chapter 45

A client receiving insulin tells the nurse their blood glucose has been low the last few mornings. Which additional statement made by the client may be a contributing factor to the decrease in the blood glucose? 1) "I have been taking a garlic supplement to prevent colds." 2) "I have been taking St. John's wort to help with my memory." 3) "I have been taking extra vitamin C because so many people have colds." 4) "I have been taking vitamin D to help build up my bones."

1) "I have been taking a garlic supplement to prevent colds." p. 717

Which statement made by a client indicates an understanding of the education about insulin administration? 1) "I should only use a calibrated insulin syringe for the injections." 2) "I should check my blood sugar immediately prior to administration of insulin." 3) "I should use the abdominal area only for insulin injections." 4) "I should provide direct pressure over the site following the injection."

1) "I should only use a calibrated insulin syringe for the injections." p. 720

The nurse has provided client education about type 2 diabetes mellitus. Which statements made by the client indicate additional teaching is needed? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1) "The prescriptions that I will be on will help me lose weight." 2) "I can take an oral prescription and will never have to inject myself. 3) "I can increase my body's ability to use the insulin by exercising regularly." 4) "I have several lifestyle changes to make." 5) "I am not at risk for kidney disease like type 1 diabetics."

1) "The prescriptions that I will be on will help me lose weight." 2) "I can take an oral prescription and will never have to inject myself." 5) "I am not at risk for kidney disease like type 1 diabetics." p. 720

Which information should the nurse include in the education about the mechanism of action for metformin (Glucophage)? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1) Decreases sugar production in the liver 2) Inhibits absorption of carbohydrates 3) Stimulates the pancreas to produce more insulin 4) Reduces insulin resistance 5) Increases energy use

1) Decreases sugar production in the liver 4) Reduces insulin resistance p. 723

Which are the primary blood tests for diagnosing diabetes? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1) Fasting plasma glucose 2) Random glucose testing 3) Hemoglobin A1C 4) Oral glucose tolerance test 5) Post prandial glucose test

1) Fasting plasma glucose 3) Hemoglobin A1C 4) Oral glucose tolerance test p.714

The nurse is reviewing the blood work of a client suspected of having diabetes. Which result should the nurse be concerned about? 1) HBA1C level is 8.4%. 2) Fasting plasma glucose of 115 g/dL. 3) Fasting plasma glucose is 110 g/dL. 4) Oral glucose tolerance test of 185 mg/dL.

1) HBA1C level is 8.4%. p. 714

The home health nurse observes a client's 3-month supply of insulin vials are not refrigerated. Which action should the nurse take? 1) Instruct the client that the insulin should be stored away from direct sunlight or excessive heat. 2) Have the client discard the vials. 3) Instruct the client to label each vial with the date when opened. 4) Instruct the client that unopened bottles can be stored for up to 3 months

1) Instruct the client that the insulin should be stored away from direct sunlight or excessive heat. p. 719

Which insulin has the longest onset? 1) Insulin detemir (Levemir) 2) Insulin glulisine (Apidra) 3) Insulin lispro (Humalog) 4) Insulin isophane (NPH)

1) Insulin detemir (Levemir) p. 716

The physician writes orders for the client with diabetes mellitus. Which order should the nurse clarify with the healthcare provider? 1) Lantus insulin 20U BID 2) Administering regular insulin 30 minutes prior to meals 3) Five units of Humalog/10 units NPH daily 4) Metformin (Glucophage) 1000 mg per day in divided doses

1) Lantus insulin 20U BID p. 716

Which prescription is classified as a biguanide? 1) Metformin HCI (Glucophage) 2) Repaglinide (Prandin) 3) Tolbutamide (Orinase) 4) Acarbose (Precose)

1) Metformin HCI (Glucophage) p.722

Which laboratory test should the nurse monitor the client for who is receiving insulin? 1) Potassium2) Serum amylase3) AST (aspartate aminotransferase)4) Sodium

1) Potassium p. 717

The nurse finds a client with diabetes mellitus type 1 unresponsive. Which is the priority nursing action? 1) Call the rapid response team. 2) Administer glucagon. 3) Administer oxygen. 4) Assess the vital signs.View Answer

2) Administer glucagon. p. 716

Which information should the nurse include when teaching a client about proper subcutaneous injection techniques? 1) Inject the area using a 60° angle. 2) Apply a pad to the site after injections. 3) Rotate sites monthly. 4) Massage the site after injection.

2) Apply a pad to the site after injections. p. 720

When should the nurse administer a client's prescribed 10 units of lispro (Humalog)? 1) Thirty minutes before meals 2) Five minutes before a meal 3) When the meal trays arrive on the floor 4) Fifteen minutes after meals

2) Five minutes before a meal p. 716

Which are thought to be the contributing factors to the development of type I diabetes? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply 1) Gender 2) Genetics 3) Ethnicity 4) Environment 5) Immunology

2) Genetics 4) Environment 5) Immunology p. 714

Which triggers the release of insulin in the body? 1) Increase in glycogen 2) Increase in blood glucose 3) Increase in carbohydrates 4) Increase in glucagon

2) Increase in blood glucose p.713

Which describes the mechanism of action of regular insulin? 1) Stimulate the pancreas to produce insulin. 2) Promote entry of glucose into the cells. 3) Facilitate the entry of glucose into the bloodstream. 4) Stimulate the pancreas to secrete more insulin.

2) Promote entry of glucose into the cells. p. 715

Which client has the highest risk of developing type 2 diabetes mellitus? 1) The 38-year-old client who smokes one pack of cigarettes per day 2) The 42-year-old client who is 50 pounds overweight 3) The 50-year-old client who does not get any physical exercise 4) The 56-year-old client who drinks three glasses of wine each evening

2) The 42-year-old client who is 50 pounds overweight p. 720

A client with type 1 diabetes mellitus receiving insulin asks the nurse if they can have a glass of wine with their dinner. Which information should the nurse provide the client? 1) The alcohol could increase your resistance to the insulin. 2) The alcohol could predispose you to hypoglycemia. 3) The alcohol could cause serious liver disease. 4) The alcohol could decrease the metabolism of the insulin.

2) The alcohol could predispose you to hypoglycemia. p. 718

A client with type 1 diabetes mellitus asks the nurse why they cannot receive insulin in a pill form. Which response should the nurse provide the client? 1) "The cells cannot recognize insulin in that form." 2) "The insulin could not be properly absorbed." 3) "The stomach acid would destroy the insulin." 4) "The action of insulin would be unpredictable."

3) "The stomach acid would destroy the insulin." p.715

Which symptom is common for a client with untreated type 1 diabetes mellitus? 1) Increased energy 2) Weight gain 3) Fatigue 4) Decreased hunger

3) Fatigue p.715

Which type of insulin should the nurse anticipate to administer intravenously to a client with a blood glucose of 563? 1) Insulin aspart (NovoLog) 2) Insulin isophane (NPH) 3) Insulin regular (Humulin R). 4) Insulin glargine (Lantus)

3) Insulin regular (Humulin R). p. 717

Which condition is a client at risk for who is prescribed a biguanide? 1) Anaphylaxis 2) Hepatotoxicity 3) Lactic acidosis 4) Pancreatitis

3) Lactic acidosis p. 722, 725

Which symptom should the nurse associate with hypoglycemia? 1) Thirst 2) Increased urination 3) Moist skin 4) Nausea

3) Moist skin p.716

Which is a primary function of the islets of Langerhans? 1) Secretion of enzymes 2) Exocrine function 3) Secretion of glucagon 4) Absorption of insulin

3) Secretion of glucagon p.713

Which information should the nurse include in the teaching of a client with type 1 diabetes mellitus that would like to participate in sports? 1) "Lower your dose of insulin." 2) "Eat a large meal after your game." 3) "Take an oral hypoglycemic agent on game days rather than insulin." 4) "Eat a meal 1 hour before the game and consume a carbohydrate snack and fluids during the game."

4) "Eat a meal 1 hour before the game and consume a carbohydrate snack and fluids during the game." p.719

Which initial question should the nurse ask the client who is receiving chlorpropamide (Diabinese) and is experiencing nausea, flushing, and palpitations? 1) "Have you taken your medication as directed?" 2) "Did you eat or drink anything new this week?" 3) "Have you increased the amount of fiber in your diet?" 4) "Have you had any alcoholic beverages to drink this week?"

4) "Have you had any alcoholic beverages to drink this week? p. 721

Which statement made by a client indicates an understanding of type 2 diabetes mellitus? 1) "My beta cells just cannot produce enough insulin for my cells." 2) "My peripheral cells have increased sensitivity to insulin." 3) "My cells have increased receptors sites, but there is not enough insulin." 4) "My cells are resistant to the insulin my pancreas makes."

4) "My cells are resistant to the insulin my pancreas makes." p. 720

Which response should the nurse provide a client that asks about dawn phenomenon? 1) "At night your body converts glycogen into glucose resulting in hyperglycemia." 2) "During the night your body releases hormones that elevate blood glucose." 3) "During the night your blood glucose levels decline and then rise again in the morning." 4) "Your body naturally produces cortisol and growth hormone between 4:00 and 8:00 am."

4) "Your body naturally produces cortisol and growth hormone between 4:00 and 8:00 am." p. 716, 717

Which information should the nurse include in the education of a client when explaining type 1 diabetes mellitus? 1) "The exocrine function of the pancreas is not working." 2) "The target cells are resistant to insulin." 3) "Your alpha cells should be able to secrete insulin, but they cannot." 4) "Your pancreas cannot secrete insulin."

4) "Your pancreas cannot secrete insulin." p. 714, 715