketosis-prone Little or no endogenous insulin Younger than 30 years of age

The nurse is assessing a patient with nonproliferative (background) retinopathy. When examining the retina, what would the nurse expect to assess? Select all that apply. Microaneurysms Focal capillary single closure Detachment Blurred optic discs Leakage of fluid or serum (exudates)

Leakage of fluid or serum (exudates) Microaneurysms Focal capillary single closure

Once digested, what percentage of carbohydrates is converted to glucose? 70 80 90 100

100

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

7:45 AM

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

Coma, anxiety, confusion, headache, and cool, moist skin

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

The short-acting insulin is withdrawn before the intermediate-acting insulin.

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

Using sterile technique during the dressing change

During a routine medical evaluation, a client is found to have a random blood glucose level of 210 mg/dL. Which client statement(s) made by the client are concerning to the nurse? Select all that apply. "At times my vision is blurry." "I have to void nearly every hour." "I cannot seem to quench my thirst." "I sleep at least 8 hours each night." "I have lost 10 pounds without even trying."

"At times my vision is blurry." "I have to void nearly every hour." "I cannot seem to quench my thirst." "I have lost 10 pounds without even trying."

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

"Ketones will tell us if your body is using other tissues for energy."

The nurse instructs the client with diabetes on self-care during days of illness. Which client statement indicates that teaching has been effective? Select all that apply. "I will test my blood sugar level every 3 to 4 hours." "I will call the doctor if I have vomiting or diarrhea." "I will increase my intake of fluids." "I will skip my diabetes medication for the day." "I will eat soft foods if I cannot tolerate regular food."

"I will increase my intake of fluids." "I will test my blood sugar level every 3 to 4 hours." "I will call the doctor if I have vomiting or diarrhea." `"I will eat soft foods if I cannot tolerate regular food."

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

"Test your blood glucose every 4 hours."

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

4 to 6 hours

A nurse is teaching a client with diabetes mellitus about self-management of his condition. The nurse should instruct the client to administer 1 unit of insulin for every: 15 g of carbohydrates. 10 g of carbohydrates. 25 g of carbohydrates. 20 g of carbohydrates.

15 g of carbohydrates.

Glycosylated hemoglobin reflects blood glucose concentrations over which period of time? 1 month 3 months 6 months 9 months

3 months

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

Begin fluid replacements.

Which factors will cause hypoglycemia in a client with diabetes? Select all that apply. Client has not consumed food and continues to take insulin or oral antidiabetic medications. Client is experiencing effects of the aging process. Client has not consumed sufficient calories. Client has been exercising more than usual. Client has been sleeping excessively.

Client has not consumed food and continues to take insulin or oral antidiabetic medications. Client has not consumed sufficient calories. Client has been exercising more than usual.

Which of the following is an age-related change that may affect diabetes? Select all that apply. Taste changes Decreased vision Increased proprioception Increased bowel motility Decreased renal function

Decreased renal function Taste changes Decreased vision

The nurse is taking the history of a client with diabetes who is experiencing autonomic neuropathy. Which would the nurse expect the client to report? Erectile dysfunction Skeletal deformities Soft tissue ulceration Paresthesias

Erectile dysfunction

Which assessment finding is most important in determining nursing care for a client with diabetes mellitus? Fruity breath Cloudy urine Respirations of 12 breaths/minute Blood sugar 170 mg/dL

Fruity breath can indicate diabetic ketoacidosis (DKA)

Which of the following insulins are used for basal dosage? Glargine (Lantus) NPH (Humulin N) Aspart (Novolog) Lispro (Humalog)

Glargine (Lantus)

Which is the best nursing explanation for the symptom of polyuria in a client with diabetes mellitus? Increased ketones in the urine promote the manufacturing of more urine. With diabetes, drinking more results in more urine production. The body's requirement for fuel drives the production of urine. High sugar pulls fluid into the bloodstream, which results in more urine production.

High sugar pulls fluid into the bloodstream, which results in more urine production.

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

Increased urine osmolarity

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

It cannot be mixed with any other type of insulin.

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? It decreases the intestinal absorption of glucose. It stimulates the pancreatic beta cells. It aids in the process of gluconeogenesis. It carries glucose into body cells.

It carries glucose into body cells.

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

It enhances the transport of glucose across the cell membrane.

A client with type 1 diabetes is experiencing polyphagia. The nurse knows to assess for which additional clinical manifestation(s) associated with this classic symptom? Dehydration Altered mental state Muscle wasting and tissue loss Weight gain

Muscle wasting and tissue loss

Lispro (Humalog) is an example of which type of insulin? Short-acting Intermediate-acting Rapid-acting Long-acting

Rapid-acting

Laboratory studies indicate a client's blood glucose level is 185 mg/dl. Two hours have passed since the client ate breakfast. Which test would yield the most conclusive diagnostic information about the client's glucose use? Fasting blood glucose test Urine ketones Serum glycosylated hemoglobin (Hb A1c) 6-hour glucose tolerance test

Serum glycosylated hemoglobin (Hb A1c)

A client with a tentative diagnosis of hyperosmolar hyperglycemic nonketotic syndrome (HHNS) has a history of type 2 diabetes that is being controlled with an oral diabetic agent, tolazamide. Which laboratory test is the most important for confirming this disorder? Serum sodium level Arterial blood gas (ABG) values Serum potassium level Serum osmolarity

Serum osmolarity

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

Synthesis of glucose from noncarbohydrate sources.

A nurse educator been invited to local seniors center to discuss health-maintaining strategies for older adults. The nurse addresses the subject of diabetes mellitus, its symptoms, and consequences. What should the educator teach the participants about type 1 diabetes? Type 1 diabetes always develops before the age of 20. The participants are unlikely to develop a new onset of type 1 diabetes. New cases of diabetes will be split roughly evenly between type 1 and type 2. New cases of diabetes are highly uncommon in older adults.

The participants are unlikely to develop a new onset of type 1 diabetes.

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

They increase the need for insulin.

A nurse is preparing the daily care plan for a client with newly diagnosed diabetes mellitus. The priority nursing concern for this client should be: administering insulin routinely and as needed via a sliding scale. checking for the presence of ketones with each void. monitoring blood glucose every 4 hours and as needed. providing client education at every opportunity.

providing client education at every opportunity.

A nurse is preparing to discharge a client with coronary artery disease and hypertension who is at risk for type 2 diabetes. Which information is important to include in the discharge teaching? How to control blood glucose through lifestyle modification with diet and exercise How to monitor ketones daily How to self-inject insulin How to recognize signs of diabetic ketoacidosis

How to control blood glucose through lifestyle modification with diet and exercise