Chapter 46: Assessment and Management of Patients with Diabetes
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? "You may be having undiagnosed infections, causing you to lose extra weight." "I will refer you to a dietician who can help you with your weight." "Don't worry about what your friends think; the carbohydrates you eat are being quickly digested, increasing your metabolism." "Your body is using protein and fat for energy instead of glucose."
"Your body is using protein and fat for energy instead of glucose."
Which statement is true regarding gestational diabetes? A glucose challenge test should be performed between 24 and 28 weeks. It occurs in most pregnancies. Onset usually occurs in the first trimester. There is a low risk for perinatal complications.
A glucose challenge test should be performed between 24 and 28 weeks.
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) "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." B) "Ketones are formed when insufficient insulin leads to cellular starvation. As cells rupture, they release these acids into the blood." 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) "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."
A young adult client with type 1 diabetes does not want to have to self-administer insulin injections several times a day. Which medication approach would the nurse recommend that best controls the condition and meets the client's needs? 1 injection per day Injection before each meal Insulin pump 2 injections premixed
Insulin pump
Which statement is correct regarding glargine insulin? It is absorbed rapidly. It is given twice daily. It cannot be mixed with any other type of insulin. Its peak action occurs in 2 to 3 hours.
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 carries glucose into body cells. It stimulates the pancreatic beta cells. It decreases the intestinal absorption of glucose. It aids in the process of gluconeogenesis.
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 decreases the intestinal absorption of glucose. It stimulates the pancreatic beta cells. It carries glucose into body cells.
It carries glucose into body cells.
Which instruction about insulin administration should a nurse give to a client? "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." "Store unopened vials of insulin in the freezer at temperatures well below freezing."
"Always follow the same order when drawing the different insulins into the syringe."
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. "I sleep at least 8 hours each night." "I cannot seem to quench my thirst." "I have to void nearly every hour." "I have lost 10 pounds without even trying." "At times my vision is blurry."
"I cannot seem to quench my thirst." "I have to void nearly every hour." "I have lost 10 pounds without even trying." "At times my vision is blurry."
A client with type 2 diabetes has recently been prescribed acarbose, and the nurse is explaining how to take this medication. The teaching is determined to be effective based on which statement by the client? "I will take this medication in the morning, 15 minutes before breakfast." "I will take this medication in the morning, with my first bite of breakfast." "This medication needs to be taken after the midday meal." "It does not matter what time of day I take this medication."
"I will take this medication in the morning, with my first bite of breakfast."
A nurse prepares teaching for a client with newly-diagnosed diabetes. Which statements about the role of insulin will the nurse include in the teaching? Select all that apply. "Insulin interferes with the release of growth hormone from the pituitary." "Insulin promotes synthesis of proteins in various body tissues." "Insulin permits entry of glucose into the cells of the body." "Insulin interferes with glucagon from the pancreas." "Insulin promotes the storage of fat in adipose tissue."
"Insulin permits entry of glucose into the cells of the body." "Insulin promotes synthesis of proteins in various body tissues." "Insulin promotes the storage of fat in adipose tissue."
An agitated, confused client arrives in the emergency department. The client's history includes type 1 diabetes, hypertension, and angina pectoris. Assessment reveals pallor, diaphoresis, headache, and intense hunger. A stat blood glucose sample measures 42 mg/dl, and the client is treated for an acute hypoglycemic reaction. After recovery, the nurse teaches the client to treat hypoglycemia by ingesting: 10 to 15 g of a simple carbohydrate. 25 to 30 g of a simple carbohydrate. 2 to 5 g of a simple carbohydrate. 18 to 20 g of a simple carbohydrate.
10 to 15 g of a simple carbohydrate.
An agitated, confused client arrives in the emergency department. The client's history includes type 1 diabetes, hypertension, and angina pectoris. Assessment reveals pallor, diaphoresis, headache, and intense hunger. A stat blood glucose sample measures 42 mg/dl, and the client is treated for an acute hypoglycemic reaction. After recovery, the nurse teaches the client to treat hypoglycemia by ingesting: 2 to 5 g of a simple carbohydrate. 25 to 30 g of a simple carbohydrate. 18 to 20 g of a simple carbohydrate. 10 to 15 g of a simple carbohydrate.
10 to 15 g of a simple carbohydrate.
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
10 to 15 minutes
What is the duration of regular insulin? 12 to 16 hours 24 hours 3 to 5 hours 4 to 6 hours
4 to 6 hours
The nurse expects that a type 1 diabetic patient may receive what percentage of his or her usual morning dose of insulin preoperatively? 50% to 60% 10% to 20% 25% to 40% 85% to 90%
50% to 60%
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% 8.0% 8.5% 7.5%
6.5%
A client is receiving insulin lispro at 7:30 AM. The nurse ensures that the client has breakfast by which time? 8:00 AM 7:45 AM 8:15 AM 8:30 AM
7:45 AM
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? Accuracy of the dosage Technique for injecting Duration of the insulin Area for insulin injection
Accuracy of the dosage
A nurse is caring for a diabetic patient with a diagnosis of nephropathy. What would the nurse expect the urinalysis report to indicate? Bacteria Red blood cells White blood cells Albumin
Albumin
The nurse is educating the patient with diabetes about the importance of increasing dietary fiber. What should the nurse explain is the rationale for the increase? Select all that apply. May reduce postprandial glucose levels Decrease the need for exogenous insulin May improve blood glucose levels Increase potassium levels Help reduce cholesterol levels
Decrease the need for exogenous insulin May improve blood glucose levels Help reduce cholesterol levels
Which of the following insulins are used for basal dosage? NPH (Humulin N) Aspart (Novolog) Lispro (Humalog) Glargine (Lantus)
Glargine (Lantus)
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. With diabetes, drinking more results in more urine production. Increased ketones in the urine promote the manufacturing of more 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.
An older adult patient is in the hospital being treated for sepsis related to a urinary tract infection. The patient has started to have an altered sense of awareness, profound dehydration, and hypotension. What does the nurse suspect the patient is experiencing? Systemic inflammatory response syndrome Diabetic ketoacidosis Multiple-organ dysfunction syndrome Hyperglycemic hyperosmolar syndrome
Hyperglycemic hyperosmolar syndrome
When the nurse is caring for a patient with type 1 diabetes, what clinical manifestation would be a priority to closely monitor? Hyponatremia Polyphagia Hypoglycemia Ketonuria
Hypoglycemia
A nurse is caring for a client with an abnormally low blood glucose concentration. What glucose level should the nurse observe when assessing laboratory results? Between 75 and 90 mg/dL (4.16 to 5.00 mmol/L) 95 mg/dL (5.27 mmol/L) Less than 70 mg/dL (3.7 mmol/L) Between 70 and 75 mg/dL (3.9 to 4.16 mmol/L)
Less than 70 mg/dL (3.7 mmol/L)
A patient is diagnosed with type 1 diabetes. What clinical characteristics does the nurse expect to see in this patient? Select all that apply. Little or no endogenous insulin Younger than 30 years of age Older than 65 years of age Obesity at diagnoses Ketosis-prone
Little or no endogenous insulin Younger than 30 years of age Ketosis-prone
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 calcium level of 8.9 mg/dl Serum glucose level of 52 mg/dl
Serum glucose level of 52 mg/dl
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 Serum osmolarity Serum potassium level Arterial blood gas (ABG) values
Serum osmolarity
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: The process of gluconeogenesis will be inhibited. Insulin will be released to facilitate the transport of sugar. Glycogenesis will be decreased by the liver. The pancreatic hormone glucagon will stimulate the liver to release stored glucose.
The pancreatic hormone glucagon will stimulate the liver to release stored glucose.
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? New cases of diabetes are highly uncommon in older adults. New cases of diabetes will be split roughly evenly between type 1 and type 2. The participants are unlikely to develop a new onset of 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.
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: urine glucose level. serum fructosamine level. glycosylated hemoglobin level. fasting blood glucose level.
glycosylated hemoglobin level.
Which is a characteristic of type 2 diabetes? presence of islet antibodies ketosis-prone when insulin absent little or no insulin insulin resistance
insulin resistance
Which of the following medications is considered a glitazone? pioglitazone dapagliflozin metformin metformin with glyburide
pioglitazone Remember: glitazone, pio(glitazone),
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: polyphagia. anorexia. polyuria. polydipsia.
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: polyphagia. polyuria. polydipsia. anorexia.
polyphagia.
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: A) provide time for privacy. B) suggest referral to a sex counselor or other appropriate professional. C) encourage the client to ask questions about personal sexuality. D) provide support for the spouse or significant other.
suggest referral to a sex counselor or other appropriate professional.
Which instruction about insulin administration should a nurse give to a client? "Shake the vials before withdrawing the insulin." "Store unopened vials of insulin in the freezer at temperatures well below freezing." "Discard the intermediate-acting insulin if it appears cloudy." "Always follow the same order when drawing the different insulins into the syringe."
"Always follow the same order when drawing the different insulins into the syringe."
Which instruction should a nurse give to a client with diabetes mellitus when teaching about "sick day rules"? "Follow your regular meal plan, even if you're nauseous." "It's okay for your blood glucose to go above 300 mg/dl while you're sick." "Test your blood glucose every 4 hours." "Don't take your insulin or oral antidiabetic agent if you don't eat."
"Test your blood glucose every 4 hours."
Glycosylated hemoglobin reflects blood glucose concentrations over which period of time? 1 month 3 months 6 months 9 months
3 months
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? 8.0% 8.5% 6.5% 7.5 %
6.5%
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: 12:30 PM. 2:30 PM. 10:30 AM. 8:30 AM.
8:30 AM.
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? Dietitian Social worker Home health nurse Psychiatrist
Dietitian
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? A) Fasting blood glucose test B) Serum glycosylated hemoglobin (Hb A1c) C) 6-hour glucose tolerance test D) Urine ketones
B) Serum glycosylated hemoglobin (Hb A1c)
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? Administering a dose of intermediate-acting insulin before the evening meal Increasing morning dose of long-acting insulin Decreasing evening bedtime dose of intermediate-acting insulin and administering a bedtime snack Changing the time of evening injection of intermediate-acting insulin from dinnertime to bedtime
Changing the time of evening injection of intermediate-acting insulin from dinnertime to bedtime
Which factors will cause hypoglycemia in a client with diabetes? Select all that apply. Client has been exercising more than usual. Client has been sleeping excessively. Client is experiencing effects of the aging process. 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. Client has not consumed food and continues to take insulin or oral antidiabetic medications. Client has not consumed sufficient calories.
Which of the following is an age-related change that may affect diabetes? Select all that apply. Decreased vision Increased bowel motility Taste changes Increased proprioception Decreased renal function
Decreased renal function Taste changes Decreased vision
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. It is rapidly absorbed and has a fast onset of action. Do not mix with other insulins. Draw up the drug first, then add regular insulin.
Do not mix with other insulins.
A nurse is providing education to a client who is newly diagnosed with diabetes mellitus. What are classic symptoms associated with diabetes? Increased weight gain, appetite, and thirst Loss of appetite, increased urination, and dehydration Increased thirst, hunger, and urination Increased weight loss, dehydration, and fatigue
Increased thirst, hunger, and urination
A nurse is assessing a client who is receiving total parenteral nutrition (TPN). Which finding suggests that the client has developed hyperglycemia? Increased urine output Decreased appetite Diaphoresis Cheyne-Stokes respirations
Increased urine output
A client with type 1 diabetes is admitted to an acute care facility with diabetic ketoacidosis. To correct this acute diabetic emergency, which measure should the health care team take first? Administer insulin. Initiate fluid replacement therapy.
Initiate fluid replacement therapy.
Capillary glucose monitoring is being performed every 4 hours for a female client diagnosed with hyperosmolar, hyperglycemic nonketotic syndrome (HHNS). Insulin is administered using a scale of regular insulin according to glucose results. At 2 p.m., the client has a capillary glucose level of 250 mg/dl for which she receives 8 units of regular insulin. The nurse should expect which of the following?
Onset to be at 2:15 p.m. and its peak to be at 3 p.m
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 Altered glucose metabolism Obesity Rare ketosis
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 Altered glucose metabolism Rare ketosis
Presence of autoantibodies against islet cells
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? Slow, shallow respirations Cool, moist skin Rapid, thready pulse Arm and leg trembling
Rapid, thready pulse
A client is admitted to the unit with diabetic ketoacidosis (DKA). Which insulin would the nurse expect to administer intravenously? Regular Lente Glargine NPH
Regular
What is the only insulin that can be given intravenously? NPH Regular Lantus Ultralente
Regular
Which category of oral antidiabetic agents exerts the primary action by directly stimulating the pancreas to secrete insulin? Biguanides Alpha-glucosidase inhibitors Sulfonylureas Thiazolidinediones
Sulfonylureas Both end with reas: Panc(reas), sulfonylu(reas)
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? Polyuria, polydipsia, and polyphagia Dry skin, bradycardia, and somnolence Bradycardia, thirst, and anxiety Sweating, tremors, and tachycardia
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? The client has not consumed sufficient calories. The client continues medication therapy despite adequate food intake. The client has eaten and has not taken or received insulin. The client has been exercising more than usual.
The client has eaten and has not taken or received insulin.
Which may be a potential cause of hypoglycemia in the client diagnosed with diabetes mellitus? The client has not eaten but continues to take insulin or oral antidiabetic medications. The client has not complied with the prescribed treatment regimen. The client has not been exercising. The client has eaten but has not taken or received insulin.
The client has not eaten but continues to take insulin or oral antidiabetic medications.
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 consumption of carbohydrates The client's mental and emotional status The client's exercise routine History of radiographic contrast studies that used iodine
The client's consumption of carbohydrates
A client with diabetes mellitus must learn how to self-administer insulin. The physician has ordered 10 units of U-100 regular insulin and 35 units of U-100 isophane insulin suspension (NPH) to be taken before breakfast. When teaching the client how to select and rotate insulin injection sites, the nurse should provide which instruction? "Administer insulin into areas of scar tissue or hypertrophy whenever possible." "Administer insulin into sites above muscles that you plan to exercise heavily later that day." "Inject insulin into healthy tissue with large blood vessels and nerves." "Rotate injection sites within the same anatomic region, not among different regions."
"Rotate injection sites within the same anatomic region, not among different regions."
Health teaching for a patient with diabetes who is prescribed Humulin N, an intermediate NPH insulin, would include which of the following advice? "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." "You should expect your insulin to reach its peak effectiveness by 9:00 AM if you take it at 8:00 AM." "Your insulin will begin to act in 15 minutes."
"You should take your insulin after breakfast and after dinner."
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? "Don't worry about what your friends think; the carbohydrates you eat are being quickly digested, increasing your metabolism." "Your body is using protein and fat for energy instead of glucose." "I will refer you to a dietician who can help you with your weight." "You may be having undiagnosed infections, causing you to lose extra weight."
"Your body is using protein and fat for energy instead of glucose."
An agitated, confused client arrives in the emergency department. The client's history includes type 1 diabetes, hypertension, and angina pectoris. Assessment reveals pallor, diaphoresis, headache, and intense hunger. A stat blood glucose sample measures 42 mg/dl, and the client is treated for an acute hypoglycemic reaction. After recovery, the nurse teaches the client to treat hypoglycemia by ingesting: 25 to 30 g of a simple carbohydrate. 10 to 15 g of a simple carbohydrate. 18 to 20 g of a simple carbohydrate. 2 to 5 g of a simple carbohydrate.
10 to 15 g of a simple carbohydrate.
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 neutral protamine Hagedorn (NPH) insulin in normal saline solution 100 units of NPH insulin in dextrose 5% in water 100 units of regular insulin in dextrose 5% in water 100 units of regular insulin in normal saline solution
100 units of regular insulin in normal saline solution
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: 160 mg/dL 180 mg/dL 140 mg/dL 120 mg/dL
180 mg/dL
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) When mixing insulin, the regular insulin is drawn up into the syringe first. B) If two different types of insulin are ordered, they need to be given in separate injections. C) There is no need to inject air into the bottle of insulin before withdrawing the insulin. D) When mixing insulin, the NPH insulin is drawn up into the syringe first.
A) When mixing insulin, the regular insulin is drawn up into the syringe first.
Which statement about fluid replacement is accurate for a client with hyperosmolar hyperglycemic nonketotic syndrome? Administer 2 to 3 L of IV fluid rapidly. Administer IV fluid slowly to prevent circulatory overload and collapse. Administer a dextrose solution containing normal saline solution. Administer 10 L of IV fluid over the first 24 hours.
Administer 2 to 3 L of IV fluid rapidly.
Which clinical characteristic is associated with type 2 diabetes (previously referred to as non-insulin-dependent diabetes mellitus)? Client is usually thin at diagnosis Blood glucose can be controlled through diet and exercise Clients demonstrate islet cell antibodies Client is prone to ketosis
Blood glucose can be controlled through diet and exercise
A client is admitted with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which laboratory finding should the nurse expect in this client? Plasma bicarbonate 12 mEq/L Blood urea nitrogen (BUN) 15 mg/dl Blood glucose level 1,100 mg/dl Arterial pH 7.25
Blood glucose level 1,100 mg/dl
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 glucose level of 250 mg/dL B) Serum bicarbonate of 19 mEq/L C) Blood pH of 6.9 D) PaCO2 of 40 mm Hg
Blood pH of 6.9
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: Impaired adjustment. Health-seeking behaviors (diabetes control). Defensive coping. Deficient knowledge (treatment regimen).
Deficient knowledge (treatment regimen).
Which of the following is a characteristic of diabetic ketoacidosis (DKA)? Select all that apply. Elevated blood urea nitrogen (BUN) and creatinine Normal arterial pH level Absent ketones Rapid onset More common in type 1 diabetes
Elevated blood urea nitrogen (BUN) and creatinine Rapid onset More common in type 1 diabetes
Which information should be included in the teaching plan for a client receiving glargine, which is "peakless" basal insulin? Administer the total daily dosage in 2 doses. Do not mix with other insulins. Draw up the drug first, then add regular insulin. Glargine is rapidly absorbed and has a fast onset of action.
Do not mix with other insulins.
The nurse is caring for a client receiving insulin isophane suspension (NPH) at breakfast. What is an important dietary consideration for the nurse to keep in mind? Provide fewest amount of carbohydrates at lunch meal. Encourage midday snack. Make sure breakfast is not delayed. Delay dinner meal.
Encourage midday snack.
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? Glycosylated hemoglobin level Fasting blood glucose level Glucose via an oral glucose tolerance test Glucose via a urine dipstick test
Glycosylated hemoglobin level
A patient with diabetic ketoacidosis (DKA) has had a large volume of fluid infused for rehydration. What potential complication from rehydration should the nurse monitor for? Hypokalemia Hyperglycemia Hyperkalemia Hyponatremia
Hypokalemia
A young adult client with type 1 diabetes does not want to have to self-administer insulin injections several times a day. Which medication approach would the nurse recommend that best controls the condition and meets the client's needs? 1 injection per day 2 injections premixed Injection before each meal Insulin pump
Insulin pump
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? Numbness Dizziness Increased hunger Fatigue
Increased hunger
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? Insulin is absorbed rapidly regardless of the injection site. Insulin is absorbed more slowly at abdominal injection sites than at other sites. Insulin is absorbed more rapidly at abdominal injection sites than at other sites. Insulin is absorbed unpredictably at all injection sites.
Insulin is absorbed more rapidly at abdominal injection sites than at other sites.
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
Low blood glucose concentration
The nurse suspects that a patient with diabetes has developed proliferative retinopathy. The nurse confirms this by the presence of which of the following diagnostic signs? Microaneurysm formation Decreased capillary permeability Neovascularization into the vitreous humor The leakage of capillary wall fragments into surrounding areas
Neovascularization into the vitreous humor
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. Obtain a serum glucose level. Notify the physician. Give the client 4 oz of milk and a graham cracker with peanut butter.
Obtain a repeat fingerstick glucose level.
Lispro (Humalog) is an example of which type of insulin? Long-acting Rapid-acting Intermediate-acting Short-acting
Rapid-acting
Which may be a potential cause of hypoglycemia in the client diagnosed with diabetes mellitus? The client has not complied with the prescribed treatment regimen. The client has not been exercising. 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.
The client has not eaten but continues to take insulin or oral antidiabetic medications.
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 cause wide fluctuations in the need for insulin. They have no effect. They decrease the need for insulin. They increase the need for insulin.
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 decrease the need for insulin. They have no effect. They cause wide fluctuations in the need for insulin. They increase the need for insulin.
They increase the need for insulin.
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.
This insulin has no peak action and does not cause a hypoglycemic reaction.
The nurse understands that a client with diabetes mellitus is at greater risk for developing which of the following complications? Urinary tract infections Lifelong obesity Low blood pressure Elevated triglycerides
Urinary tract infections
The nurse is preparing an educational session about foot care for clients with diabetes. Which information will the nurse include in the education? Select all that apply. Shave any calluses with a disposable razor. Wear binding compression socks daily. Check the bottom of the feet with a mirror every day. Check the inside of shoes before putting them on. Apply lotion between the toes after bathing.
Check the inside of shoes before putting them on. Check the bottom of the feet with a mirror every day.
A client with type 2 diabetes asks the nurse why he can't have a pancreatic transplant. Which of the following would the nurse include as a possible reason? Increased risk for urologic complications Need for exocrine enzymatic drainage Need for lifelong immunosuppressive therapy Underlying problem of insulin resistance
Underlying problem of insulin resistance
