Chap 51-Assessment and Management of Patients with Diabetes

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

c) NPH

The nurse is describing the action of insulin in the body to a client newly diagnosed with type 1 diabetes. Which of the following would the nurse explain as being the primary action? a) It stimulates the pancreatic beta cells. b) It decreases the intestinal absorption of glucose. c) It enhances transport of glucose across the cell wall. d) It aids in the process of gluconeogenesis.

c) It enhances transport of glucose across the cell wall.

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

d) Regular

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

b) Ketones

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

c) Rapid-acting

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? a) "I skip lunch when I don't feel hungry." b) "I avoid exposure to the sun as much as possible." c) "I always wear my medical identification bracelet." d) "I always carry hard candy to eat in case my blood sugar level drops."

a) "I skip lunch when I don't feel hungry."

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

a) Albumin

The nurse is reviewing the initial laboratory test results of a client diagnosed with DKA. Which of the following would the nurse expect to find? a) Blood pH of 6.9 b) Blood glucose level of 250 mg/dL c) Serum bicarbonate of 19 mEq/L d) PaCO2 of 40 mm Hg

a) Blood pH of 6.9

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? a) Glucagon b) Hydrocortisone c) 50% dextrose d) Epinephrine

a) Glucagon

A client with diabetes mellitus is receiving an oral antidiabetic agent. The nurse observes for which symptom when caring for this client? a) Hypoglycemia b) Polyuria c) Polydipsia d) Blurred vision

a) Hypoglycemia

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

a) Increased thirst, hunger, and urination

A patient is diagnosed with type 1 diabetes. What clinical characteristics does the nurse expect to see in this patient? (Select all that apply.) a) Little endogenous insulin b) Ketosis-prone c) Older than 65 years of age d) Younger than 30 years of age e) Obesity at diagnoses

a) Little endogenous insulin b) Ketosis-prone d) Younger than 30 years of age

A client with diabetes is receiving an oral anti diabetic agent that acts to help the tissues use available insulin more efficiently. Which of the following agents would the nurse expect to administer? a) Metformin b) Glyburide c) Glipizide d) Repaglinide

a) Metformin

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? a) Metformin b) Glyburide c) Glipizide d) Repaglinide

a) Metformin

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

a) Sweating, tremors, and tachycardia

Which of the following factors would a nurse identify as a most likely cause of diabetic ketoacidosis (DKA) in a client with diabetes? a) The client has eaten and has not taken or received insulin. b) The client has not consumed sufficient calories. c) The client continues medication therapy despite adequate food intake. d) The client has been exercising more than usual.

a) The client has eaten and has not taken or received insulin.

A nurse is assigned to care for a patient who is suspected of having type 2 diabetes. Select all the clinical manifestations that the nurse knows could be consistent with this diagnosis. a) Wounds that heal slowly or respond poorly to treatment b) Blurred or deteriorating vision c) Sudden weight loss and anorexia d) Fatigue and irritability e) Polyuria and polydipsia

a) Wounds that heal slowly or respond poorly to treatment b) Blurred or deteriorating vision d) Fatigue and irritability e) Polyuria and polydipsia

During a class on exercise for clients with diabetes mellitus, a client asks the nurse educator how often to exercise. To meet the goals of planned exercise, the nurse educator should advise the client to exercise: a) at least three times per week. b) at least once per week. c) at least five times per week. d) every day.

a) at least three times per week.

A client tells the nurse that she has been working hard for the past 3 months to control her type 2 diabetes with diet and exercise. To determine the effectiveness of the client's efforts, the nurse should check: a) glycosylated hemoglobin level. b) fasting blood glucose level. c) serum fructosamine level. d)urine glucose level.

a) glycosylated hemoglobin level.

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

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

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

b) "Test your blood glucose every 4 hours."

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? a) Check the client's urine for the presence of sugar and acetone. b) Administer 50% glucose intravenously. c) Infuse 1000 mL D5W over a 12-hour period. d) Encourage the client to drink orange juice with added sugar.

b) Administer 50% glucose intravenously.

Which combination of adverse effects should a nurse monitor for when administering I.V. insulin to a client with diabetic ketoacidosis? a) Hypocalcemia and hyperkalemia b) Hypokalemia and hypoglycemia c) Hyperkalemia and hyperglycemia d) Hypernatremia and hypercalcemia

b) Hypokalemia and hypoglycemia

The nurse is educating the diabetic client on setting up a sick plan to manage blood glucose control during times of minor illness such as influenza. Which is the most important teaching item to include? a) Decrease food intake until nausea passes. b) Increase frequency of glucose self-monitoring. c) Do not take insulin if not eating. d) Take half the usual dose of insulin until symptoms resolve.

b) Increase frequency of glucose self-monitoring.

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? a) Numbness b) Increased hunger c) Fatigue d) Dizziness

b) Increased hunger

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

b) Increased urine output

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? a) Insulin is absorbed rapidly regardless of the injection site. b) Insulin is absorbed more rapidly at abdominal injection sites than at other sites. c) Insulin is absorbed unpredictably at all injection sites. d) Insulin is absorbed more slowly at abdominal injection sites than at other sites.

b) Insulin is absorbed more rapidly at abdominal injection sites than at other sites.

Which type of insulin acts most quickly? a) Glargine b) NPH c) Regular d) Lispro

b) NPH

A patient who is diagnosed with type 1 diabetes would be expected to: a) Receive daily doses of a hypoglycemic agent. b) Need exogenous insulin. c) Be restricted to an American Diabetic Association diet. d) Have no damage to the islet cells of the pancreas.

b) Need exogenous insulin.

A characteristic of type 2 diabetes includes which of the following? a) Ketosis-prone when insulin absent b) No islet cell antibodies c) Little insulin d) Often have islet antibodies

b) No islet cell antibodies

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

b) Presence of islet cell antibodies

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

b) They increase the need for insulin.

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

b) Using sterile technique during the dressing change

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? a) There is no need to inject air into the bottle of insulin before withdrawing the insulin. b) When mixing insulin, the regular insulin is drawn up into the syringe first. c) If two different types of insulin are ordered, they need to be given in separate injections. d) When mixing insulin, the NPH insulin is drawn up into the syringe first.

b) When mixing insulin, the regular insulin is drawn up into the syringe first.

A nurse is providing dietary instructions to a client with hypoglycemia. To control hypoglycemic episodes, the nurse should recommend: a) increasing intake of vitamins B and D and taking iron supplements. b) consuming a low-carbohydrate, high-protein diet and avoiding fasting. c) increasing saturated fat intake and fasting in the afternoon. d) eating a candy bar if light-headedness occurs.

b) consuming a low-carbohydrate, high-protein diet and avoiding fasting.

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

c) "Always follow the same order when drawing the different insulins into the syringe."

A nurse is teaching a client recovering from diabetic ketoacidosis (DKA) about management of "sick days." The client asks the nurse why it is important to monitor the urine for ketones. Which statement is the nurse's best response? a) "Ketones are formed when insufficient insulin leads to cellular starvation. As cells rupture, they release these acids into the blood." b) "Excess glucose in the blood is metabolized by the liver and turned into ketones, which are an acid." c) "Ketones accumulate in the blood and urine when fat breaks down in the absence of insulin. Ketones signal an insulin deficiency that will cause the body to start breaking down stored fat for energy." d) "When the body does not have enough insulin, hyperglycemia occurs. Excess glucose is broken down by the liver, causing acidic by-products to be released."

c) "Ketones accumulate in the blood and urine when fat breaks down in the absence of insulin. Ketones signal an insulin deficiency that will cause the body to start breaking down stored fat for energy."

Health teaching for a patient with diabetes who is prescribed Humulin N, an intermediate NPH insulin, would include which of the following advice? a) "Your insulin will begin to act in 15 minutes." b) "Your insulin will last 8 hours, and you will need to take it three times a day." c) "You should take your insulin after you eat breakfast and dinner." d) "You should expect your insulin to reach its peak effectiveness by 12 noon if you take it at 8:00 AM."

c) "You should take your insulin after you eat breakfast and dinner."

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? a) Duration of the insulin b) Area for insulin injection c) Accuracy of the dosage d) Technique for injecting

c) Accuracy of the dosage

A patient is admitted to the health care center with abdominal pain, nausea, and vomiting. The medical reports indicate a history of type 1 diabetes. The nurse suspects the patient's symptoms to be that of diabetic ketoacidosis (DKA). Which of the following actions will help the nurse confirm the diagnosis? a) Assessing for excessive sweating b) Assessing the patient's ability to move all extremities c) Assessing the patient's breath odor d) Assessing the patient's ability to take a deep breath

c) Assessing the patient's breath odor

A client with long-standing type 1 diabetes is admitted to the hospital with unstable angina pectoris. After the client's condition stabilizes, the nurse evaluates the diabetes management regimen. The nurse learns that the client sees the physician every 4 weeks, injects insulin after breakfast and dinner, and measures blood glucose before breakfast and at bedtime. Consequently, the nurse should formulate a nursing diagnosis of: a) Health-seeking behaviors (diabetes control). b) Defensive coping. c) Deficient knowledge (treatment regimen). d) Impaired adjustment.

c) Deficient knowledge (treatment regimen).

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

c) It cannot be mixed with any other type of insulin.

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? a) Maintenance of a low-sodium, low-protein diet b) Vigorous physical activity at least three times weekly c) Maintenance of healthy blood pressure and prompt treatment of hypertension d) Subcutaneous injection of 5,000 units of heparin twice daily

c) Maintenance of healthy blood pressure and prompt treatment of hypertension

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

c) Regular

A patient has been newly diagnosed with type 2 diabetes, and the nurse is assisting with the development of a meal plan. What step should be taken into consideration prior to making the meal plan? a) Determining whether the patient is on insulin or taking oral antidiabetic medication b) Ensuring that the patient understands that some favorite foods may not be allowed on the meal plan and substitutes will need to be found c) Reviewing the patient's diet history to identify eating habits and lifestyle and cultural eating patterns d) Making sure that the patient is aware that quantity of foods will be limited

c) Reviewing the patient's diet history to identify eating habits and lifestyle and cultural eating patterns

A client with diabetes mellitus is receiving an oral antidiabetic agent. When caring for this client, the nurse should observe for signs of: a) polydipsia b) blurred vision c) hypoglycemia d) polyuria

c) hypoglycemia

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

d) "I might need insulin later on but probably not as much or as often."

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? a) "I will refer you to a dietician who can help you with your weight." b) "You may be having undiagnosed infections, causing you to lose extra weight." c) "Don't worry about what your friends think; the carbohydrates you eat are being quickly digested, increasing your metabolism." d) "Your body is using protein and fat for energy instead of glucose."

d) "Your body is using protein and fat for energy instead of glucose."

A client who is suspected of having diabetes is undergoing a postprandial glucose test. Which result would the nurse interpret as suggestive of diabetes? a) 70 mg /dL b) 110 mg/dL c) 220 mg/dL d) 160 mg/dL

d) 160 mg/dL

A client with type 1 diabetes is scheduled to receive 30 units of 70/30 insulin. There is no 70/30 insulin available. As a substitution, the nurse may give the client: a) 20 units regular insulin and 10 units NPH. b) 21 units regular insulin and 9 units NPH. c) 10 units regular insulin and 20 units NPH. d) 9 units regular insulin and 21 units neutral protamine Hagedorn (NPH).

d) 9 units regular insulin and 21 units neutral protamine Hagedorn (NPH).

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

d) Dietitian

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

d) Nervousness, diaphoresis, and confusion

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

d) Sensory neuropathy