Chapter 46: Management of Patients with Metabolic Disorders
"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? · "Ketones will tell us if your body is using other tissues for energy." · "The spleen releases ketones when your body can't use glucose." · "Ketones help the physician determine how serious your diabetes is." · "Ketones can damage your kidneys and eyes."
Promote absorption.
A client newly diagnosed with type 1 diabetes asks the nurse why injection site rotation is important. What is the nurse's best response? · Prevent muscle destruction. · Promote absorption. · Avoid infection. · Minimize discomfort.
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? · Administering a dose of intermediate-acting insulin before the evening meal · Decreasing evening bedtime dose of intermediate-acting insulin and administering a bedtime snack · Increasing morning dose of long-acting insulin · Changing the time of evening injection of intermediate-acting insulin from dinnertime to bedtime
Finger
A client with type 1 diabetes mellitus is receiving short-acting insulin to maintain control of blood glucose levels. In providing glucometer instructions, the nurse would instruct the client to use which site for most accurate findings? · Forearm · Finger · Thigh · Upper arm
Administering 1 ampule of 50% dextrose solution, per physician's order
A client with type 1 diabetes presents with a decreased level of consciousness and a fingerstick glucose level of 39 mg/dl. His family reports that he has been skipping meals in an effort to lose weight. Which nursing intervention is most appropriate? · Administering a 500-ml bolus of normal saline solution · Inserting a feeding tube and providing tube feedings · Observing the client for 1 hour, then rechecking the fingerstick glucose level · Administering 1 ampule of 50% dextrose solution, per physician's order
check blood glucose at 3:00 a.m.
A client with type 1 diabetes reports waking up in the middle of the night feeling nervous and confused, with tremors, sweating, and a feeling of hunger. Morning fasting blood glucose readings have been 110 to 140 mg/dL. The client admits to exercising excessively and skipping meals over the past several weeks. Based on these symptoms, the nurse plans to instruct the client to · check blood glucose at 3:00 a.m. · eat a complex carbohydrate snack in the evening before bed. · administer an increased dose of neutral protamine Hagedorn insulin in the evening. · skip the evening neutral protamine Hagedorn insulin dose on days when exercising and skipping meals.
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 stimulates the pancreatic beta cells. · It aids in the process of gluconeogenesis. · 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? · Take half the usual dose of insulin until symptoms resolve. · Decrease food intake until nausea passes. · Increase frequency of glucose self-monitoring. · Do not take insulin if not eating.
The client has eaten and has not taken or received insulin.
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 continues medication therapy despite adequate food intake. · The client has not consumed sufficient calories. · The client has been exercising more than usual. · The client has eaten and has not taken or received insulin.
· Hypertension · Family history · History of gestational diabetes · Age greater of 45 years or older · Obesity
Which of the following is a risk factor for the development of diabetes mellitus? Select all that apply. · Hypertension · Family history · History of gestational diabetes · Age greater of 45 years or older · Obesity
Decreased vision Taste changes Decreased renal function
Which of the following is an age-related change that may affect diabetes? Select all that apply. · Decreased vision · Increased bowel motility · Taste changes · Decreased renal function · Increased proprioception
ketoacidosis
A client with a history of type 1 diabetes is demonstrating fast, deep, labored breathing and has fruity odored breath. What could be the cause of the client's current serious condition? · ketoacidosis · hyperosmolar hyperglycemic nonketotic syndrome · All options are correct. · hepatic disorder
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 osmolarity · Serum potassium level · Arterial blood gas (ABG) values · Serum sodium level
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
Deficient knowledge (treatment regimen).
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. · Defensive coping. · Deficient knowledge (treatment regimen). · Health-seeking behaviors (diabetes control).
The participants are unlikely to develop a new onset of type 1 diabetes.
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.
Nervousness, diaphoresis, and confusion
A nurse expects to find which signs and symptoms in a client experiencing hypoglycemia? · Nervousness, diaphoresis, and confusion · Polyuria, headache, and fatigue · Polydipsia, pallor, and irritability · Polyphagia and flushed, dry skin
Below-normal serum potassium level
A nurse expects to note an elevated serum glucose level in a client with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which other laboratory finding should the nurse anticipate? · Serum alkalosis · Below-normal serum potassium level · Serum ketone bodies · Elevated serum acetone level
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? · Dietitian · Home health nurse · Psychiatrist · Social worker
providing client education at every opportunity.
A nurse is preparing the daily care plan for a client with newly diagnosed diabetes mellitus. The priority nursing concern for this client should be: · administering insulin routinely and as needed via a sliding scale. · providing client education at every opportunity. · checking for the presence of ketones with each void. · monitoring blood glucose every 4 hours and as needed.
"I'm going to give your son some insulin. Then I'll be happy to talk with you."
A nurse is preparing to administer insulin to a child who's just been diagnosed with type 1 diabetes. When the child's mother stops the nurse in the hall, she's crying and anxious to talk about her son's condition. The nurse's best response is: · "Everything will be just fine. I'll be back in a minute and then we can talk." · "I can't talk now. I have to give your son his insulin as soon as possible." · "I'm going to give your son some insulin. Then I'll be happy to talk with you." · "If you'll wait in your son's room, the physician will talk with you as soon as he's free."
"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? · "Excess glucose in the blood is metabolized by the liver and turned into ketones, which are an acid." · "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." · "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."
"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." · "Always follow the same order when drawing the different insulins into the syringe." · "Discard the intermediate-acting insulin if it appears cloudy."
"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"? · "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." · "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? · Cleaning the wound with a povidone-iodine solution · Applying a heating pad · Debriding the wound three times per day · Using sterile technique during the dressing change
Rapid, thready pulse
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? · Rapid, thready pulse · Slow, shallow respirations · Cool, moist skin · Arm and leg trembling
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? · CAT scan · hematocrit B1C · postprandial glucose · glycosylated hemoglobin
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 · CAT scan · postprandial glucose
Insulin pump
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? · Insulin pump · 1 injection per day · 2 injections premixed · Injection before each meal
Peripheral neuropathy
An older adult patient that has type 2 diabetes comes to the emergency department with second-degree burns to the bottom of both feet and states, "I didn't feel too hot but my feet must have been too close to the heater." What does the nurse understand is most likely the reason for the decrease in temperature sensation? Peripheral neuropathy A faulty heater Autonomic neuropathy Sudomotor neuropathy
Decrease the need for exogenous insulin May improve blood glucose levels Help reduce cholesterol levels
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. · Decrease the need for exogenous insulin · Increase potassium levels · May reduce postprandial glucose levels · May improve blood glucose levels · Help reduce cholesterol levels
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? · Less common than type 1 diabetes · Insulin resistance or insufficient insulin production · Onset most common during adolescence · Little relation to prediabetes
Insulin production insufficient
The nurse is preparing a presentation for a group of adults at a local community center about diabetes. Which of the following would the nurse include as associated with type 2 diabetes? · Insulin production insufficient · Less common than type 1 diabetes · Little to no relation to pre-diabetes · Onset most common during adolescence
Insulin production insufficient
The nurse is preparing a presentation for a group of adults at a local community center about diabetes. Which of the following would the nurse include as associated with type 2 diabetes? · Onset most common during adolescence · Little to no relation to pre-diabetes · Less common than type 1 diabetes · Insulin production insufficient
Check the inside of shoes before putting them on. · Check the bottom of the feet with a mirror every day.
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. · Wear binding compression socks daily. · Check the inside of shoes before putting them on. · Check the bottom of the feet with a mirror every day. · Apply lotion between the toes after bathing. · Shave any calluses with a disposable razor.
NPH
The nurse is preparing to administer intermediate-acting insulin to a patient with diabetes. Which insulin will the nurse administer? · Lispro (Humalog) · Iletin II · Glargine (Lantus) · NPH
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
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? · Paresthesias · Soft tissue ulceration · Skeletal deformities · Erectile dysfunction
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. · Absent ketones · Elevated blood urea nitrogen (BUN) and creatinine · Rapid onset · More common in type 1 diabetes · Normal arterial pH level
pioglitazone
Which of the following medications is considered a glitazone? · metformin · metformin with glyburide · dapagliflozin · pioglitazone
Diet soda
Which of the following would be considered a "free" item from the exchange list? · 1 tsp olive oil · Diet soda · Medium apple · Green salad
A glucose challenge test should be performed between 24 and 28 weeks.
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.
Insulin waning
Which term refers to the progressive increase in blood glucose from bedtime to morning? · Somogyi effect · Diabetic ketoacidosis (DKA) · Insulin waning · Dawn phenomenon
Lispro
Which type of insulin acts most quickly? · Regular · Lispro · NPH · Glargine
Lispro
Which type of insulin acts most quickly? · Regular · NPH · Glargine · Lispro
Blindness · Kidney disease · Limb amputation · Cardiovascular disease
client has been diagnosed with diabetes and discusses treatment strategies with the nurse. What consequences of untreated diabetes should the nurse include with client teaching? Select all that apply. · Blindness · Kidney disease · Limb amputation · Cardiovascular disease · Liver failure
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 · Numbness · Increased hunger · Fatigue
glycosylated hemoglobin level.
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: · serum fructosamine level. · fasting blood glucose level. · glycosylated hemoglobin level. · urine glucose level.
Need exogenous insulin.
A patient who is diagnosed with type 1 diabetes would be expected to: · Have no damage to the islet cells of the pancreas. · Receive daily doses of a hypoglycemic agent. · Need exogenous insulin. · Be restricted to an American Diabetic Association diet.
138 mg/dL, 2 hours postprandial.
A patient who is 6 months' pregnant was evaluated for gestational diabetes mellitus. The doctor considered prescribing insulin based on the serum glucose result of: · 80 mg/dL, 1 hour postprandial. · 138 mg/dL, 2 hours postprandial. · 90 mg/dL before meals. · 120 mg/dL, 1 hour postprandial.
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? · Administer prescribed dose of insulin. · Give prescribed antiemetics. · Begin fluid replacements. · 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.
Hypokalemia
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 · Hyponatremia · Hyperkalemia
"I can avoid getting sick by not becoming dehydrated and by paying attention to my need to urinate, drink, or eat more than usual."
A client diagnosed with hyperosmolar hyperglycemic nonketotic syndrome (HHNS) is stabilized and prepared for discharge. When preparing the client for discharge and home management, which statement indicates that the client understands his condition and how to control it? · "If I begin to feel especially hungry and thirsty, I'll eat a snack high in carbohydrates." · "I can avoid getting sick by not becoming dehydrated and by paying attention to my need to urinate, drink, or eat more than usual." · "If I experience trembling, weakness, and headache, I should drink a glass of soda that contains sugar." · "I will have to monitor my blood glucose level closely and notify the physician if it's constantly elevated."
Assess the client's breath odor
A client 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 client's symptoms to be those of diabetic ketoacidosis (DKA). Which action will help the nurse confirm the diagnosis? · Assess the client's ability to move all extremities · Assess the client's ability to take a deep breath · Assess the client's breath odor · Assess for excessive sweating
Regular
A client is admitted to the unit with diabetic ketoacidosis (DKA). Which insulin would the nurse expect to administer intravenously? · NPH · Glargine · Lente · Regular
Blood glucose level 1,100 mg/dl
A client is admitted with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which laboratory finding should the nurse expect in this client? · Blood glucose level 1,100 mg/dl · Plasma bicarbonate 12 mEq/L · Blood urea nitrogen (BUN) 15 mg/dl · Arterial pH 7.25
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
Deficient fluid volume related to osmotic diuresis
A client with a serum glucose level of 618 mg/dl is admitted to the facility. He's awake and oriented, has hot dry skin, and has the following vital signs: temperature of 100.6° F (38.1° C), heart rate of 116 beats/minute, and blood pressure of 108/70 mm Hg. Based on these assessment findings, which nursing diagnosis takes highest priority? · Ineffective thermoregulation related to dehydration · Imbalanced nutrition: Less than body requirements related to insulin deficiency · Decreased cardiac output related to elevated heart rate · Deficient fluid volume related to osmotic diuresis
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% · 8.5% · 8.0%
Metformin
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? · Glyburide · Repaglinide · Metformin · Glipizide
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? · Polyuria · Allergic reactions · Low blood glucose concentration · Hypertonicity
Change the second IV solution to dextrose 5% in water.
A client with diabetic ketoacidosis was admitted to the intensive care unit 4 hours ago and has these laboratory results: blood glucose level 450 mg/dl, serum potassium level 2.5 mEq/L, serum sodium level 140 mEq/L, and urine specific gravity 1.025. The client has two IV lines in place with normal saline solution infusing through both. Over the past 4 hours, his total urine output has been 50 ml. Which physician order should the nurse question? · Hold insulin infusion for 30 minutes. · Change the second IV solution to dextrose 5% in water. · Add 40 mEq potassium chloride to an infusion of half normal saline solution and infuse at a rate of 10 mEq/hour.
Underlying problem of insulin resistance
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 · Underlying problem of insulin resistance · Need for lifelong immunosuppressive therapy · Need for exocrine enzymatic drainage
Weight reduction through diet and exercise
A client with newly diagnosed type 2 diabetes is admitted to the metabolic unit. The primary goal for this admission is education. Which goal should the nurse incorporate into her teaching plan? · An eye examination every 2 years until age 50 · Weight reduction through diet and exercise · Maintenance of blood glucose levels between 180 and 200 mg/dl · Smoking reduction but not complete cessation
Weight reduction through diet and exercise
A client with newly diagnosed type 2 diabetes is admitted to the metabolic unit. The primary goal for this admission is education. Which goal should the nurse incorporate into her teaching plan? · Smoking reduction but not complete cessation · Weight reduction through diet and exercise · An eye examination every 2 years until age 50 · Maintenance of blood glucose levels between 180 and 200 mg/dl
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? · Polyuria, polydipsia, and polyphagia · Sweating, tremors, and tachycardia · Bradycardia, thirst, and anxiety · Dry skin, bradycardia, and somnolence
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 2 diabetes. · is pregnant and has type 2 diabetes. · has type 1 diabetes. · prefers to take insulin orally.
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 · Weight gain · Dehydration · Muscle wasting and tissue loss
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 will be placed on a strict low-sugar diet for better control." · "You misunderstood the doctor. Let's ask for clarification." · "Some doctors do not treat blood sugar elevation until symptoms appear." · "Diet, exercise, and weight loss can eliminate the need for medication."
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: · 12:30 PM. · 8:30 AM. · 10:30 AM. · 2:30 PM.
Decrease in blood sugar to a hypoglycemic level between 2:00 to 3:00 AM · Increase in blood glucose from 3:00 AM until breakfast · Normal bedtime blood glucose
A hospitalized, insulin-dependent patient with diabetes has been experiencing morning hyperglycemia. The patient will be awakened once or twice during the night to test blood glucose levels. The health care provider suspects that the cause is related to the Somogyi effect. Which of the following indicators support this diagnosis? Select all that apply. · Elevated blood glucose at bedtime · Rise in blood glucose about 11:00 AM · Decrease in blood sugar to a hypoglycemic level between 2:00 to 3:00 AM · Increase in blood glucose from 3:00 AM until breakfast · Normal bedtime blood glucose
Control blood glucose levels.
A nurse educates a group of clients with diabetes mellitus on the prevention of diabetic nephropathy. Which of the following suggestions would be most important? · Control blood glucose levels. · Drink plenty of fluids. · Eat a high-fiber diet. · Take the antidiabetic drugs regularly.
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? · Increased urine output · Cheyne-Stokes respirations · Diaphoresis · Decreased appetite
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.V. bolus of dextrose 50%. · I.M. or subcutaneous glucagon. · 10 units of fast-acting insulin. · 15 to 20 g of a fast-acting carbohydrate such as orange juice.
Albumin
A nurse is caring for a diabetic patient with a diagnosis of nephropathy. What would the nurse expect the urinalysis report to indicate? · Red blood cells · Bacteria · Albumin · White blood cells
wash and inspect the feet daily.
A nurse is developing a teaching plan for a client with diabetes mellitus. A client with diabetes mellitus should: · walk barefoot at least once each day. · use commercial preparations to remove corns. · cut the toenails by rounding edges. · wash and inspect the feet daily.
"The fruit has less sugar than the juice." "Eating the fruit instead of drinking juice decreases the glycemic index by slowing absorption."
A nurse is educating a client about the benefits of fruit versus fruit juice in the diabetic diet. The client states, "What difference does it make if you drink the juice or eat the fruit? It is all the same." What are the best responses by the nurse? Select all that apply. · "Eating the fruit will give you more vitamins and minerals than the juice will." · "Eating the fruit is more satisfying than drinking the juice. You will get full faster." · "The fruit has less sugar than the juice." · "Eating the fruit will lead to hyperglycemia and the fruit juice will not lead to hyperglycemia." · "Eating the fruit instead of drinking juice decreases the glycemic index by slowing absorption."
beta cells of the pancreas.
A nurse is explaining the action of insulin to a client with diabetes mellitus. During client teaching, the nurse reviews the process of insulin secretion in the body. The nurse is correct when she states that insulin is secreted from the: · parafollicular cells of the thyroid. · beta cells of the pancreas. · adenohypophysis. alpha cells of the pancreas
High blood sugar decreases blood circulation to nerves.
A nurse is inspecting the feet of a client with diabetes and finds a tack sticking in the sole of one foot. The client denies feeling anything unusual in the foot. Which is the best rationale for this finding? · Nephropathy is a common complication of diabetes mellitus. · In diabetes, the autonomic nerves are affected. · Motor neuropathy causes muscles to weaken and atrophy. · High blood sugar decreases blood circulation to nerves.
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? · If administered immediately, there is no requirement for withdrawing one type of insulin before another. · The short-acting insulin is withdrawn before the intermediate-acting insulin. · Different types of insulin are not to be mixed in the same syringe. · The intermediate-acting insulin is withdrawn before the short-acting insulin.
How to control blood glucose through lifestyle modification with diet and exercise
A nurse is preparing to discharge a client with coronary artery disease and hypertension who is at risk for type 2 diabetes. Which information is important to include in the discharge teaching? · How to monitor ketones daily · How to recognize signs of diabetic ketoacidosis · How to self-inject insulin · How to control blood glucose through lifestyle modification with diet and exercise
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? · Increased thirst, hunger, and urination · Increased weight gain, appetite, and thirst · Increased weight loss, dehydration, and fatigue · Loss of appetite, increased urination, and dehydration
Change the needle every 3 days.
A nurse is teaching a client about insulin infusion pump use. What intervention should the nurse include to prevent infection at the injection site? · Wear sterile gloves when inserting the needle. · Change the needle every 3 days. · Take the ordered antibiotics before initiating treatment. · Use clean technique when changing the needle.
Glucagon
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? · Epinephrine · Hydrocortisone · Glucagon · 50% dextrose
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? · Obesity · Altered glucose metabolism · Presence of autoantibodies against islet cells · Rare ketosis
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 carries glucose into body cells. · It stimulates the pancreatic beta cells. · It aids in the process of gluconeogenesis. · It decreases the intestinal absorption of glucose.
Ketones
Which is a by-product of fat breakdown in the absence of insulin and accumulates in the blood and urine? · Cholesterol · Ketones · Creatinine · Hemoglobin
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
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 five times per week. · every day. · at least three times per week.
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? · Glycosylated hemoglobin level · Glucose via an oral glucose tolerance test · Glucose via a urine dipstick test · Fasting blood glucose level
· "I have to void nearly every hour." · "At times my vision is blurry." "I have lost 10 pounds without even trying." · "I cannot seem to quench my thirst."
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 have to void nearly every hour." · "At times my vision is blurry." · "I sleep at least 8 hours each night." · "I have lost 10 pounds without even trying." · "I cannot seem to quench my thirst."
70% NPH insulin and 30% regular insulin
Every morning, a client with type 1 diabetes receives 15 units of Humulin 70/30. What does this type of insulin contain? · 70% regular insulin and 30% NPH insulin · 70 units of regular insulin and 30 units of NPH insulin · 70% NPH insulin and 30% regular insulin · 70 units of neutral protamine Hagedorn (NPH) insulin and 30 units of regular insulin
Increases lean muscle mass Increases resting metabolic rate as muscle size increases Decreases total cholesterol Increases glucose uptake by body muscles
Exercise lowers blood glucose levels. Which of the following are the physiologic reasons that explain this statement. Select all that apply. Increases lean muscle mass Increases resting metabolic rate as muscle size increases Decreases the levels of high-density lipoproteins Decreases total cholesterol Increases glucose uptake by body muscles
Increased urine osmolarity
For a client with hyperglycemia, which assessment finding best supports a nursing diagnosis of Deficient fluid volume? · Increased urine osmolarity · Cool, clammy skin · Jugular vein distention · Decreased serum sodium level
Increased urine osmolarity
For a client with hyperglycemia, which assessment finding best supports a nursing diagnosis of Deficient fluid volume? · Jugular vein distention · Decreased serum sodium level · Cool, clammy skin · Increased urine osmolarity
3 months
Glycosylated hemoglobin reflects blood glucose concentrations over which period of time? · 1 month · 3 months · 6 months · 9 months
"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 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." · "You should take your insulin after breakfast and after dinner." · "Your insulin will begin to act in 15 minutes."
Rapid-acting
Lispro (Humalog) is an example of which type of insulin? · Intermediate-acting · Long-acting · Short-acting · Rapid-acting
Synthesis of glucose from noncarbohydrate sources.
Insulin is a hormone secreted by the Islets of Langerhans and is essential for the metabolism of carbohydrates, fats, and protein. The nurse understands the physiologic importance of gluconeogenesis, which refers to the: · Synthesis of glucose from noncarbohydrate sources. · Transport of potassium. · Storage of glucose as glycogen in the liver. · Release of glucose.
Beta cells
Insulin is secreted by which of the following types of cells? · Beta cells · Basal cells · Melanocytes · Neural cells
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? · Fasting blood glucose test · Urine ketones · 6-hour glucose tolerance test · Serum glycosylated hemoglobin (Hb A1c)
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 · Urine ketones · Fasting blood glucose test
100
Once digested, what percentage of carbohydrates is converted to glucose? · 70 · 80 · 90 · 100
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 · Decreases risk of developing insulin resistance and hyperglycemia · Decreases need for pancreas to produce more cells · Creates an overall feeling of well-being and lowers risk of depression
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? · Nephropathy · Retinopathy · Sensory neuropathy · Autonomic neuropathy
Type 2
The greatest percentage of people have which type of diabetes? · Gestational · Type 2 · Type 1 · Impaired glucose tolerance
50% to 60%
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% · 85% to 90% · 25% to 40% · 10% to 20%
When mixing insulin, the regular insulin is drawn up into the syringe first.
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? · There is no need to inject air into the bottle of insulin before withdrawing the insulin. · If two different types of insulin are ordered, they need to be given in separate injections. · When mixing insulin, the NPH insulin is drawn up into the syringe first. · When mixing insulin, the regular insulin is drawn up into the syringe first.
Neovascularization into the vitreous humor
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? · Decreased capillary permeability · Microaneurysm formation · The leakage of capillary wall fragments into surrounding areas · Neovascularization into the vitreous humor
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 process of gluconeogenesis will be inhibited. · The pancreatic hormone glucagon will stimulate the liver to release stored glucose. · Insulin will be released to facilitate the transport of sugar.
Patient's eating and sleeping habits
Which of the following factors should the nurse take into consideration when planning meals and selecting the type and dosage of insulin or oral hypoglycemic agent for an elderly patient with diabetes mellitus? · Cognitive problems · Patient's eating and sleeping habits · Patient's ability to self-administer insulin · Patient's history
4 to 6 hours
What is the duration of regular insulin? · 24 hours · 3 to 5 hours · 4 to 6 hours · 12 to 16 hours
Patient's eating and sleeping habits
Which of the following factors should the nurse take into consideration when planning meals and selecting the type and dosage of insulin or oral hypoglycemic agent for an elderly patient with diabetes mellitus? · Patient's history · Patient's ability to self-administer insulin · Patient's eating and sleeping habits · Cognitive problems
"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: · "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." · "The circulation in your feet can help us determine how severe your diabetes is." · "The physician wants to be sure your shoes fit properly so you won't develop pressure sores."
Decreased renal function
Which age-related change may affect diabetes and its management? · Increased thirst · Decreased renal function · Hypotension · Increased bowel motility
Blood glucose can be controlled through diet and exercise
Which clinical characteristic is associated with type 2 diabetes (previously referred to as non-insulin-dependent diabetes mellitus)? · Clients demonstrate islet cell antibodies · Blood glucose can be controlled through diet and exercise · Client is prone to ketosis · Client is usually thin at diagnosis
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 factors will cause hypoglycemia in a client with diabetes? Select all that apply. · 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. · Client has not consumed sufficient calories.
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. · It is rapidly absorbed and has a fast onset of action. · Draw up the drug first, then add regular insulin. · Do not mix with other insulins.
· Polyuria and polydipsia · Fatigue and irritability · Wounds that heal slowly or respond poorly to treatment Blurred or deteriorating vision
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. · Polyuria and polydipsia · Fatigue and irritability · Wounds that heal slowly or respond poorly to treatment · Sudden weight loss and anorexia · Blurred or deteriorating vision
10 to 15 g of a simple carbohydrate.
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: · 18 to 20 g of a simple carbohydrate. · 10 to 15 g of a simple carbohydrate. · 2 to 5 g of a simple carbohydrate. · 25 to 30 g of a simple carbohydrate.
An elevated blood glucose concentration contributes to complications of diabetes, such as diminished vision.
which would be included in the teaching plan for a client diagnosed with diabetes mellitus? · The only diet change needed in the treatment of diabetes is to stop eating sugar. · An elevated blood glucose concentration contributes to complications of diabetes, such as diminished vision. · Once insulin injections are started in the treatment of type 2 diabetes, they can never be discontinued.
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? · With diabetes, drinking more results in more urine production. · 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.
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? · 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 · 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
"I'll wear cotton socks with well-fitting shoes."
· Which statement indicates that a client with diabetes mellitus understands proper foot care? · "I'll wear cotton socks with well-fitting shoes." · "I'll schedule an appointment with my physician if my feet start to ache." · "I'll go barefoot around the house to avoid pressure areas on my feet." · "I'll rotate insulin injection sites from my left foot to my right foot."
"Your body is using protein and fat for energy instead of glucose
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? · "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." · "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
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. · polydipsia. · polyphagia. · polyuria.
"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 less insulin when you exercise or reduce your food intake." · "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."
Regular
A client is admitted to the unit with diabetic ketoacidosis (DKA). Which insulin would the nurse expect to administer intravenously? · NPH · Regular · Lente · Glargine
7:45 AM
A client is receiving insulin lispro at 7:30 AM. The nurse ensures that the client has breakfast by which time? · 8:30 AM · 8:15 AM · 8:00 AM · 7:45 AM
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? · Sweating, tremors, and tachycardia · Dry skin, bradycardia, and somnolence · Polyuria, polydipsia, and polyphagia · Bradycardia, thirst, and anxiety
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? · Increased weight gain, appetite, and thirst · Increased thirst, hunger, and urination · Loss of appetite, increased urination, and dehydration · Increased weight loss, dehydration, and fatigue
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: · 20 g of carbohydrates. · 25 g of carbohydrates. · 10 g of carbohydrates. · 15 g of carbohydrates.
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 · Rare ketosis · Altered glucose metabolism · Obesity
Hyperglycemic hyperosmolar syndrome
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? · Hyperglycemic hyperosmolar syndrome · Systemic inflammatory response syndrome · Diabetic ketoacidosis · Multiple-organ dysfunction syndrome
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: · Insulin will be released to facilitate the transport of sugar. · The process of gluconeogenesis will be inhibited. · The pancreatic hormone glucagon will stimulate the liver to release stored glucose. · Glycogenesis will be decreased by the liver.
The client has eaten and has not taken or received insulin.
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 has eaten and has not taken or received insulin. · The client continues medication therapy despite adequate food intake. · The client has been exercising more than usual.
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? · Duration of the insulin · Area for insulin injection · Accuracy of the dosage · Technique for injecting
Glargine (Lantus)
Which of the following insulins are used for basal dosage? · Glargine (Lantus) · NPH (Humulin N) · Aspart (Novolog) · Lispro (Humalog)
Rapid-acting
Lispro (Humalog) is an example of which type of insulin? · Rapid-acting · Long-acting · Intermediate-acting · Short-acting
Intermediate-acting
NPH is an example of which type of insulin? · Intermediate-acting · Long-acting · Rapid-acting · Short-acting
Sulfonylureas
Which category of oral antidiabetic agents exerts the primary action by directly stimulating the pancreas to secrete insulin? · Thiazolidinediones · Alpha-glucosidase inhibitors · Biguanides · Sulfonylureas
180 mg/dL
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: · 180 mg/dL · 120 mg/dL · 160 mg/dL · 140 mg/dL
Inhibit the production of glucose by the liver.
A patient is prescribed Glucophage, an oral antidiabetic agent classified as a biguanide. The nurse knows that a primary action of this drug is its ability to: · Increase the absorption of carbohydrates in the intestines. · Decrease the body's sensitivity to insulin. · Stimulate the beta cells of the pancreas to secrete insulin. · Inhibit the production of glucose by the liver.
"For dinner I ate a 3-ounce hamburger on a bun, with ketchup, pickle, and onion; a green salad with 1 teaspoon Italian dressing; 1 cup of watermelon; and a diet soda."
A 1200-calorie diet and exercise are prescribed for a client with newly diagnosed type 2 diabetes. The nurse is teaching the client about meal planning using exchange lists. The teaching is determined to be effective based on which statement by the client? · "For dinner I ate 4-ounces of sliced roast beef on a bagel with lettuce, tomato, and onion; 1 ounce low-fat cheese; 1 tablespoon mayonnaise; 1 cup fresh strawberry shortcake; and unsweetened iced tea." · "For dinner I ate a 3-ounce hamburger on a bun, with ketchup, pickle, and onion; a green salad with 1 teaspoon Italian dressing; 1 cup of watermelon; and a diet soda." · "For dinner I ate 2 cups of cooked pasta with 3-ounces of boiled shrimp, 1 cup plum tomatoes, half a cup of peas in a garlic-wine sauce, 2 cups fresh strawberries, and ice water with lemon." · "For dinner I ate 2 ounces of sliced turkey, 1 cup mashed sweet potatoes, half a cup of carrots, half a cup of peas, a 3-ounce dinner roll, 1 medium banana, and a diet so
Infuse 0.9% normal saline solution 1 L/hr for 2 hours.
A client is admitted with diabetic ketoacidosis (DKA). Which order from the physician should the nurse implement first? · Infuse 0.9% normal saline solution 1 L/hr for 2 hours. · Start an infusion of regular insulin at 50 U/hr. · Administer regular insulin 30 U IV push. Administer sodium bicarbonate 50 mEq IV push
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? · Skipping insulin doses during illness · Recent weight gain of 20 lb (9.1 kg) · Failure to monitor blood glucose levels · Crying whenever diabetes is mentioned
"I'm thirsty all the time. I just can't get enough to drink."
A client is evaluated for type 1 diabetes. Which client comment correlates best with this disorder? · "I'm thirsty all the time. I just can't get enough to drink." · "I notice pain when I urinate." · "It seems like I have no appetite. I have to make myself eat." · "I have a cough and cold that just won't go away."
"I skip lunch when I don't feel hungry."
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? · "I always carry hard candy to eat in case my blood sugar level drops." · "I always wear my medical identification bracelet." · "I avoid exposure to the sun as much as possible." · "I skip lunch when I don't feel hungry."
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? · Glipizide · Glyburide · Repaglinide · Metformin
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 increase the need for insulin. · They decrease the need for insulin. · They have no effect. · They cause wide fluctuations in the need for insuli
1/2 cup fruit juice or regular soft drink
A client with diabetes mellitus has a blood glucose level of 40 mg/dL. Which rapidly absorbed carbohydrate would be most effective? · 4 oz of skim milk · 1/2 tbsp honey or syrup · 1/2 cup fruit juice or regular soft drink · three to five LifeSavers candies
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 52 mg/dl · Serum calcium level of 10.2 mg/dl · Serum glucose level of 450 mg/dl · Serum calcium level of 8.9 mg/dl
Hypoglycemia
A client with diabetes mellitus is receiving an oral antidiabetic agent. The nurse observes for which condition when caring for this client? Polydipsia Hypoglycemia Polyuria Blurred vision
"Rotate injection sites within the same anatomic region, not among different regions."
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 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." · "Administer insulin into areas of scar tissue or hypertrophy whenever possible."
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? · Administer potassium replacements. · Monitor serum electrolytes and blood glucose levels. · Administer glucose. · Administer isotonic fluid at a high volume.
rapid-acting insulin only.
A client with type 1 diabetes has been on a regimen of multiple daily injection therapy. He's being converted to continuous subcutaneous insulin therapy via an insulin pump. While teaching the client about continuous subcutaneous insulin therapy, the nurse should tell him that the regimen includes the use of: · rapid-acting insulin only. · short- and long-acting insulins. · intermediate- and long-acting insulins. · short- and intermediate-acting insulins.
Initiate fluid replacement therapy.
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? · Correct diabetic ketoacidosis. · Determine the cause of diabetic ketoacidosis. · Administer insulin. · Initiate fluid replacement therapy.
9 units regular insulin and 21 units neutral protamine Hagedorn (NPH).
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: · 21 units regular insulin and 9 units NPH. · 9 units regular insulin and 21 units neutral protamine Hagedorn (NPH). · 20 units regular insulin and 10 units NPH. · 10 units regular insulin and 20 units NPH.
Abdomen
A client with type 1 diabetes is to receive a short-acting insulin and an intermediate-acting insulin subcutaneously before breakfast. The nurse would administer the insulin at which site as the preferred site? · Thighs · Arms · Abdomen · Upper buttock
Use all available injection sites within one area.
A client with type 1 diabetes mellitus is being taught about self-injection of insulin. Which fact about site rotation should the nurse include in the teaching? · Rotate sites from area to area every other day. · Use all available injection sites within one area. · Choose a different site at random for each injection.
"I will take this medication in the morning, with my first bite of breakfast."
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." · "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."
Insulin is an anabolic hormone.
A diabetic client using insulin reports weight gain. Which response from the nurse explains the most likely cause of the weight increase? · Faulty fat metabolism is shut off. · Weight gain is attributed to fluid retention. · Insulin is an anabolic hormone. · Insulin provides more efficient use of glucose.
Insulin is absorbed more rapidly at abdominal injection sites than at other sites.
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.
3,500 per week.
A female patient with diabetes who weighs 150 pounds has an ideal body weight of 118 pounds. She can lose 1 pound per week and drop her extra 32 pounds in approximately 8 months. To meet this goal, the nurse advises the patient to decrease her calories by: · 2,500 per week. · 3,500 per week. · 2,000 per week. · 3,000 per week.
Miglitol
A group of students are reviewing the various types of drugs that are used to treat diabetes mellitus. The students demonstrate understanding of the material when they identify which of the following as an example of an alpha-glucosidase inhibitor? · Glyburide · Miglitol · Rosiglitazone · Metformin
"Destruction of special cells in the pancreas causes a decrease in insulin production. Glucose levels rise because insulin normally breaks it down."
A newly admitted client with a diagnosis of type 1 diabetes asks the nurse what caused their diabetes. When the nurse is explaining to the client the etiology of type 1 diabetes, what process should the nurse describe? "The tissues in your body are resistant to the action of insulin, making the glucose levels in your blood increase." "Destruction of special cells in the pancreas causes a decrease in insulin production. Glucose levels rise because insulin normally breaks it down." "The amount of glucose that your body makes overwhelms your pancreas and decreases your production of insulin." "Damage to your pancreas causes an increase in the amount of glucose that it releases, and there is not enough insulin to control it."
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? · Diaphoresis · Increased urine output · Cheyne-Stokes respirations · Decreased appetite
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: · encourage the client to ask questions about personal sexuality. · provide support for the spouse or significant other. · suggest referral to a sex counselor or other appropriate professional. · provide time for privacy.
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 regular insulin in dextrose 5% in water · 100 units of NPH insulin in dextrose 5% in water · 100 units of neutral protamine Hagedorn (NPH) insulin in normal saline solution
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? · If administered immediately, there is no requirement for withdrawing one type of insulin before another. · Different types of insulin are not to be mixed in the same syringe. · The short-acting insulin is withdrawn before the intermediate-acting insulin. · The intermediate-acting insulin is withdrawn before the short-acting insulin.
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 intermediate-acting insulin is withdrawn before the short-acting insulin. · The short-acting insulin is withdrawn before the intermediate-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.
"Insulin promotes synthesis of proteins in various body tissues." Insulin promotes the storage of fat in adipose tissue." "Insulin permits entry of glucose into the cells of the body."
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 promotes synthesis of proteins in various body tissues." · "Insulin interferes with glucagon from the pancreas." · "Insulin promotes the storage of fat in adipose tissue." · "Insulin interferes with the release of growth hormone from the pituitary." · "Insulin permits entry of glucose into the cells of the body."
Younger than 30 years of age · Ketosis-prone · Little or no endogenous insulin
A patient is diagnosed with type 1 diabetes. What clinical characteristics does the nurse expect to see in this patient? Select all that apply. · Younger than 30 years of age · Ketosis-prone · Little or no endogenous insulin · Older than 65 years of age · Obesity at diagnoses
138 mg/dL, 2 hours postprandial.
A patient who is 6 months' pregnant was evaluated for gestational diabetes mellitus. The doctor considered prescribing insulin based on the serum glucose result of: · 80 mg/dL, 1 hour postprandial. · 90 mg/dL before meals. · 138 mg/dL, 2 hours postprandial. · 120 mg/dL, 1 hour postprandial.
Serum potassium level
After being sick for 3 days, a client with a history of diabetes mellitus is admitted to the hospital with diabetic ketoacidosis (DKA). The nurse should evaluate which diagnostic test results to prevent dysrhythmias? · Serum sodium level · Serum calcium level · Serum chloride level · Serum potassium level
Switch the client to a different oral antidiabetic agent.
After taking glipizide (Glucotrol) for 9 months, a client experiences secondary failure. What should the nurse expect the physician to do? · Order an additional oral antidiabetic agent. · Initiate insulin therapy. · Restrict carbohydrate intake to less than 30% of the total caloric intake. · Switch the client to a different oral antidiabetic agent.
"I might need insulin later on but probably not as much or as often."
After teaching a client with type 1 diabetes who is scheduled to undergo an islet cell transplant, which client statement indicates successful teaching? · "I might need insulin later on but probably not as much or as often." · "I will receive a whole organ with extra cells to produce insulin." · "This transplant will provide me with a cure for my diabetes." · "They'll need to create a connection from the pancreas to allow enzymes to drain."
Peripheral neuropathy
An older adult patient that has type 2 diabetes comes to the emergency department with second-degree burns to the bottom of both feet and states, "I didn't feel too hot but my feet must have been too close to the heater." What does the nurse understand is most likely the reason for the decrease in temperature sensation? Sudomotor neuropathy Peripheral neuropathy Autonomic neuropathy A faulty heater
"I will test my blood sugar level every 3 to 4 hours." · "I will call the doctor if I have vomiting or diarrhea." "I will increase my intake of fluids." · "I will eat soft foods if I cannot tolerate regular food."
The nurse instructs the client with diabetes on self-care during days of illness. Which client statement indicates that teaching has been effective? Select all that apply. · "I will test my blood sugar level every 3 to 4 hours." · "I will call the doctor if I have vomiting or diarrhea." · "I will skip my diabetes medication for the day." · "I will increase my intake of fluids." · "I will eat soft foods if I cannot tolerate regular food."
short-acting
The nurse is administering an insulin drip to a patient in ketoacidosis. What insulin does the nurse know can be used intravenously? intermediate-acting long-acting short-acting rapid acting
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
· Microaneurysms · Focal capillary single closure · Leakage of fluid or serum (exudates)
The nurse is assessing a patient with nonproliferative (background) retinopathy. When examining the retina, what would the nurse expect to assess? Select all that apply. · Microaneurysms · Focal capillary single closure · Leakage of fluid or serum (exudates) · Blurred optic discs · Detachment
Encourage midday snack.
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. · Delay dinner meal. · Make sure breakfast is not delayed. · Encourage midday snack.
It enhances the transport of glucose across the cell membrane.
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 enhances the transport of glucose across the cell membrane. · It decreases the intestinal absorption of glucose. · It aids in the process of gluconeogenesis. · It stimulates the pancreatic beta cells.
Urinary tract infections
The nurse understands that a client with diabetes mellitus is at greater risk for developing which of the following complications? · Low blood pressure · Elevated triglycerides · Urinary tract infections · Lifelong obesity
3 AM
When the dawn phenomenon occurs, the patient has relatively normal blood glucose until approximate what time of day? · 9 AM · 7 AM · 3 AM · 5 AM
Hypoglycemia
When the nurse is caring for a patient with type 1 diabetes, what clinical manifestation would be a priority to closely monitor? · Hyponatremia · Polyphagia · Ketonuria · Hypoglycemia
Hypoglycemia
When the nurse is caring for a patient with type 1 diabetes, what clinical manifestation would be a priority to closely monitor? · Polyphagia · Ketonuria · Hypoglycemia · Hyponatremia
Fruity breath
Which assessment finding is most important in determining nursing care for a client with diabetes mellitus? · Cloudy urine · Fruity breath · Blood sugar 170 mg/dL · Respirations of 12 breaths/minu
Blood glucose can be controlled through diet and exercise
Which clinical characteristic is associated with type 2 diabetes (previously referred to as non-insulin-dependent diabetes mellitus)? · Clients demonstrate islet cell antibodies · Client is usually thin at diagnosis · Blood glucose can be controlled through diet and exercise · Client is prone to ketosis
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
weight loss
Which factor is the focus of nutrition intervention for clients with type 2 diabetes? · blood glucose level · carbohydrate intake · weight loss · protein metabolism
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 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.
"I wrote down the steps in case I forget what to do."
Which statement best indicates that a client understands how to administer his own insulin injections? · "If I'm not feeling well, I can get a friend or neighbor to help me." · "I wrote down the steps in case I forget what to do." · "I need to be sure no air bubbles remain." · "I need to wash my hands before I give myself my injection."
It cannot be mixed with any other type of insulin.
Which statement is correct regarding glargine insulin? · Its peak action occurs in 2 to 3 hours. · It cannot be mixed with any other type of insulin. · It is absorbed rapidly. · It is given twice daily.
