Chapter 30: Diabetes Mellitus 5-8

Rapid administration of intravenous normal saline

A 30-year-old type 1 diabetic has been admitted to the critical care unit with a diagnosis of diabetic ketoacidosis following a drinking binge over the course of a weekend. The nurse should anticipate that this patient will require what immediate intervention? IV administration of calcium gluconate Subcutaneous administration of 30 units of insulin glargine (Lantus) Oral administration of 2 g of metformin (Glucophage) Rapid administration of intravenous normal saline

15 g of carbohydrates.

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: 10 g of carbohydrates. 15 g of carbohydrates. 20 g of carbohydrates. 25 g of carbohydrates.

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

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. Type 2 diabetes mellitus is less common than type 1 diabetes mellitus. Approximately one-half of the clients diagnosed with type 2 diabetes are obese.

3 months

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

Serum glycosylated hemoglobin (Hb A1c)

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? Serum glycosylated hemoglobin (Hb A1c) 6-hour glucose tolerance test Fasting blood glucose test Urine ketones

Rapid-acting

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

Type 2

The greatest percentage of people have which type of diabetes? Type 1 Type 2 Gestational Impaired glucose tolerance

Accuracy of the dosage

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? Technique for injecting Accuracy of the dosage Duration of the insulin Area for insulin injection

Fruity breath

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

7:45 AM

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

180 mg/dL

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: 120 mg/dL 140 mg/dL 160 mg/dL 180 mg/dL

Erectile dysfunction

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? Soft tissue ulceration Skeletal deformities Paresthesias Erectile dysfunction

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

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? Making sure that the patient is aware that quantity of foods will be limited Ensuring that the patient understands that some favorite foods may not be allowed on the meal plan and substitutes will need to be found Determining whether the patient is on insulin or taking oral antidiabetic medication Reviewing the patient's diet history to identify eating habits and lifestyle and cultural eating patterns

Hypokalemia and hypoglycemia

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

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

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

Administer glucose.

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? Monitor serum electrolytes and blood glucose levels. Administer glucose. Administer isotonic fluid at a high volume. Administer potassium replacements.

Muscle wasting and tissue loss

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? Altered mental state Muscle wasting and tissue loss Weight gain Dehydration

suggest referral to a sex counselor or other appropriate professional.

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: provide time for privacy. suggest referral to a sex counselor or other appropriate professional. provide support for the spouse or significant other. encourage the client to ask questions about personal sexuality.

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

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

Increased urine output

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

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

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

Decreased renal function Taste changes Decreased vision

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

Begin fluid replacements.

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? Give prescribed antiemetics. Begin fluid replacements. Administer prescribed dose of insulin. Administer bicarbonate to correct acidosis.

This insulin has no peak action and does not cause a hypoglycemic reaction.

A client receives a daily injection of glargine insulin at 7:00 a.m. When should the nurse monitor this client for a hypoglycemic reaction? Between 8:00 and 10:00 a.m. Between 4:00 and 6:00 p.m. Between 7:00 and 9:00 p.m. This insulin has no peak action and does not cause a hypoglycemic reaction.

pioglitazone

Which of the following medications is considered a glitazone? metformin metformin with glyburide pioglitazone dapagliflozin

They increase the need for insulin.

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

Exercise a similar amount at a similar time each day

A diabetes nurse is discussing lifestyle measures that a patient with a recent diagnosis of type 1 diabetes can use to manage his disease. When discussing the benefits of exercise with this patient, the nurse should recommend that he: Eat a snack immediately following exercise to prevent hypoglycemia Use exercise to lower his blood sugar during hyperglycemic episodes Avoid physical activity until he is able to manage his blood sugars independently Exercise a similar amount at a similar time each day

Diet soda

Which of the following would be considered a "free" item from the exchange list? Diet soda Green salad Medium apple 1 tsp olive oil

100 units of regular insulin in normal saline solution

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 normal saline solution 100 units of neutral protamine Hagedorn (NPH) insulin in normal saline solution 100 units of regular insulin in dextrose 5% in water 100 units of NPH insulin in dextrose 5% in water

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

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

"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."

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? "Ketones are formed when insufficient insulin leads to cellular starvation. As cells rupture, they release these acids into the blood." "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." "Excess glucose in the blood is metabolized by the liver and turned into ketones, which are an acid." "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."

Obtain a repeat fingerstick glucose level.

A nurse obtains a fingerstick glucose level of 45 mg/dl on a client newly diagnosed with diabetes mellitus. The client is alert and oriented, and the client's skin is warm and dry. How should the nurse intervene? Obtain a repeat fingerstick glucose level. Notify the physician. Obtain a serum glucose level. Give the client 4 oz of milk and a graham cracker with peanut butter.

Lispro

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

"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."

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."

"You should take your insulin after breakfast and after dinner."

Health teaching for a patient with diabetes who is prescribed Humulin N, an intermediate NPH insulin, would include which of the following advice? "Your insulin will begin to act in 15 minutes." "You should expect your insulin to reach its peak effectiveness by 9:00 AM if you take it at 8:00 AM." "You should take your insulin after breakfast and after dinner." "Your insulin will last 8 hours, and you will need to take it three times a day."

Insulin resistance or insufficient insulin production

The nurse is preparing a presentation for a group of adults at a local community center about diabetes. Which characteristic would the nurse inform the group is associated with type 2 diabetes? Onset most common during adolescence Insulin resistance or insufficient insulin production Little relation to prediabetes Less common than type 1 diabetes

"Be sure to apply a moisturizer to feet daily."

The nurse is providing information about foot care to a client with diabetes. Which of the following would the nurse include? "Wash your feet in hot water every day." "Use a razor to remove corns or calluses." "Be sure to apply a moisturizer to feet daily." "Wear well-fitting comfortable rubber shoes."

Blood pH of 6.9

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? Blood pH of 6.9 PaCO2 of 40 mm Hg Blood glucose level of 250 mg/dL Serum bicarbonate of 19 mEq/L

Urinary tract infections

The nurse understands that a client with diabetes mellitus is at greater risk for developing which of the following complications? Lifelong obesity Urinary tract infections Low blood pressure Elevated triglycerides

Sulfonylureas

Which category of oral antidiabetic agents exerts the primary action by directly stimulating the pancreas to secrete insulin? Thiazolidinediones Biguanides Alpha-glucosidase inhibitors Sulfonylureas

Weight loss

Which factor is the focus of nutrition intervention for clients with type 2 diabetes? Protein metabolism Blood glucose level Weight loss Carbohydrate intake

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

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

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

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