Diabetes
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." -"I have lost 10 pounds without even trying." -"I sleep at least 8 hours each night." -"I cannot seem to quench my thirst." -"At times my vision is blurry."
"At times my vision is blurry." "I have to void nearly every hour." "I cannot seem to quench my thirst." "I have lost 10 pounds without even trying." Explanation: Criteria for the diagnosis of diabetes include symptoms of diabetes plus a random or casual plasma glucose concentration equal to or greater than 200 mg/dL. Symptoms of diabetes include vision changes, polyuria (or the increased need to urinate), polydipsia (or increased thirst), and sudden weight loss.
A client newly diagnosed with diabetes mellitus asks why he needs ketone testing when the disease affects his blood glucose levels. How should the nurse respond? -"The spleen releases ketones when your body can't use glucose." -"Ketones will tell us if your body is using other tissues for energy." -"Ketones can damage your kidneys and eyes." -"Ketones help the physician determine how serious your diabetes is."
"Ketones will tell us if your body is using other tissues for energy." Explanation: The nurse should tell the client that ketones are a byproduct of fat metabolism and that ketone testing can determine whether the body is breaking down fat to use for energy. The spleen doesn't release ketones when the body can't use glucose. Although ketones can damage the eyes and kidneys and help the physician evaluate the severity of a client's diabetes, these responses by the nurse are incomplete.
Which instruction should a nurse give to a client with diabetes mellitus when teaching about "sick day rules"? -"Don't take your insulin or oral antidiabetic agent if you don't eat." -"It's okay for your blood glucose to go above 300 mg/dl while you're sick." -"Test your blood glucose every 4 hours." -"Follow your regular meal plan, even if you're nauseous."
"Test your blood glucose every 4 hours." Explanation: The nurse should instruct a client with diabetes mellitus to check his blood glucose levels every 3 to 4 hours and take insulin or an oral antidiabetic agent as usual, even when he's sick. If the client's blood glucose level rises above 300 mg/dl, he should call his physician immediately. If the client is unable to follow the regular meal plan because of nausea, he should substitute soft foods, such as gelatin, soup, and custard.
Which factors will cause hypoglycemia in a client with diabetes? Select all that apply. -Client is experiencing effects of the aging process. -Client has been sleeping excessively. -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.
-Client has not consumed food and continues to take insulin or oral antidiabetic medications. -Client has not consumed sufficient calories. -Client has been exercising more than usual. Explanation: Hypoglycemia can occur when a client with diabetes is not eating at all and continues to take insulin or oral antidiabetic medications, is not eating sufficient calories to compensate for glucose-lowering medications, or is exercising more than usual. Excessive sleep and aging are not factors in the onset of hypoglycemia.
Which of the following clients diagnosed with type 1 diabetes is most likely to meet the therapeutic goal of adequate glucose control? -A client who skips breakfast when the glucose reading is greater than 220 mg/dL (12.3 mmol/L) -A client who never deviates from the prescribed dose of insulin -A client who adheres closely to a meal plan and meal schedule -A client who eliminates carbohydrates from the daily intake
A client who adheres closely to a meal plan and meal schedule Explanation: The therapeutic goal for diabetes management is to achieve normal blood glucose levels without hypoglycemia. Therefore, diabetes management involves constant assessment and modification of the treatment plan by health professionals and daily adjustments in therapy (possibly including insulin) by clients. For clients who require insulin to help control blood glucose levels, maintaining consistency in the amount of calories and carbohydrates ingested at meals is essential. In addition, consistency in the approximate time intervals between meals and snacks helps maintain overall glucose control. Skipping meals is never advisable for person with type 1 diabetes.
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 bicarbonate to correct acidosis. -Give prescribed antiemetics. -Begin fluid replacements. -Administer prescribed dose of insulin.
Begin fluid replacements. Explanation: Management of DKA is aimed at correcting dehydration, electrolyte loss, and acidosis before correcting the hyperglycemia with insulin.
Which of the following is a characteristic of diabetic ketoacidosis (DKA)? Select all that apply. -Absent ketones -Elevated blood urea nitrogen (BUN) and creatinine -Normal arterial pH level -More common in type 1 diabetes -Rapid onset
Elevated blood urea nitrogen (BUN) and creatinine Rapid onset More common in type 1 diabetes Explanation: DKA is characterized by an elevated BUN and creatinine, rapid onset, and it is more common in type 1 diabetes. Hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is characterized by the absence of urine and serum ketones and a normal arterial pH level.
Which assessment finding is most important in determining nursing care for a client with diabetes mellitus? -Blood sugar 170 mg/dL -Respirations of 12 breaths/minute -Fruity breath -Cloudy urine
Fruity breath Explanation: The rising ketones and acetone in the blood can lead to acidosis and be detected as a fruity odor on the breath. Ketoacidosis needs to be treated to prevent further complications such as Kussmaul respirations (fast, labored breathing) and renal shutdown. A blood sugar of 170 mg/dL is not ideal but will not result in glycosuria and/or trigger the classic symptoms of diabetes mellitus. Cloudy urine may indicate a UTI.
Which is the best nursing explanation for the symptom of polyuria in a client with diabetes mellitus? -The body's requirement for fuel drives the production of urine. -With diabetes, drinking more results in more urine production. -Increased ketones in the urine promote the manufacturing of more urine. -High sugar pulls fluid into the bloodstream, which results in more urine production.
High sugar pulls fluid into the bloodstream, which results in more urine production. Explanation: The hypertonicity from concentrated amounts of glucose in the blood pulls fluid into the vascular system, resulting in polyuria. The urinary frequency triggers the thirst response, which then results in polydipsia. Ketones in the urine and body requirements do not affect the production of urine.
Which combination of adverse effects should a nurse monitor for when administering IV insulin to a client with diabetic ketoacidosis? -Hypokalemia and hypoglycemia -Hypocalcemia and hyperkalemia -Hyperkalemia and hyperglycemia -Hypernatremia and hypercalcemia
Hypokalemia and hypoglycemia Explanation: Blood glucose needs to be monitored in clients receiving IV insulin because of the risk of hyperglycemia or hypoglycemia. Hypoglycemia might occur if too much insulin is administered. Hypokalemia, not hyperkalemia, might occur because I.V. insulin forces potassium into cells, thereby lowering the plasma level of potassium. Calcium and sodium levels aren't affected by IV insulin administration.
A 60-year-old client comes to the ED reporting weakness, vision problems, increased thirst, increased urination, and frequent infections that do not seem to heal easily. The physician suspects that the client has diabetes. Which classic symptom should the nurse watch for to confirm the diagnosis of diabetes? -Numbness -Increased hunger -Fatigue -Dizziness
Increased hunger Explanation: The classic symptoms of diabetes are the three Ps: polyuria (increased urination), polydipsia (increased thirst), and polyphagia (increased hunger). Some of the other symptoms include tingling, numbness, and loss of sensation in the extremities and fatigue.
A nurse is assessing a client who is receiving total parenteral nutrition (TPN). Which finding suggests that the client has developed hyperglycemia? -Cheyne-Stokes respirations -Decreased appetite -Increased urine output -Diaphoresis
Increased urine output Explanation: Glucose supplies most of the calories in TPN; if the glucose infusion rate exceeds the client's rate of glucose metabolism, hyperglycemia arises. When the renal threshold for glucose reabsorption is exceeded, osmotic diuresis occurs, causing an increased urine output. A decreased appetite and diaphoresis suggest hypoglycemia, not hyperglycemia. Cheyne-Stokes respirations are characterized by a period of apnea lasting 10 to 60 seconds, followed by gradually increasing depth and frequency of respirations. Cheyne-Stokes respirations typically occur with cerebral depression or heart failure.
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 decreases the intestinal absorption of glucose. -It aids in the process of gluconeogenesis. -It stimulates the pancreatic beta cells. -It enhances the transport of glucose across the cell membrane.
It enhances the transport of glucose across the cell membrane. Explanation: Insulin carries glucose into body cells as their preferred source of energy. Besides, it promotes the liver's storage of glucose as glycogen and inhibits the breakdown of glycogen back into glucose. Insulin does not aid in gluconeogenesis but inhibits the breakdown of glycogen back into glucose.
A patient is diagnosed with type 1 diabetes. What clinical characteristics does the nurse expect to see in this patient? Select all that apply. -Ketosis-prone -Little or no endogenous insulin -Obesity at diagnoses -Younger than 30 years of age -Older than 65 years of age
Ketosis-prone Little or no endogenous insulin Younger than 30 years of age Explanation: Type I diabetes mellitus is associated with the following characteristics: onset any age, but usually young (<30 y); usually thin at diagnosis, recent weight loss; etiology includes genetic, immunologic, and environmental factors (e.g., virus); often have islet cell antibodies; often have antibodies to insulin even before insulin treatment; little or no endogenous insulin; need exogenous insulin to preserve life; and ketosis prone when insulin absent.
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? -Cool, moist skin -Rapid, thready pulse -Arm and leg trembling -Slow, shallow respirations
Rapid, thready pulse Explanation: This client's abnormally high blood glucose level indicates hyperglycemia, which typically causes polyuria, polyphagia, and polydipsia. Because polyuria leads to fluid loss, the nurse should expect to assess signs of deficient fluid volume, such as a rapid, thready pulse; decreased blood pressure; and rapid respirations. Cool, moist skin and arm and leg trembling are associated with hypoglycemia. Rapid respirations — not slow, shallow ones — are associated with hyperglycemia.
A client diagnosed with type 2 diabetes achieves adequate glycemic control through diet and exercise. Upon being admitted to the hospital for a cholecystectomy, however, the client has required insulin injections on two occasions. The nurse would identify what as the likely cause for this short-term change in treatment? -Alterations in bile metabolism and release have likely caused hyperglycemia. -Stress has likely caused an increase in the client's blood sugar levels. -The client has likely overestimated their ability to control the diabetes using nonpharmacologic measures. -The client's volatile fluid balance surrounding surgery has likely caused unstable blood sugars.
Stress has likely caused an increase in the client's blood sugar levels. Explanation: During periods of physiologic stress, such as surgery, blood glucose levels tend to increase, because levels of stress hormones (epinephrine, norepinephrine, glucagon, cortisol, and growth hormone) increase. The client's need for insulin is unrelated to the action of bile, the client's overestimation of previous blood sugar control, or fluid imbalance.
Which of the following factors would a nurse identify as a most likely cause of diabetic ketoacidosis (DKA) in a client with diabetes? -The client has not consumed sufficient calories. -The client continues medication therapy despite adequate food intake. -The client has been exercising more than usual. -The client has eaten and has not taken or received insulin.
The client has eaten and has not taken or received insulin. Explanation: If the client has eaten and has not taken or received insulin, DKA is more likely to develop. Hypoglycemia is more likely to develop if the client has not consumed food and continues to take insulin or oral antidiabetic medications, if the client has not consumed sufficient calories, or if client has been exercising more than usual.
A client diagnosed with type 1 diabetes informs the nurse that their most recent urine test for ketones was positive. What is the nurse's most plausible conclusion based on this assessment finding? -The client should promptly eat some protein and carbohydrates. -The client should withhold the next scheduled dose of insulin. -The client would benefit from a dose of metformin. -The client's insulin levels are inadequate.
The client's insulin levels are inadequate. Explanation: Ketones in the urine signal that there is a deficiency of insulin and that control of type 1 diabetes is deteriorating. Withholding insulin or eating food would exacerbate the client's ketonuria. Metformin will not cause short-term resolution of hyperglycemia.
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 will be split roughly evenly between type 1 and type 2. -Type 1 diabetes always develops before the age of 20. -The participants are unlikely to develop a new onset of type 1 diabetes. -New cases of diabetes are highly uncommon in older adults.
The participants are unlikely to develop a new onset of type 1 diabetes. Explanation: Type 1 diabetes usually (but not always) develops in people younger than 20. In older adults, an onset of type 2 is far more common. A significant number of older adults develops type 2 diabetes.
A client receives a daily injection of glargine insulin at 7:00 a.m. When should the nurse monitor this client for a hypoglycemic reaction? -Between 8:00 and 10:00 a.m. -Between 4:00 and 6:00 p.m. -Between 7:00 and 9:00 p.m. -This insulin has no peak action and does not cause a hypoglycemic reaction.
This insulin has no peak action and does not cause a hypoglycemic reaction. Explanation: "Peakless" basal or very long-acting insulins are approved by the U.S. Food and Drug Administration for use as a basal insulin; that is, the insulin is absorbed very slowly over 24 hours and can be given once a day. It has is no peak action.