Chapter 30: Diabetes Mellitus 1-4

Type 1 diabetes

A 15-year-old boy is brought to the emergency department with symptoms of hyperglycemia. Following diagnostic testing, a diagnosis of diabetes mellitus is made. What classification will be used to describe a 15-year-old with diabetes who requires daily insulin injections? Type 1 diabetes Type 2 diabetes Juvenile diabetes Prediabetes

Increased hunger

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? Dizziness Fatigue Numbness Increased hunger

polyphagia.

A client has been recently diagnosed with type 2 diabetes, and reports continued weight loss despite increased hunger and food consumption. This condition is called: anorexia. polyuria. polydipsia. polyphagia.

"You'll need less insulin when you exercise or reduce your food intake."

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? "You'll need more insulin when you exercise or increase your food intake." "You'll need less insulin when you increase your food intake." "You'll need more insulin when you exercise or decrease your food intake." "You'll need less insulin when you exercise or reduce your food intake."

The client's consumption of carbohydrates

A client is diagnosed with diabetes mellitus. The client reports visiting the gym regularly and is a vegetarian. Which of the following factors is important to consider when the nurse assesses the client? The client's mental and emotional status The client's consumption of carbohydrates The client's exercise routine History of radiographic contrast studies that used iodine

Crying whenever diabetes is mentioned

A client is diagnosed with diabetes mellitus. Which assessment finding best supports a nursing diagnosis of Ineffective coping related to diabetes mellitus? Recent weight gain of 20 lb (9.1 kg) Failure to monitor blood glucose levels Skipping insulin doses during illness Crying whenever diabetes is mentioned

Administering a dose of intermediate-acting insulin before the evening meal

A client newly diagnosed with type 1 diabetes has an unusual increase in blood glucose from bedtime to morning. The physician suspects the client is experiencing insulin waning. Based on this diagnosis, the nurse expects which change to the client's medication regimen? Changing the time of evening injection of intermediate-acting insulin from dinnertime to bedtime Decreasing evening bedtime dose of intermediate-acting insulin and administering a bedtime snack Administering a dose of intermediate-acting insulin before the evening meal Increasing morning dose of long-acting insulin

glycosylated hemoglobin

A client with a 30-year history of type 2 diabetes is having an annual physical and blood work. Which test result would the physician be most concerned with when monitoring the client's treatment compliance? hematocrit B1C glycosylated hemoglobin postprandial glucose CAT scan

Serum osmolarity

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 potassium level Serum sodium level Arterial blood gas (ABG) values Serum osmolarity

6.5%

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? 7.5% 6.5% 8.0% 8.5%

Serum glucose level of 52 mg/dl

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? Serum glucose level of 450 mg/dl Serum calcium level of 10.2 mg/dl Serum glucose level of 52 mg/dl Serum calcium level of 8.9 mg/dl

Low blood glucose concentration

A client with diabetes mellitus is prescribed to switch from animal to synthesized human insulin. Which factor should the nurse monitor when caring for the client? Allergic reactions Polyuria Hypertonicity Low blood glucose concentration

Hypoglycemia

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

Sweating, tremors, and tachycardia

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

has type 2 diabetes.

A client with type 1 diabetes asks the nurse about taking an oral antidiabetic agent. The nurse explains that these medications are effective only if the client: has type 1 diabetes. is pregnant and has type 2 diabetes. has type 2 diabetes. prefers to take insulin orally.

"It tells us about your sugar control for the last 3 months."

A client with type 1 diabetes has a highly elevated glycosylated hemoglobin (Hb) test result. In discussing the result with the client, the nurse is most accurate in stating: "The test must be repeated following a 12-hour fast." "It looks like you aren't following the ordered diabetic diet." "It tells us about your sugar control for the last 3 months." "Your insulin regimen must be altered significantly."

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

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

"Diet, exercise, and weight loss can eliminate the need for medication."

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? "You misunderstood the doctor. Let's ask for clarification." "You will be placed on a strict low-sugar diet for better control." "Diet, exercise, and weight loss can eliminate the need for medication." "Some doctors do not treat blood sugar elevation until symptoms appear."

Technique for daily inspection of all of the surfaces of both feet

A diabetes nurse is teaching an older adult patient who has been recently diagnosed with type 2 diabetes about the importance of foot care. To reduce this patient's risk of developing a diabetic foot ulcer, what practice should the nurse teach? Exercises that can be used to promote circulation in the patient's feet The correct technique for soaking the feet in Epsom salts each evening Technique for daily inspection of all of the surfaces of both feet The correct placement of pillows to prevent the feet from being placed in a dependent position

8:30 AM.

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: 8:30 AM. 10:30 AM. 12:30 PM. 2:30 PM.

"Destruction of special cells in the pancreas causes a decrease in insulin production, and the level of sugar in your bloodstream increases."

A newly admitted patient with type 1 diabetes asks the nurse what caused her diabetes. In response, the nurse is explaining to the patient the etiology of type 1 diabetes. Which of the following is the most appropriate explanation by the nurse? "The tissues in your body are resistant to the action of insulin, making insulin less effective." "An acidic substance forms when your liver breaks down fatty acids because of the lack of insulin in your body." "The secretion of placental hormones is causing your body to be resistant to insulin." "Destruction of special cells in the pancreas causes a decrease in insulin production, and the level of sugar in your bloodstream increases."

15 to 20 g of a fast-acting carbohydrate such as orange juice.

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: I.M. or subcutaneous glucagon. I.V. bolus of dextrose 50%. 15 to 20 g of a fast-acting carbohydrate such as orange juice. 10 units of fast-acting insulin.

Dietitian

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? Home health nurse Dietitian Psychiatrist Social worker

increased thirst, hunger, and urination

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

Presence of autoantibodies against islet cells

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? Presence of autoantibodies against islet cells Obesity Rare ketosis Altered glucose metabolism

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

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

Fasting plasma glucose ≥126 mg/dL

A patient presents to the clinic complaining of symptoms that suggest diabetes mellitus. What criteria would support a diagnosis of diabetes mellitus? Fasting plasma glucose ≥126 mg/dL Random plasma >150 mg/dL Random plasma glucose >126 mg/dL Fasting plasma glucose >100 mg/dL

Maintenance of healthy blood pressure and prompt treatment of hypertension

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

Ascertain the patient's readiness and willingness to learn

After recently being admitted to the emergency department with signs and symptoms of hyperglycemia, a 33-year-old man was subsequently diagnosed with diabetes. The patient's blood sugars have been stabilized, and the man has begun diabetes education with a nurse educator. When working with this patient, the nurse educator should first: Ascertain the patient's readiness and willingness to learn Explain the various insulin delivery devices to the patient Ask the patient what questions he currently has about diabetes Teach the patient about the essential concepts of nutrition

Avoiding the complications associated with foot ulcers may mean the difference between institutionalization and continued independent living.

An elderly patient has come to the clinic with his daughter. The patient is a diabetic and is concerned about foot care. The nurse goes over foot care with the patient and his daughter as the nurse realizes that foot care is extremely important. Why would the nurse believe that foot care is so important to this patient? An elderly patient with foot ulcers experiences severe foot pain due to diabetic polyneuropathy. Avoiding the complications associated with foot ulcers may mean the difference between institutionalization and continued independent living. Hypoglycemia is a dangerous situation, and it may lead to unsteadiness and falls. Drugs that patients are required to take for their diabetic condition often decrease circulation to the lower extremities.

Glycosylated hemoglobin level

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? Fasting blood glucose level Glucose via a urine dipstick test Glycosylated hemoglobin level Glucose via an oral glucose tolerance test

at least three times per week.

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

Beta cells

Insulin is secreted by which of the following types of cells? Melanocytes Neural cells Beta cells Basal cells

Intermediate-acting

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

A patient who adheres to a meal plan and meal schedule.

The nurse has cared for four patients with type 1 diabetes over the past few shifts. Based upon components of managing diabetes, which patient will likely have the greatest success in maintaining tight glucose control of his or her type 1 diabetes? A patient who skips breakfast when her morning glucose reading is greater than 220 mg/dL. A patient who never deviates from his prescribed dose of insulin. A patient who adheres to a meal plan and meal schedule. A patient who eliminates carbohydrates from her daily intake.

Increases ability for glucose to get into the cell and lowers blood sugar

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? Increases ability for glucose to get into the cell and lowers blood sugar Creates an overall feeling of well-being and lowers risk of depression Decreases need for pancreas to produce more cells Decreases risk of developing insulin resistance and hyperglycemia

Sensory neuropathy

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? Autonomic neuropathy Retinopathy Sensory neuropathy Nephropathy

10 to 15 minutes

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

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

Increase frequency of glucose self-monitoring.

The nurse is educating the client with diabetes 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? Decrease food intake until nausea passes. Do not take insulin if not eating. Increase frequency of glucose self-monitoring. Take half the usual dose of insulin until symptoms resolve.

Ensure that the insulin is not given near a previous injection site

The nurse is preparing to administer a patient's scheduled dose of Novolin 70/30. When administering this dose of insulin, the nurse should: Aspirate before injecting the insulin into the patient's subcutaneous tissue Ensure that the insulin is not given near a previous injection site Massage the injection site gently for 10 to 15 seconds after administration Use a 3 mL syringe with a 24 gauge,- to-inch needle

The pancreatic hormone glucagon will stimulate the liver to release stored glucose.

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

"Diabetes can affect sensation in your feet and you can hurt yourself without realizing it."

When referred to a podiatrist, a client newly diagnosed with diabetes mellitus asks, "Why do you need to check my feet when I'm having a problem with my blood sugar?" The nurse's most helpful response to this statement is: "The physician wants to be sure your shoes fit properly so you won't develop pressure sores." "The circulation in your feet can help us determine how severe your diabetes is." "Diabetes can affect sensation in your feet and you can hurt yourself without realizing it." "It's easier to get foot infections if you have diabetes."

Presence of islet cell antibodies

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

Do not mix with other insulins.

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

"Test your blood glucose every 4 hours."

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

Using sterile technique during the dressing change

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

insulin resistance

Which is a characteristic of type 2 diabetes? presence of islet antibodies little or no insulin insulin resistance ketosis-prone when insulin absent

The client has not eaten but continues to take insulin or oral antidiabetic medications.

Which may be a potential cause of hypoglycemia in the client diagnosed with diabetes mellitus? The client has not been exercising. The client has not complied with the prescribed treatment regimen. The client has not eaten but continues to take insulin or oral antidiabetic medications. The client has eaten but has not taken or received insulin.

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

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