Chapter 64: Care of Patients with Diabetes Mellitus

SG#50 The patient with diabetes has a foot that is warm, swollen, and painful. Walking causes the arch of the foot to collapse and gives the foot a "rocker bottom" shape. Which foot deformity does the nurse recognize? a. Hallux valgus b. Claw-toe deformity c. Charcot foot d. Diabetic foot ulcer

c. Charcot foot

SG#27 Which class of antidiabetic medication must be held after using contrast media until adequate kidney function is established? a. Alpha-glucosidase inhibitors, which include miglitol b. Biguanides, which include metformin c. Meglitinides, which include nateglinide d. Second-generation sulfonylureas, which include glipizide.

b. Biguanides, which include metformin

SG#36 A patient asks the nurse how insulin injection site rotation should be accomplished. What is the nurse's best response? a. "Rotation within one site is preferred to avoid changes in insulin absorption." b. "Change rotation sites after a week or two to avoid lipohypertrophy." c. "Rotation from site to site each day is best for the most insulin absorption." d. "Always rotate insulin injections sites within 4-5 inches from the umbilicus."

a. "Rotation within one site is preferred to avoid changes in insulin absorption."

SG#40 A patient with diabetic ketoacidosis is on an insulin drip of 50 units of regular insulin in 250ml of normal saline. The current blood glucose level is 549 mg/dL. According to insulin protocol, the insulin drip needs to be changed to 8 units per hour. At what rate does the nurse set the pump? a. 40mL/hr b. 50mL/hr c. 60mL/hr d. 75mL/hr

a. 40mL/hr

1.A nurse assesses clients at a health fair. Which clients should the nurse counsel to be tested for diabetes? (Select all that apply.) a. 56-year-old African-American male b. Female with a 30-pound weight gain during pregnancy c. Male with a history of pancreatic trauma d. 48-year-old woman with a sedentary lifestyle e. Male with a body mass index greater than 25 kg/m2 f. 28-year-old female who gave birth to a baby weighing 9.2 pounds

a. 56-year-old African-American male d. 48-year-old woman with a sedentary lifestyle e. Male with a body mass index greater than 25 kg/m2 f. 28-year-old female who gave birth to a baby weighing 9.2 pounds Risk factors for type 2 diabetes include certain ethnic/racial groups (African Americans, American Indians, Hispanics), obesity and physical inactivity, and giving birth to large babies. Pancreatic trauma and a 30-pound gestational weight gain are not risk factors.

SG#18 In which situations does the nurse teach a patient to perform urine ketone testing? Select all that apply a. Acute illness or stress b. When blood glucose levels are above 200 mg/dL c. When symptoms of diabetic ketoacidosis (DKA) are present d. To evaluate the effectiveness of diabetic ketoacidosis (DKA) treatment e. When a diabetic patient is in a weight-loss program f. When a diabetic patient has a diagnosis of hyperglycemic-hyperosmolar state (HHS)

a. Acute illness or stress c. When symptoms of diabetic ketoacidosis (DKA) are present e. When a diabetic patient is in a weight-loss program

14.A nurse assesses a client with diabetes mellitus and notes the client only responds to a sternal rub by moaning, has capillary blood glucose of 33 g/dL, and has an intravenous line that is infiltrated with 0.45% normal saline. Which action should the nurse take first? a. Administer 1 mg of intramuscular glucagon. b. Encourage the client to drink orange juice. c. Insert a new intravenous access line. d. Administer 25 mL dextrose 50% (D50) IV push.

a. Administer 1 mg of intramuscular glucagon. The clients blood glucose level is dangerously low. The nurse needs to administer glucagon IM immediately to increase the clients blood glucose level. The nurse should insert a new IV after administering the glucagon and can use the new IV site for future doses of D50 if the clients blood glucose level does not rise. Once the client is awake, orange juice may be administered orally along with a form of protein such as a peanut butter.

31.A nurse assesses a client who has diabetes mellitus and notes the client is awake and alert, but shaky, diaphoretic, and weak. Five minutes after administering a half-cup of orange juice, the clients clinical manifestations have not changed. Which action should the nurse take next? a. Administer another half-cup of orange juice. b. Administer a half-ampule of dextrose 50% intravenously. c. Administer 10 units of regular insulin subcutaneously. d. Administer 1 mg of glucagon intramuscularly.

a. Administer another half-cup of orange juice. This client is experiencing mild hypoglycemia. For mild hypoglycemic manifestations, the nurse should administer oral glucose in the form of orange juice. If the symptoms do not resolve immediately, the treatment should be repeated. The client does not need intravenous dextrose, insulin, or glucagon.

SG#26 Which class of antidiabetic medication should be taken with the first bite of a meal to be fully effective? a. Alpha-glucosidase inhibitors, which include miglitol b. Biguanides, which include metformin c. Meglitinides, which include nateglinide d. Second-generation sulfonylureas, which include glipizide.

a. Alpha-glucosidase inhibitors, which include miglitol

SG#47 Which infection control measures must the nurse teach a patient who will be performing SMBG? Select all that apply. a. Always wash hands before monitoring glucose. b. regular cleaning of the meter is critical. c. Do not reuse lancets. d. Do not share blood glucose monitoring equipment. e. Sterilized blood glucose monitor before each use. f. Family members who help with testing should wear gloves.

a. Always wash hands before monitoring glucose. b. regular cleaning of the meter is critical. c. Do not reuse lancets. d. Do not share blood glucose monitoring equipment. f. Family members who help with testing should wear gloves.

2.A nurse assesses a client who is experiencing diabetic ketoacidosis (DKA). For which manifestations should the nurse monitor the client? (Select all that apply.) a. Deep and fast respirations b. Decreased urine output c. Tachycardia d. Dependent pulmonary crackles e. Orthostatic hypotension

a. Deep and fast respirations c. Tachycardia e. Orthostatic hypotension DKA leads to dehydration, which is manifested by tachycardia and orthostatic hypotension. Usually clients have Kussmaul respirations, which are fast and deep. Increased urinary output (polyuria) is severe. Because of diuresis and dehydration, peripheral edema and crackles do not occur.

SG#11 Which complications of DM are considered emergencies? Select all that apply a. Diabetic ketoacidosis(DKA) b. Hypoglycemia c. Diabetic retinopathy d. Hyperglycemic-hyperosmolar state (HHS) e. Diabetic neuropathy f. Diabetic nephropathy

a. Diabetic ketoacidosis(DKA) b. Hypoglycemia d. Hyperglycemic-hyperosmolar state (HHS)

3.A nurse teaches a client with diabetes mellitus about foot care. Which statements should the nurse include in this clients teaching? (Select all that apply.) a. Do not walk around barefoot. b. Soak your feet in a tub each evening. c. Trim toenails straight across with a nail clipper. d. Treat any blisters or sores with Epsom salts. e. Wash your feet every other day.

a. Do not walk around barefoot. c. Trim toenails straight across with a nail clipper. Clients who have diabetes mellitus are at high risk for wounds on the feet secondary to peripheral neuropathy and poor arterial circulation. The client should be instructed to not walk around barefoot or wear sandals with open toes. These actions place the client at higher risk for skin breakdown of the feet. The client should be instructed to trim toenails straight across with a nail clipper. Feet should be washed daily with lukewarm water and soap, but feet should not be soaked in the tub. The client should contact the provider immediately if blisters or sores appear and should not use home remedies to treat these wounds.

26.A preoperative nurse assesses a client who has type 1 diabetes mellitus prior to a surgical procedure. The clients blood glucose level is 160 mg/dL. Which action should the nurse take? a. Document the finding in the clients chart. b. Administer a bolus of regular insulin IV. c. Call the surgeon to cancel the procedure. d. Draw blood gases to assess the metabolic state.

a. Document the finding in the clients chart. Clients who have type 1 diabetes and are having surgery have been found to have fewer complications, lower rates of infection, and better wound healing if blood glucose levels are maintained at between 140 and 180 mg/dL throughout the perioperative period. The nurse should document the finding and proceed with other operative care. The need for a bolus of insulin, canceling the procedure, or drawing arterial blood gases is not required.

42.A nurse prepares to administer insulin to a client at 1800. The clients medication administration record contains the following information: Insulin glargine: 12 units daily at 1800 Regular insulin: 6 units QID at 0600, 1200, 1800, 2400 Based on the clients medication administration record, which action should the nurse take? a. Draw up and inject the insulin glargine first, and then draw up and inject the regular insulin. b. Draw up and inject the insulin glargine first, wait 20 minutes, and then draw up and inject the regular insulin. c. First draw up the dose of regular insulin, then draw up the dose of insulin glargine in the same syringe, mix, and inject the two insulins together. d. First draw up the dose of insulin glargine, then draw up the dose of regular insulin in the same syringe, mix, and inject the two insulins together.

a. Draw up and inject the insulin glargine first, and then draw up and inject the regular insulin. Insulin glargine must not be diluted or mixed with any other insulin or solution. Mixing results in an unpredictable alteration in the onset of action and time to peak action. The correct instruction is to draw up and inject first the glargine and then the regular insulin right afterward.

SG#23 A patient with diabetes is scheduled to have a blood glucose test the next morning. Which instruction does the nurse give the patient? a. Eat the usual diet but have nothing after midnight. b. Take the usual oral hypoglycemic tablet in the morning. c. Eat a clear liquid breakfast in the morning. d. Follow the usual diet and medication regimen.

a. Eat the usual diet but have nothing after midnight.

SG#14 A patient is admitted with a blood glucose level of 900 mg/dL. IV fluids and insulin are administered. Two hours after treatment is initiated, the blood glucose level is 400 mg/dL. Which complication is the patient most at risk for developing? a. Hypoglycemia b. Pulmonary embolus c. Renal shutdown d. Pulmonary edema

a. Hypoglycemia

24.After teaching a client who is recovering from pancreas transplantation, the nurse assesses the clients understanding. Which statement made by the client indicates a need for additional education? a. If I develop an infection, I should stop taking my corticosteroid. b. If I have pain over the transplant site, I will call the surgeon immediately. c. I should avoid people who are ill or who have an infection. d. I should take my cyclosporine exactly the way I was taught.

a. If I develop an infection, I should stop taking my corticosteroid. Immunosuppressive agents should not be stopped without the consultation of the transplantation physician, even if an infection is present. Stopping immunosuppressive therapy endangers the transplanted organ. The other statements are correct. Pain over the graft site may indicate rejection. Anti-rejection drugs cause immunosuppression, and the client should avoid crowds and people who are ill. Changing the routine of antirejection medications may cause them to not work optimally.

18.An emergency department nurse assesses a client with ketoacidosis. Which clinical manifestation should the nurse correlate with this condition? a. Increased rate and depth of respiration b. Extremity tremors followed by seizure activity c. Oral temperature of 102 F (38.9 C) d. Severe orthostatic hypotension

a. Increased rate and depth of respiration Ketoacidosis decreases the pH of the blood, stimulating the respiratory control areas of the brain to buffer the effects of increasing acidosis. The rate and depth of respiration are increased (Kussmaul respirations) in an attempt to excrete more acids by exhalation. Tremors, elevated temperature, and orthostatic hypotension are not associated with ketoacidosis.

SG#20 Which statements about type 1 DM are accurate? Select all that apply. a. It is an autoimmune disorder b. Most people with type 1 DM are obese c. Age of onset is typically younger than 30 d. Etiology may be attributed to viral infections e. It can be treated with oral anti-diabetic medications and insulin f. It involves insulin resistance that progresses leading to decreased beta cell secretion of insulin

a. It is an autoimmune disorder c. Age of onset is typically younger than 30 d. Etiology may be attributed to viral infections

SG#21 Which statements about type 2 DM are accurate? Select all that apply a. It peaks about the age of 50 b. Most people with type 2 DM are obese c. It typically has an abrupt onset d. People with type 2 DM have insulin resistance e. It can be treated with oral anti-diabetic medications and insulin f. Presence of metabolic syndrome increases the risk for type 2 DM

a. It peaks about the age of 50 b. Most people with type 2 DM are obese d. People with type 2 DM have insulin resistance e. It can be treated with oral anti-diabetic medications and insulin f. Presence of metabolic syndrome increases the risk for type 2 DM

SG#49 Intensive therapy with good glucose control results in delayed occurence in which diabetic complications? Select all that apply? a. Macrovascular disease b. Cardiovascular disease c. Stroke d. Retinopathy e. Nephropathy f. Neuropathy

a. Macrovascular disease b. Cardiovascular disease d. Retinopathy e. Nephropathy f. Neuropathy

6.A nurse teaches a client who is diagnosed with diabetes mellitus. Which statement should the nurse include in this clients plan of care to delay the onset of microvascular and macrovascular complications? a. Maintain tight glycemic control and prevent hyperglycemia. b. Restrict your fluid intake to no more than 2 liters a day. c. Prevent hypoglycemia by eating a bedtime snack. d. Limit your intake of protein to prevent ketoacidosis.

a. Maintain tight glycemic control and prevent hyperglycemia. Hyperglycemia is a critical factor in the pathogenesis of long-term diabetic complications. Maintaining tight glycemic control will help delay the onset of complications. Restricting fluid intake is not part of the treatment plan for clients with diabetes. Preventing hypoglycemia and ketosis, although important, are not as important as maintaining daily glycemic control.

SG#5 People from which cultures tend to have a higher incidence of DM? Select all that apply. a. Mexican American b. African American c. Caucasian d. American Indian e. Eastern European f. Alaskan Indian

a. Mexican American b. African American d. American Indian f. Alaskan Indian

SG#46 The patient's urinalysis shows proteinuria. Which pathophysiology does the nurse suspect. a. Nephropathy b. Neuropathy c. Retinopathy d. Gastroparesis

a. Nephropathy

SG#31 For which patient should the health care provider avoid prescribing rosiglitazone? a. Patient with symptomatic heart failure b. Patient with new-onset asthma c. Patient with kidney disease d. Patient with hyperthyroidism

a. Patient with symptomatic heart failure

5.A nurse collaborates with the interdisciplinary team to develop a plan of care for a client who is newly diagnosed with diabetes mellitus. Which team members should the nurse include in this interdisciplinary team meeting? (Select all that apply.) a. Registered dietitian b. Clinical pharmacist c. Occupational therapist d. Health care provider e. Speech-language pathologist

a. Registered dietitian b. Clinical pharmacist d. Health care provider When planning care for a client newly diagnosed with diabetes mellitus, the nurse should collaborate with a registered dietitian, clinical pharmacist, and health care provider. The focus of treatment for a newly diagnosed client would be nutrition, medication therapy, and education. The nurse could also consult with a diabetic educator. There is no need for occupational therapy or speech therapy at this time.

SG# 32 The patient with type 2 diabetes is prescribed sitagliptin for glucose regulation. Which key changes does the nurse teach a patient to report to the health care provider immediately? Select all that apply. a. Report any signs of jaundice. b. Report any signs of bleeding. c. Report any blue-gray discoloration of the abdomen. d. Report any cough or flu symptoms. e. Report any sudden onset of abdominal pain. f. Report any rash or other signs of allergic reaction.

a. Report any signs of jaundice. c. Report any blue-gray discoloration of the abdomen. e. Report any sudden onset of abdominal pain. f. Report any rash or other signs of allergic reaction.

SG#37 A patient will be using an external insulin pump. What instruction does the nurse give the patient about the pump? a. SMBG levels should be done three or more times a day. b. The insulin supply must be replaced every 2-4 weeks. c. The pump's battery should be checked on a regular weekly schedule. d. The needle site must be changed every day.

a. SMBG levels should be done three or more times a day.

4.A nurse provides diabetic education at a public health fair. Which disorders should the nurse include as complications of diabetes mellitus? (Select all that apply.) a. Stroke b. Kidney failure c. Blindness d. Respiratory failure e. Cirrhosis

a. Stroke b. Kidney failure c. Blindness Complications of diabetes mellitus are caused by macrovascular and microvascular changes. Macrovascular complications include coronary artery disease, cerebrovascular disease, and peripheral vascular disease. Microvascular complications include nephropathy, retinopathy, and neuropathy. Respiratory failure and cirrhosis are not complications of diabetes mellitus.

SG#13 Which factors differentiate diabetic ketoacidosis (DKA) from hyperglycemic-hyperosmolar state (HHS)? Select all that apply. a. Sudden versus gradual onset b. Amount of ketones produced c. Serum bicarbonate levels d. Amount of volume depletion e. Dosage of insulin needed f. Level of hyperglycemia

a. Sudden versus gradual onset b. Amount of ketones produced f. Level of hyperglycemia

13.After teaching a client with diabetes mellitus to inject insulin, the nurse assesses the clients understanding. Which statement made by the client indicates a need for additional teaching? a. The lower abdomen is the best location because it is closest to the pancreas. b. I can reach my thigh the best, so I will use the different areas of my thighs. c. By rotating the sites in one area, my chance of having a reaction is decreased. d. Changing injection sites from the thigh to the arm will change absorption rates

a. The lower abdomen is the best location because it is closest to the pancreas. The abdominal site has the fastest rate of absorption because of blood vessels in the area, not because of its proximity to the pancreas. The other statements are accurate assessments of insulin administration.

15.A nurse cares for a client with diabetes mellitus who is visually impaired. The client asks, Can I ask my niece to prefill my syringes and then store them for later use when I need them? How should the nurse respond? a. Yes. Prefilled syringes can be stored for 3 weeks in the refrigerator in a vertical position with the needle pointing up. b. Yes. Syringes can be filled with insulin and stored for a month in a location that is protected from light. c. Insulin reacts with plastic, so prefilled syringes are okay, but you will need to use glass syringes. d. No. Insulin syringes cannot be prefilled and stored for any length of time outside of the container.

a. Yes. Prefilled syringes can be stored for 3 weeks in the refrigerator in a vertical position with the needle pointing up. Insulin is relatively stable when stored in a cool, dry place away from light. When refrigerated, prefilled plastic syringes are stable for up to 3 weeks. They should be stored in the refrigerator in the vertical position with the needle pointing up to prevent suspended insulin particles from clogging the needle.

5.A nurse cares for a client who has a family history of diabetes mellitus. The client states, My father has type 1 diabetes mellitus. Will I develop this disease as well? How should the nurse respond? a. Your risk of diabetes is higher than the general population, but it may not occur. b. No genetic risk is associated with the development of type 1 diabetes mellitus. c. The risk for becoming a diabetic is 50% because of how it is inherited. d. Female children do not inherit diabetes mellitus, but male children will.

a. Your risk of diabetes is higher than the general population, but it may not occur. Risk for type 1 diabetes is determined by inheritance of genes coding for HLA-DR and HLA-DQ tissue types. Clients who have one parent with type 1 diabetes are at increased risk for its development. Diabetes (type 1) seems to require interaction between inherited risk and environmental factors, so not everyone with these genes develops diabetes. The other statements are not accurate.

35.A nurse cares for a client who has diabetes mellitus. The nurse administers 6 units of regular insulin and 10 units of NPH insulin at 0700. At which time should the nurse assess the client for potential problems related to the NPH insulin? a. 0800 b. 1600 c. 2000 d. 2300

b. 1600 Neutral protamine Hagedorn (NPH) is an intermediate-acting insulin with an onset of 1.5 hours, peak of 4 to 12 hours, and duration of action of 22 hours. Checking the client at 0800 would be too soon. Checking the client at 2000 and 2300 would be too late. The nurse should check the client at 1600.

43.A nurse prepares to administer prescribed regular and NPH insulin. Place the nurses actions in the correct order to administer these medications. 1. Inspect bottles for expiration dates. 2. Gently roll the bottle of NPH between the hands. 3. Wash your hands. 4. Inject air into the regular insulin. 5. Withdraw the NPH insulin. 6. Withdraw the regular insulin. 7. Inject air into the NPH bottle. 8. Clean rubber stoppers with an alcohol swab. a. 1, 3, 8, 2, 4, 6, 7, 5 b. 3, 1, 2, 8, 7, 4, 6, 5 c. 8, 1, 3, 2, 4, 6, 7, 5 d. 2, 3, 1, 8, 7, 5, 4, 6

b. 3, 1, 2, 8, 7, 4, 6, 5 After washing hands, it is important to inspect the bottles and then to roll the NPH to mix the insulin. Rubber stoppers should be cleaned with alcohol after rolling the NPH and before sticking a needle into either bottle. It is important to inject air into the NPH bottle before placing the needle in a regular insulin bottle to avoid mixing of regular and NPH insulin. The shorter-acting insulin is always drawn up first.

12.A nurse cares for a client with diabetes mellitus who asks, Why do I need to administer more than one injection of insulin each day? How should the nurse respond? a. You need to start with multiple injections until you become more proficient at self-injection. b. A single dose of insulin each day would not match your blood insulin levels and your food intake patterns. c. A regimen of a single dose of insulin injected each day would require that you eat fewer carbohydrates. d. A single dose of insulin would be too large to be absorbed, predictably putting you at risk for insulin shock.

b. A single dose of insulin each day would not match your blood insulin levels and your food intake patterns. Even when a single injection of insulin contains a combined dose of different-acting insulin types, the timing of the actions and the timing of food intake may not match well enough to prevent wide variations in blood glucose levels. One dose of insulin would not be appropriate even if the client decreased carbohydrate intake. Additional injections are not required to allow the client practice with injections, nor will one dose increase the clients risk of insulin shock.

9.A nurse teaches a client with type 2 diabetes mellitus who is prescribed glipizide (Glucotrol). Which statement should the nurse include in this clients teaching? a. Change positions slowly when you get out of bed. b. Avoid taking nonsteroidal anti-inflammatory drugs (NSAIDs). c. If you miss a dose of this drug, you can double the next dose. d. Discontinue the medication if you develop a urinary infection.

b. Avoid taking nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs potentiate the hypoglycemic effects of sulfonylurea agents. Glipizide is a sulfonylurea. The other statements are not applicable to glipizide.

SG#1 Which statements about type 2 diabetes mellitus (DM) are most characteristic? Select all that apply a. Autoimmune process causes beta cell destruction b. Cells have decreased ability to respond to insulin c. Diagnosis is based on result of 100-g glucose tolerance test d. Most patients diagnosed are obese adults e. Usually has abrupt onset of thirst and weight loss f. Most patients are not dependent on insulin

b. Cells have decreased ability to respond to insulin d. Most patients diagnosed are obese adults f. Most patients are not dependent on insulin

8.A nurse teaches a client about self-monitoring of blood glucose levels. Which statement should the nurse include in this clients teaching to prevent bloodborne infections? a. Wash your hands after completing each test. b. Do not share your monitoring equipment. c. Blot excess blood from the strip with a cotton ball. d. Use gloves when monitoring your blood glucose.

b. Do not share your monitoring equipment. Small particles of blood can adhere to the monitoring device, and infection can be transported from one user to another. Hepatitis B in particular can survive in a dried state for about a week. The client should be taught to avoid sharing any equipment, including the lancet holder. The client should be taught to wash his or her hands before testing. The client would not need to blot excess blood away from the strip or wear gloves.

SG#19 The patient asks the nurse "Why am I getting glucagon?" Which response by the nurse is most accurate? a. Glucagon competes for insulin at the receptor sites b. Glucagon frees glucose from hepatic stores of glycogen c. Glucagon supplies glycogen directly to the vital tissues d. Glucagon is a glucose substitute for rapid replacement

b. Glucagon frees glucose from hepatic stores of glycogen

SG#41 Which insulins are considered to have a rapid onset of action? Select all that apply. a. Novolin 70/30 b. Glulisine c. Humulin N d. Aspart e. Lispro f. Glargine

b. Glulisine d. Aspart e. Lispro

41.A nurse reviews laboratory results for a client with diabetes mellitus who is prescribed an intensified insulin regimen: Fasting blood glucose: 75 mg/dL Postprandial blood glucose: 200 mg/dL Hemoglobin A1c level: 5.5% How should the nurse interpret these laboratory findings? a. Increased risk for developing ketoacidosis b. Good control of blood glucose c. Increased risk for developing hyperglycemia d. Signs of insulin resistance

b. Good control of blood glucose The client is maintaining blood glucose levels within the defined ranges for goals in an intensified regimen. Because the clients glycemic control is good, he or she is not at higher risk for ketoacidosis or hyperglycemia and is not showing signs of insulin resistance.

SG#12 In determining if a patient is hypoglycemic, in addition to checking the patient's blood glucose, the nurse assesses the patient for which characteristics? Select all that apply a. Nausea b. Hunger c. Irritability d. Tremors e. Profuse perspiration f. Rapid, deep respirations

b. Hunger c. Irritability d. Tremors e. Profuse perspiration

44.A nurse reviews the chart and new prescriptions for a client with diabetic ketoacidosis: Vital Signs and Assessment Laboratory Results Medications Blood pressure: 90/62 mm Hg Pulse: 120 beats/min Respiratory rate: 28 breaths/min Urine output: 20 mL/hr via catheter Serum potassium: 2.6 mEq/L Potassium chloride 40 mEq IV bolus STAT Increase IV fluid to 100 mL/hr Which action should the nurse take? a. Administer the potassium and then consult with the provider about the fluid order. b. Increase the intravenous rate and then consult with the provider about the potassium prescription. c. Administer the potassium first before increasing the infusion flow rate. d. Increase the intravenous flow rate before administering the potassium.

b. Increase the intravenous rate and then consult with the provider about the potassium prescription. The client is acutely ill and is severely dehydrated and hypokalemic. The client requires more IV fluids and potassium. However, potassium should not be infused unless the urine output is at least 30 mL/hr. The nurse should first increase the IV rate and then consult with the provider about the potassium.

SG#33 Which statement about insulin is true? a. Exogenous insulin is necessary for management of all cases of type 2 DM. b. Insulin's effectiveness depends on the patient's absorption of the drug. c. Insulin doses should be regulated according to self-monitoring urine glucose levels. d. Insulin administered in multiple doses per day decreases the flexibility of a patient's lifestyle.

b. Insulin's effectiveness depends on the patient's absorption of the drug.

SG#3 Why is glucose vital to the body's cells? a. It is used to build cell membranes b. It is used by cells to produce energy c. It affects the process of protein metabolism d. It provides nutrients for genetic material

b. It is used by cells to produce energy

28.A nurse reviews the medication list of a client with a 20-year history of diabetes mellitus. The client holds up the bottle of prescribed duloxetine (Cymbalta) and states, My cousin has depression and is taking this drug. Do you think Im depressed? How should the nurse respond? a. Many people with long-term diabetes become depressed after a while. b. Its for peripheral neuropathy. Do you have burning pain in your feet or hands? c. This antidepressant also has anti-inflammatory properties for diabetic pain. d. No. Many medications can be used for several different disorders.

b. Its for peripheral neuropathy. Do you have burning pain in your feet or hands? Damage along nerves causes peripheral neuropathy and leads to burning pain along the nerves. Many drugs, including duloxetine (Cymbalta), can be used to treat peripheral neuropathy. The nurse should assess the client for this condition and then should provide an explanation of why this drug is being used. This medication, although it is used for depression, is not being used for that reason in this case. Duloxetine does not have antiinflammatory properties. Telling the client that many medications are used for different disorders does not provide the client with enough information to be useful.

36.After teaching a client with type 2 diabetes mellitus, the nurse assesses the clients understanding. Which statement made by the client indicates a need for additional teaching? a. I need to have an annual appointment even if my glucose levels are in good control. b. Since my diabetes is controlled with diet and exercise, I must be seen only if I am sick. c. I can still develop complications even though I do not have to take insulin at this time. d. If I have surgery or get very ill, I may have to receive insulin injections for a short time.

b. Since my diabetes is controlled with diet and exercise, I must be seen only if I am sick. Clients with diabetes need to be seen at least annually to monitor for long-term complications, including visual changes, microalbuminuria, and lipid analysis. The client may develop complications and may need insulin in the future.

SG#48 Which statements about sensory alteration in patients with diabetes are accurate? Select all that apply. a. Very few patients with diabetic foot ulcers have peripheral sensory neuropathy. b. Loss of pain, pressure, and temperature sensation in the foot increases the risk for injury. c. Sensory neuropathy causes loss of normal sweating and skin temperature regulation. d. Sensory alterations can be delayed by keeping the blood glucose level as close to normal as possible. e. Reduced blood flow to the foot results in increased risk for ulcer formation. f. Healing of foot wounds is reduced because of impaired sensation.

b. Loss of pain, pressure, and temperature sensation in the foot increases the risk for injury. c. Sensory neuropathy causes loss of normal sweating and skin temperature regulation. d. Sensory alterations can be delayed by keeping the blood glucose level as close to normal as possible. e. Reduced blood flow to the foot results in increased risk for ulcer formation.

SG#25 Which are considered the early signs of diabetic nephropathy? Select all that apply. a. Positive urine red blood cells b. Microalbuminuria c. Positive urine glucose d. Positive urine white blood cells e. Elevated serum uric acid f. Hypertension

b. Microalbuminuria e. Elevated serum uric acid f. Hypertension

33.A nurse teaches a client with diabetes mellitus about sick day management. Which statement should the nurse include in this clients teaching? a. When ill, avoid eating or drinking to reduce vomiting and diarrhea. b. Monitor your blood glucose levels at least every 4 hours while sick. c. If vomiting, do not use insulin or take your oral antidiabetic agent. d. Try to continue your prescribed exercise regimen even if you are sick.

b. Monitor your blood glucose levels at least every 4 hours while sick. When ill, the client should monitor his or her blood glucose at least every 4 hours. The client should continue taking the medication regimen while ill. The client should continue to eat and drink as tolerated but should not exercise while sick.

SG#44 Which diabetic complication is associated with diabetic peripheral neuropathy? a. End-stage kidney disease b. Muscle weakness c. Permanent blindness d. Retinal hemorrhage

b. Muscle weakness

23.A nurse cares for a client who is diagnosed with acute rejection 2 months after receiving a simultaneous pancreas-kidney transplant. The client states, I was doing so well with my new organs, and the thought of having to go back to living on hemodialysis and taking insulin is so depressing. How should the nurse respond? a. Following the drug regimen more closely would have prevented this. b. One acute rejection episode does not mean that you will lose the new organs. c. Dialysis is a viable treatment option for you and may save your life. d. Since you are on the national registry, you can receive a second transplantation.

b. One acute rejection episode does not mean that you will lose the new organs. An episode of acute rejection does not automatically mean that the client will lose the transplant. Pharmacologic manipulation of host immune responses at this time can limit damage to the organ and allow the graft to be maintained. The other statements either belittle the client or downplay his or her concerns. The client may not be a candidate for additional organ transplantation.

SG#4 A patient with type I diabetes mellitus presents to the emergency department (ED) with a blood sugar of 640 mg/dL and reports being constantly thirsty and having to urinate "all of the time." How does the nurse document this subjective finding? a. Polydipsia and polyphagia b. Polydipsia and polyuria c. Polycoria and polyuria d. Polypahgia and polyesthesia

b. Polydipsia and polyuria

29.A nurse assesses a client with diabetes mellitus. Which clinical manifestation should alert the nurse to decreased kidney function in this client? a. Urine specific gravity of 1.033 b. Presence of protein in the urine c. Elevated capillary blood glucose level d. Presence of ketone bodies in the urineRestriction of dietary protein to 0.8 g/kg of body weight per day is recommended for clients with microalbuminuria to delay progression to renal failure. The clients diet does not need to be decreased in carbohydrates, fats, or total calories.

b. Presence of protein in the urine Renal dysfunction often occurs in the client with diabetes. Proteinuria is a result of renal dysfunction. Specific gravity is elevated with dehydration. Elevated capillary blood glucose levels and ketones in the urine are consistent with diabetes mellitus but are not specific to renal function.

30.A nurse develops a dietary plan for a client with diabetes mellitus and new-onset microalbuminuria. Which component of the clients diet should the nurse decrease? a. Carbohydrates b. Proteins c. Fats d. Total calories

b. Proteins Restriction of dietary protein to 0.8 g/kg of body weight per day is recommended for clients with microalbuminuria to delay progression to renal failure. The clients diet does not need to be decreased in carbohydrates, fats, or total calories.

SG#43 The diabetic patient experiences early morning hyperglycemia (Somogyi effect) as a result of the counterregulatory response to hypoglycemia. What action will the nurse expect for this condition? Select all that apply. a. Administer a 10 pm dose of intermediate acting insulin. b. Provide an evening snack to ensure adequate dietary intake. c. Evaluate insulin dosage and exercise program. d. Add an oral antidiabetic drug to patient's regimen. e. Increase blood glucose checks to every 2 hours around the clock. f. Diagnosis is accomplished by blood glucose monitoring during the night.

b. Provide an evening snack to ensure adequate dietary intake. c. Evaluate insulin dosage and exercise program. f. Diagnosis is accomplished by blood glucose monitoring during the night.

11.A nurse cares for a client who is prescribed pioglitazone (Actos). After 6 months of therapy, the client reports that his urine has become darker since starting the medication. Which action should the nurse take? a. Assess for pain or burning with urination. b. Review the clients liver function study results. c. Instruct the client to increase water intake. d. Test a sample of urine for occult blood.

b. Review the clients liver function study results. Thiazolidinediones (including pioglitazone) can affect liver function; liver function should be assessed at the start of therapy and at regular intervals while the client continues to take these drugs. Dark urine is one indicator of liver impairment because bilirubin is increased in the blood and is excreted in the urine. The nurse should check the clients most recent liver function studies. The nurse does not need to assess for pain or burning with urination and does not need to check the urine for occult blood. The client does not need to be told to increase water intake.

SG#35 A diabetic patient is on a mixed-dose insulin protocol of 8 units regular insulin and 12 units NPH insulin at 7 am. At 10:30am, the patient reports feeling uneasy, shaky, and has a headache. Which is the probable explanation for this? a. The NPH insulin's action is peaking, and there is an insufficient blood glucoses level. b. The regular insulin's action is peaking, and there is an insufficient blood glucose level. c. The patient consumed too many calories at breakfast and now has an elevated blood glucose level. d. The symptoms are unrelated to the insulin administered in the early morning or food taken in at lunchtime.

b. The regular insulin's action is peaking, and there is an insufficient blood glucose level.

SG#24 The nurse is providing discharge teaching to a patient about self-monitoring of blood glucose (SMBG). What information does the nurse include? Select all that apply. a. Only perform SMBG before breakfast. b. Wash hands before using the meter. c. Do a retest if the results seem unusual. d. It is okay to reuse lancets in the home setting. e. Do not share the meter. f. How to calibrate the machine.

b. Wash hands before using the meter. c. Do a retest if the results seem unusual. e. Do not share the meter. f. How to calibrate the machine.

1.A nurse is teaching a client with diabetes mellitus who asks, Why is it necessary to maintain my blood glucose levels no lower than about 60 mg/dL? How should the nurse respond? a. Glucose is the only fuel used by the body to produce the energy that it needs. b. Your brain needs a constant supply of glucose because it cannot store it. c. Without a minimum level of glucose, your body does not make red blood cells. d. Glucose in the blood prevents the formation of lactic acid and prevents acidosis.

b. Your brain needs a constant supply of glucose because it cannot store it.

19.A nurse assesses a client who has diabetes mellitus. Which arterial blood gas values should the nurse identify as potential ketoacidosis in this client? a. pH 7.38, HCO3 22 mEq/L, PCO2 38 mm Hg, PO2 98 mm Hg b. pH 7.28, HCO3 18 mEq/L, PCO2 28 mm Hg, PO2 98 mm Hg c. pH 7.48, HCO3 28 mEq/L, PCO2 38 mm Hg, PO2 98 mm Hg d. pH 7.32, HCO3 22 mEq/L, PCO2 58 mm Hg, PO2 88 mm Hg

b. pH 7.28, HCO3 18 mEq/L, PCO2 28 mm Hg, PO2 98 mm Hg When the lungs can no longer offset acidosis, the pH decreases to below normal. A client who has diabetic ketoacidosis would present with arterial blood gas values that show primary metabolic acidosis with decreased bicarbonate levels and a compensatory respiratory alkalosis with decreased carbon dioxide levels.

SG#6 Which individual is at greatest risk for developing type 2 DM? a. 25 yr old african-american woman b. 36 yr old african-american man c. 56 yr old hispanic woman d. 40 yr old hispanic man

c. 56 yr old hispanic woman

45.At 4:45 p.m., a nurse assesses a client with diabetes mellitus who is recovering from an abdominal hysterectomy 2 days ago. The nurse notes that the client is confused and diaphoretic. The nurse reviews the assessment data provided in the chart below: Capillary Blood Glucose Testing (AC/HS) Dietary Intake At 0630: 95 At 1130: 70 At 1630: 47 Breakfast: 10% eaten client states she is not hungry Lunch: 5% eaten client is nauseous; vomits once After reviewing the clients assessment data, which action is appropriate at this time? a. Assess the clients oxygen saturation level and administer oxygen. b. Reorient the client and apply a cool washcloth to the clients forehead. c. Administer dextrose 50% intravenously and reassess the client. d. Provide a glass of orange juice and encourage the client to eat dinner.

c. Administer dextrose 50% intravenously and reassess the client. The clients symptoms are related to hypoglycemia. Since the client has not been tolerating food, the nurse should administer dextrose intravenously. The clients oxygen level could be checked, but based on the information provided, this is not the priority. The client will not be reoriented until the glucose level rises.

25.A nurse assesses a client with diabetes mellitus 3 hours after a surgical procedure and notes the clients breath has a fruity odor. Which action should the nurse take? a. Encourage the client to use an incentive spirometer. b. Increase the clients intravenous fluid flow rate. c. Consult the provider to test for ketoacidosis. d. Perform meticulous pulmonary hygiene care.

c. Consult the provider to test for ketoacidosis. The stress of surgery increases the action of counterregulatory hormones and suppresses the action of insulin, predisposing the client to ketoacidosis and metabolic acidosis. One manifestation of ketoacidosis is a fruity odor to the breath. Documentation should occur after all assessments have been completed. Using an incentive spirometer, increasing IV fluids, and performing pulmonary hygiene will not address this clients problem.

4.A nurse assesses a client who has a 15-year history of diabetes and notes decreased tactile sensation in both feet. Which action should the nurse take first? a. Document the finding in the clients chart. b. Assess tactile sensation in the clients hands. c. Examine the clients feet for signs of injury. d. Notify the health care provider.

c. Examine the clients feet for signs of injury. Diabetic neuropathy is common when the disease is of long duration. The client is at great risk for injury in any area with decreased sensation because he or she is less able to feel injurious events. Feet are common locations for neuropathy and injury, so the nurse should inspect them for any signs of injury. After assessment, the nurse should document findings in the clients chart. Testing sensory perception in the hands may or may not be needed. The health care provider can be notified after assessment and documentation have been completed.

34.A nurse assesses a client who is being treated for hyperglycemic-hyperosmolar state (HHS). Which clinical manifestation indicates to the nurse that the therapy needs to be adjusted? a. Serum potassium level has increased. b. Blood osmolarity has decreased. c. Glasgow Coma Scale score is unchanged. d. Urine remains negative for ketone bodies.

c. Glasgow Coma Scale score is unchanged. A slow but steady improvement in central nervous system functioning is the best indicator of therapy effectiveness for HHS. Lack of improvement in the level of consciousness may indicate inadequate rates of fluid replacement. The Glasgow Coma Scale assesses the clients state of consciousness against criteria of a scale including best eye, verbal, and motor responses. An increase in serum potassium, decreased blood osmolality, and urine negative for ketone bodies do not indicate adequacy of treatment.

40.After teaching a client who is newly diagnosed with type 2 diabetes mellitus, the nurse assesses the clients understanding. Which statement made by the client indicates a need for additional teaching? a. I should increase my intake of vegetables with higher amounts of dietary fiber. b. My intake of saturated fats should be no more than 10% of my total calorie intake. c. I should decrease my intake of protein and eliminate carbohydrates from my diet. d. My intake of water is not restricted by my treatment plan or medication regimen.

c. I should decrease my intake of protein and eliminate carbohydrates from my diet. The client should not completely eliminate carbohydrates from the diet, and should reduce protein if microalbuminuria is present. The client should increase dietary intake of complex carbohydrates, including vegetables, and decrease intake of fat. Water does not need to be restricted unless kidney failure is present.

SG#38 A 47-year-old patient with a history of type 2 DM and emphysema who reports smoking three packs of cigarettes per day is admitted to the hospital with a diagnosis of acute pneumonia. The patient is placed on his regular oral antidiabetic agents, sliding-scale insulin, and antibiotic medications. On day 2 of hospitalization, the health care provider orders prednisone therapy. What does the nurse expect the blood glucose to do? a. Decrease b. Stay the same c. Increase d. Return to normal

c. Increase

SG#34 Which statement about insulin administration is correct? a. Insulin may be given orally, intravenously, or subcutaneously. b. Insulin injections should be spaced no closer than one-half inch apart. c. Insulin absorption is fastest in the abdomen except for a 2-inch radius around the navel. d. Shake the bottle of intermediate-acting insulin and then draw it into the syringe.

c. Insulin absorption is fastest in the abdomen except for a 2-inch radius around the navel.

SG#2 Which statement is true about insulin? a. It is secreted by alpha cells in the islets of Langerhans b. It is a catabolic hormone that builds up glucagon reserves c. It is necessary for glucose transport across cell membrane d. It is stored in muscles and converted to fat for storage

c. It is necessary for glucose transport across cell membrane

SG#9 A patient with hyperglycemia displays a rapid and deep respiratory pattern. The nurse would describe this as which respiratory pattern? a. Tachypnea b. Cheyne-strokes respiration c. Kussmaul respiration d. Biot respiration

c. Kussmaul respiration

SG#29 Which class of antidiabetic medication should be taken just before or with meals? a. Alpha-glucosidase inhibitors, which include miglitol b. Biguanides, which include metformin c. Meglitinides, which include nateglinide d. Sulfonylureas, which include chlorpromazine.

c. Meglitinides, which include nateglinide

SG#30 Which oral agent may cause lactic acidosis in patients with kidney impairment? a. Nateglinide b. Repaglinide c. Metformin d. Miglitol

c. Metformin

SG#10 When assessing a patient with hyperglycemia the nurse would evaluate the patient for changes in which electrolyte? a. Sodium b. Chloride c. Potassium d. Magnesium

c. Potassium

SG#15 What type of insulin is used in the emergency treatment of DKA and hyperglycemic-hyperosmolar nonketotic syndrome (HHNS)? a. NPH b. Lente c. Regular d. Protamine zinc

c. Regular

SG#17 Glucagon is used primarily to treat the patient with which disorder? a. DKA b. Idiosyncratic reaction to insulin c. Severe hypoglycemia d. Hyperglycemic-hyperosmolar state (HHS)

c. Severe hypoglycemia

SG#7 According to the American Diabetes Association (ADA), which laboratory finding is most indicative of DM? a. Fasting blood glucose = 80 mg/dL b. 2-hour postprandial blood glucose = 110 c. 1- hour glucose tolerance blood glucose = 110 mg/dL d. 2- hour glucose tolerance blood glucose = 210 mg/d

d. 2- hour glucose tolerance blood glucose = 210 mg/d

7.A nurse assesses clients who are at risk for diabetes mellitus. Which client is at greatest risk? a. A 29-year-old Caucasian b. A 32-year-old African- American c. A 44-year-old Asian d. A 48-year-old American Indian

d. A 48-year-old American Indian Diabetes is a particular problem among African Americans, Hispanics, and American Indians. The incidence of diabetes increases in all races and ethnic groups with age. Being both an American Indian and middle-aged places this client at highest risk.

20.A nurse cares for a client experiencing diabetic ketoacidosis who presents with Kussmaul respirations. Which action should the nurse take? a. Administration of oxygen via face mask b. Intravenous administration of 10% glucose c. Implementation of seizure precautions d. Administration of intravenous insulin

d. Administration of intravenous insulin The rapid, deep respiratory efforts of Kussmaul respirations are the bodys attempt to reduce the acids produced by using fat rather than glucose for fuel. Only the administration of insulin will reduce this type of respiration by assisting glucose to move into cells and to be used for fuel instead of fat. The client who is in ketoacidosis may not experience any respiratory impairment and therefore does not need additional oxygen. Giving the client glucose would be contraindicated. The client does not require seizure precautions.

SG#45 A patient will be using rapid acting insulin injected by an external insulin pump. What does the nurse tell the patient about the pump? a. SMBG levels can be done only twice a day. b. The insulin supply must be replaced every 2-4 weeks. c. The pump's battery should be checked on a regular weekly schedule. d. Be sure to match your insulin dose to the carbohydrate (CHO) content of your diet.

d. Be sure to match your insulin dose to the carbohydrate (CHO) content of your diet.

16.A nurse teaches a client who is prescribed an insulin pump. Which statement should the nurse include in this clients discharge education? a. Test your urine daily for ketones. b. Use only buffered insulin in your pump. c. Store the insulin in the freezer until you need it. d. Change the needle every 3 days.

d. Change the needle every 3 days. Having the same needle remain in place through the skin for longer than 3 days drastically increases the risk for infection in or through the delivery system. Having an insulin pump does not require the client to test for ketones in the urine. Insulin should not be frozen. Insulin is not buffered.

3.After teaching a young adult client who is newly diagnosed with type 1 diabetes mellitus, the nurse assesses the clients understanding. Which statement made by the client indicates a correct understanding of the need for eye examinations? a. At my age, I should continue seeing the ophthalmologist as I usually do. b. I will see the eye doctor when I have a vision problem and yearly after age c. My vision will change quickly. I should see the ophthalmologist twice a year. d. Diabetes can cause blindness, so I should see the ophthalmologist yearly.

d. Diabetes can cause blindness, so I should see the ophthalmologist yearly. Diabetic retinopathy is a leading cause of blindness in North America. All clients with diabetes, regardless of age, should be examined by an ophthalmologist (rather than an optometrist or optician) at diagnosis and at least yearly thereafter.

SG#39 Which laboratory test is the best indicator of a patient's average blood glucose level and/or compliance with the DM regimen over the last 3 months? a. Postprandial blood glucose test b. Oral glucose tolerance test (OGTT) c. Casual blood glucose test d. Glycosylated hemoglobin (HbA1c)

d. Glycosylated hemoglobin (HbA1c)

17.After teaching a client who has diabetes mellitus and proliferative retinopathy, nephropathy, and peripheral neuropathy, the nurse assesses the clients understanding. Which statement made by the client indicates a correct understanding of the teaching? a. I have so many complications; exercising is not recommended. b. I will exercise more frequently because I have so many complications. c. I used to run for exercise; I will start training for a marathon. d. I should look into swimming or water aerobics to get my exercise.

d. I should look into swimming or water aerobics to get my exercise. Exercise is not contraindicated for this client, although modifications based on existing pathology are necessary to prevent further injury. Swimming or water aerobics will give the client exercise without the worry of having the correct shoes or developing a foot injury. The client should not exercise too vigorously.

10.After teaching a client with type 2 diabetes mellitus who is prescribed nateglinide (Starlix), the nurse assesses the clients understanding. Which statement made by the client indicates a correct understanding of the prescribed therapy? a. Ill take this medicine during each of my meals. b. I must take this medicine in the morning when I wake. c. I will take this medicine before I go to bed. d. I will take this medicine immediately before I eat.

d. I will take this medicine immediately before I eat. Nateglinide is an insulin secretagogue that is designed to increase meal-related insulin secretion. It should be taken immediately before each meal. The medication should not be taken without eating as it will decrease the clients blood glucose levels. The medication should be taken before meals instead of during meals.

38.A nurse assesses a client with diabetes mellitus who self-administers subcutaneous insulin. The nurse notes a spongy, swelling area at the site the client uses most frequently for insulin injection. Which action should the nurse take? a. Apply ice to the site to reduce inflammation. b. Consult the provider for a new administration route. c. Assess the client for other signs of cellulitis. d. Instruct the client to rotate sites for insulin injection.

d. Instruct the client to rotate sites for insulin injection. The clients tissue has been damaged from continuous use of the same site. The client should be educated to rotate sites. The damaged tissue is not caused by cellulitis or any type infection, and applying ice may cause more damage to the tissue. Insulin can only be administered subcutaneously and intravenously. It would not be appropriate or practical to change the administration route.

SG#22 The nurse is teaching people in a community education class about modifiable risk factors for type 2 DM. Which factors would the nurse discuss? Select all that apply. a. Age b. Family history c. Working in a low-stress environment d. Maintaining ideal body weight e. Maintaining adequate physical activity f. Lack of exercise

d. Maintaining ideal body weight e. Maintaining adequate physical activity f. Lack of exercise

SG#8 The nurse would observe the patient with untreated hyperglycemia for which condition? a. Respiratory acidosis b. Metabolic alkalosis c. Respiratory alkalosis d. Metabolic acidosis

d. Metabolic acidosis

39.A nurse reviews the medication list of a client recovering from a computed tomography (CT) scan with IV contrast to rule out small bowel obstruction. Which medication should alert the nurse to contact the provider and withhold the prescribed dose? a. Pioglitazone (Actos) b. Glimepiride (Amaryl) c. Glipizide (Glucotrol) d. Metformin (Glucophage)

d. Metformin (Glucophage) Glucophage should not be administered when the kidneys are attempting to excrete IV contrast from the body. This combination would place the client at high risk for kidney failure. The nurse should hold the metformin dose and contact the provider. The other medications are safe to administer after receiving IV contrast.

21.A nurse cares for a client who has type 1 diabetes mellitus. The client asks, Is it okay for me to have an occasional glass of wine? How should the nurse respond? a. Drinking any wine or alcohol will increase your insulin requirements. b. Because of poor kidney function, people with diabetes should avoid alcohol. c. You should not drink alcohol because it will make you hungry and overeat. d. One glass of wine is okay with a meal and is counted as two fat exchanges.

d. One glass of wine is okay with a meal and is counted as two fat exchanges. Under normal circumstances, blood glucose levels will not be affected by moderate use of alcohol when diabetes is well controlled. Because alcohol can induce hypoglycemia, it should be ingested with or shortly after a meal. One alcoholic beverage is substituted for two fat exchanges when caloric intake is calculated. Kidney function is not impacted by alcohol intake. Alcohol is not associated with increased hunger or overeating.

SG#28 Which class of antidiabetic medication is most likely to cause hypoglycemia even when hyperglycemia is not present? a. Alpha-glucosidase inhibitors, which include miglitol b. Biguanides, which include metformin c. Meglitinides, which include nateglinide d. Second-generation sulfonylureas, which include glipizide.

d. Second-generation sulfonylureas, which include glipizide. `

2.A nurse reviews laboratory results for a client with diabetes mellitus who presents with polyuria, lethargy, and a blood glucose of 560 mg/dL. Which laboratory result should the nurse correlate with the clients polyuria? a. Serum sodium: 163 mEq/L b. Serum creatinine: 1.6 mg/dL c. Presence of urine ketone bodies d. Serum osmolarity: 375 mOsm/kg

d. Serum osmolarity: 375 mOsm/kg Hyperglycemia causes hyperosmolarity of extracellular fluid. This leads to polyuria from an osmotic diuresis. The clients serum osmolarity is high. The clients sodium would be expected to be high owing to dehydration. Serum creatinine and urine ketone bodies are not related to the polyuria.

32.A nurse reviews the laboratory results of a client who is receiving intravenous insulin. Which should alert the nurse to intervene immediately? a. Serum chloride level of 98 mmol/L b. Serum calcium level of 8.8 mg/dL c. Serum sodium level of 132 mmol/L d. Serum potassium level of 2.5 mmol/L

d. Serum potassium level of 2.5 mmol/L Insulin activates the sodium-potassium ATPase pump, increasing the movement of potassium from the extracellular fluid into the intracellular fluid, resulting in hypokalemia. In hyperglycemia, hypokalemia can also result from excessive urine loss of potassium. The chloride level is normal. The calcium and sodium levels are slightly low, but this would not be related to hyperglycemia and insulin administration.

37.When teaching a client recently diagnosed with type 1 diabetes mellitus, the client states, I will never be able to stick myself with a needle. How should the nurse respond? a. I can give your injections to you while you are here in the hospital. b. Everyone gets used to giving themselves injections. It really does not hurt. c. Your disease will not be managed properly if you refuse to administer the shots. d. Tell me what it is about the injections that are concerning you.

d. Tell me what it is about the injections that are concerning you. Devote as much teaching time as possible to insulin injection and blood glucose monitoring. Clients with newly diagnosed diabetes are often fearful of giving themselves injections. If the client is worried about giving the injections, it is best to try to find out what specifically is causing the concern, so it can be addressed. Giving the injections for the client does not promote self-care ability. Telling the client that others give themselves injections may cause the client to feel bad. Stating that you dont know another way to manage the disease is dismissive of the clients concerns.

SG#42 A patient with type 2 DM, usually controlled with a second-generation sulfonylurea, develops a urinary tract infection. Due to the stress of the infection, the patient must be treated with insulin. What additional information about this treatment does the nurse explain to the patient? a. The sulfonylurea must be discontinued and insulin taken until the infection clears. b. Insulin will now be necessary to control the patient's diabetes for life. c. The sulfonylurea dose must be reduced until the infection clears. d. The insulin is necessary to supplement the second-generation sulfonylurea until the infection clears.

d. The insulin is necessary to supplement the second-generation sulfonylurea until the infection clears.

27.A nurse teaches a client with diabetes mellitus who is experiencing numbness and reduced sensation. Which statement should the nurse include in this clients teaching to prevent injury? a. Examine your feet using a mirror every day. b. Rotate your insulin injection sites every week. c. Check your blood glucose level before each meal. d. Use a bath thermometer to test the water temperature.

d. Use a bath thermometer to test the water temperature. Clients with diminished sensory perception can easily experience a burn injury when bathwater is too hot. Instead of checking the temperature of the water by feeling it, they should use a thermometer. Examining the feet daily does not prevent injury, although daily foot examinations are important to find problems so they can be addressed. Rotating insulin and checking blood glucose levels will not prevent injury.

22.A nurse teaches a client with type 1 diabetes mellitus. Which statement should the nurse include in this clients teaching to decrease the clients insulin needs? a. Limit your fluid intake to 2 liters a day. b. Animal organ meat is high in insulin. c. Limit your carbohydrate intake to 80 grams a day. d. Walk at a moderate pace for 1 mile daily.

d. Walk at a moderate pace for 1 mile daily. Moderate exercise such as walking helps regulate blood glucose levels on a daily basis and results in lowered insulin requirements for clients with type 1 diabetes mellitus. Restricting fluids and eating organ meats will not reduce insulin needs. People with diabetes need at least 130 grams of carbohydrates each day.

SG#16 Early treatment of DKA and hyperglycemic-hyperosmolar nonketotic syndrome(HHNS) includes IV administration of which fluid? a. glucagon b. potassium c. bicarbonate d. normal saline

d. normal saline