Diabetes: DKA, HHS, etc

Presence of ketones in the urine a. DKA b. HHNS

Presence of ketones in the urine is __DKA__

Hyperglycemia, ketosis, and acidemia characterize ______________________.

Ketoacidosis

Often affects elderly patients with a recent acute illness a. DKA b. HHS

Often affects elderly patients with a recent acute illness in __HHS__

A nurse is teaching a client who has a new prescription for NPH insulin. Which of the following instructions should the nurse include?

"Eat a snack 8 hours after taking this medication." NPH insulin peaks in 6-14 hours after dosing. The client is at risk for HYPOglycemia and might require a snack at this time. Clients should check blood glucose 8-10 hours after administration of NPH insulin. If HYPOglycemic, consume a small snack of 15 grams of carbs and recheck blood glucose again in 15 min.

A nurse is evaluating teaching with a client who is receiving continuous subcutaneous insulin via an external insulin pump. which of the following statements by the client indicates a need for further teaching?

"I will use insulin glargine in my insulin pump." The client should use a short-acting insulin in the pump. The pump is designed to administer rapid-acting or short acting insulin 24 hours a da. Glargine is classified as a long-acting insulin and is administered at the same time each day to maintain stable blood glucose concentration for a 24 hours period.

a nurse is caring for a client with diabetes mellitus who receives 25 units of NHP insulin every morning if her blood glucose level is above 200 mg/dl. The nurse monitors this client for hypoglycemia because NPH insulin peaks how long after administration?

4-12 hr

A nurse is reviewing laboratory values for a client who has diabetic ketoacidosis (DKA). Which of the following results should the nurse expect? A. pH 7.32, PaCO2 36 mm Hg, HCO3- 14 mEq/L B. pH 7.38, PaCO2 55 mm Hg, HCO3- 22 mEq/L C. pH 7.44, PaCO2 40 mm Hg, HCO3- 24 mEq/L D. pH 7.50, PaCO2 42 mm Hg, HCO3- 30 mEq/L

A Metabolic acidosis is a common manifestation of DKA, low/acidic pH (normal 7.35-7.45), carbon dioxide with the normal range (35-45 mmHg), and a low bicarbonate value (normal 22-26 mEq/L)

The nurse recognizes that blood glucose monitoring before meals and at bedtime is done to achieve which outcome? (Select all that apply.) A. Maintain glycemic control. B. Prevent complications of long-term hyperglycemia. C. Facilitate insulin administration that mimics the healthy pancreas. D. Provide frequent practice with the finger stick technique. E. Prevent acute complications of type 1 diabetes.

A, B, C

The nurse monitors for which clinical manifestations in the patient newly diagnosed with type 1 DM? (Select all that apply.) A. Polyuria B. Fatigue C. Weight loss D. Polyphagia E Decreased appetite

A, B, C, D

The nurse correlates which laboratory values as a diagnostic for DKA? (Select all that apply.)A. Serum bicarbonate of 15 mEq/L B. Negative anion gapC. Serum glucose of 350 mg/dL D. Positive anion gapE. Arterial pH of 7.36

A, C, D

The nurse monitors for which clinical manifestations in the patient diagnosed with type 2 diabetes mellitus? Select all that apply. a. Fatigue b. Muscle cramps c. Visual disturbances d. Poor wound healing e. Recurrent infections

A, C, D, E

The nurse understands HHS (Hyperosmolar hyperglycemic state) differs from DKA in which of the following ways? (Select all that apply.) A. HHS has a more gradual onset. B. DKA presents with higher serum glucose. C. Potassium depletion is a potential complication with HHS. D. A positive anion gap is not diagnostic for HHS. E. Ketosis is typically not present in HHS.

A, D, E

What is the most likely cause of the Somogyi effect? A. Basal insulin injections before bed without a small snack B. Naturally occurring release of hormones during the night C. Increased consumption of complex carbohydrates throughout the day D. Glucagon administration before breakfast

A. Basal insulin injections before bed without a small snack

A nurse is checking laboratory values to determine if a client with diabetes mellitus is adhering to the treatment plan. Which of the following tests should the nurse use to make this determination? A. Glycosylated hemoglobin levels B. Urine sugar and acetone levels C. Glucose tolerance test D. Fasting serum glucose

A. checking HbA1c = accurate method of determining if routinely compliant

A nurse is preparing to administer a morning dose of insulin apart to a client who has type 1 diabetes mellitus. Which of the following actions should the nurse implement?Check blood glucose immediately after breakfastAdminister insulin when breakfast arrivesHold breakfast for 1 hr after insulin adminsitrationClarify the prescription because insulin should not be administered at this time

Administer insulin when breakfast arrives

A nurse is caring for a client who has type 2 DM and is displaying manifestations of hyperglycemia. Which of the following findings indicates the client has hyperglycemia? A. Hunger B. Increased urination C. Cold, clammy skin D. Tremors

B

A nurse is conducting a home visit for an older adult client who has diabetes mellitus and takes regular insulin subcutaneously before each meal. The client appears disoriented and weak and has slurred speech. Which of the following conditions should the nurse consider first when responding to these manifestations?A. Dementia B. Hypoglycemia C. Infection D. Transient ischemic attack

B

A nurse is preparing to administer a morning dose of insulin aspart to a client who has type 1 diabetes mellitus. Which of the following actions should the nurse take? A. Check blood glucose immediately after breakfast B. Administer insulin when breakfast arrives C. Hold breakfast for 1 hr after insulin administration D. Clarify the prescription because insulin should not be administered at this time

B

A nurse is planning teaching for a client who has type 1 diabetes mellitus. Which of the following instructions should the nurse plan to include? A. Consume no more than 3 servings of alcohol per day. B. Ingest food with alcohol to reduce alcohol-induced hypoglycemia C. Increase insulin dosage before planned exercise D. Rest for 3 days between periods of vigorous exercise

B Alcohol inhibits the liver's production of glucose, consuming carbohydrates while drinking alcoholic beverages helps prevent hypoglycemia.

A patient with type 1 diabetes mellitus will be self-monitoring blood glucose levels at home. What the minimum number of measurements that this patient should make each day? a. 1 b. 3 c. 4 d. 8

C 4

A nurse in a provider's office is teaching a client about foods that are high in fiber. Which of the following food choices made by the client indicate an understanding of the teaching?SATA A. Canned peaches B. White rice C. Black beans D. Whole-grain bread E. Tomato juice

C, D

A nurse is caring for a client who has blood glucose 52 mg/dL. The client is lethargic but arousable. Which of the following actions should the nurse perform first A. Recheck blood glucose in 15 min B. Provide a carbohydrate and protein food C. Provide 15g of simple carbohydrates D. Report findings to provider

C. Provide 15g of simple carbohydrates Give carbohydrate & protein if the next meal is more than 1 hour away after the blood glucose returns to normal

A nurse is reviewing the laboratory values of a client who has a diabetic ketoacidosis. Which of the following laboratory values is consistent with diabetic ketoacidosis. A. Blood glucose 30 mg/dL B. Negative urine ketones C. Blood pH 7.38 D. Bicarbonate level 12 mEq/L

D a pt w/ DKA should have bicarb <15 bc of increased production of counter regulatory hormones leading to metabolic acidosis

A nurse is planning care for a client who is experiencing the Somogyi effect and takes intermittent-acting insulin. Which of the following actions should the nurse include in the plan? A. Move the evening intermediate-acting insulin dose 90 min before dinner B. Increase the client's morning caloric intake C. Omit the client's evening snack D. Monitor the client's nighttime blood glucose levels

D 2AM BG checks

A nurse is reviewing the laboratory results of a client who has diabetes mellitus. Which of the following results indicates the client's diabetes is controlled? A. HbA1c 8.5% B. Postprandial blood glucose 190 mg/dL C. Casual blood glucose 205 mg/dL D. Fasting blood glucose 95 mg/dL

D should be under 126

A nurse is caring for a client who has type 2 diabetes mellitus and is experiencing a hypoglycemic-hyperosmolar state (HHS). Which of the following laboratory findings should the nurse expect? A. Serum pH 7.32 B. Blood glucose 250 mg/dL C. Blood glucose 425 mg/dL D. Serum pH 7.45

D A client is experiencing HHS produces enough insulin to prevent ketosis but not enough to prevent hyperglycemia. Therefore the serum pH is within the expected reference range, glucose levels will be above 600 mg/dL.

A patient experiencing diabetic ketoacidosis (DKA) is receiving a normal saline infusion and intravenous insulin. What additional medication does the nurse expect to be prescribed for this patient? a. Diuretic b. Calcium c. Antibiotic d. Potassium

D potassium

A nurse is teaching foot care to a client who has diabetes mellitus. Which of the following information should the nurse include in the teaching:SATA A. Remove calluses using OTC remedies B. Apply lotion between toes C. Test water temperature with the fingers before bathing D. Trim toenails straight across E. Wear closed-toe shoes

D, E and after shower

A nurse is preparing to administer morning doses of insulin glargine and regular insulin to a client who has a blood glucose 278. Which of the following actions should the nurse take?Draw up the regular insulin and then the glargine insulin in the same syringe Draw up the glargine insulin then the regular insulin in the same syringe Draw up and administer regular and glargine insulin in separate syringes Administer the regular insulin, wait 1 hr, and then administer the glargine insulin

Draw up and administer regular and glargine insulin in separate syringes

A nurse is providing discharge teaching fora client who had DKA. Which of the following information should the nurse include in the teaching?

Drink 2 L per day Monitor BG q4 hr when ill Administer insulin as prescribed when ill Report ketones in urine after 24 hours of illness

A nurse is presenting information to a group of clients about nutrition habits that prevent type 2 diabetes mellitus. Which of the following should the nurse include the information (Select all that apply) Eat less meat and processed foods Decrease intake of saturated fats Increase daily fiber intake Limit saturated fat intake to 15% of daily caloric intake Include omega-3 fatty acids in the diet

Eat less meat and processed foods Decrease intake of saturated fats Increase daily fiber intake Include omega-3 fatty acids in the diet

A nurse is reviewing the health record of a client who has hyperglycemic-hyperosmolar state (HHS) The nurse should identify that which of the following data confirm this diagnosis (Select all that apply) Evidence of recent myocardial infarction BUN 35 Takes a calcium channel blocker Age 77 No insulin production

Evidence of recent MI BUN 35 Takes a calcium channel blocker Age 77

A nurse is assessing a pt who has DKA and ketones in urine. The nurse should expect which of the following findings?

Fruity odor of breath Abdominal pain Kussmaul respirations Metabolic acidosis

A nurse is assessing a client who has diabetic ketoacidosis and ketones in the urine. The nurse should expect which of the following findings (Select all that apply) Weight gain Fruity odor of breath Abdominal pain Kussmaul respirations Metabolic acidosis

Fruity odor of breath Abdominal pain Kussmaul respirations Metabolic acidosis

Polyuria in DKA results from _______________________.

Glycosuria

The substance _______________________ acts as a key, unlocking the cell so glucose can enter.

Insulin

A nurse is caring for a client who has blood glucose 52. The client is lethargic but arousable. Which of the following actions should the nurse perform first? Recheck blood glucose in 15 min Provide a carbohydrate and protein food Provide 4 oz grape juice Report findings to the provider

Provide 4 oz grape juice

A nurse is preparing to administer IV fluids to a client who has DKA. Which of the following findings should the nurse take?

Rapidly administer IV infusion of 0.9% sodium chloride

A nurse is reviewing the health record of a client who has HHS. The nurse should identify that which of the following data confirms this diagnosis?

Recent myocardial infarction BUN 35 Takes Calcium channel blocker Age 77 years

a nurse is caring for an adolescent client who has a long history of diabetes and is being admitted to the ER confused, flushed ans with acetone odor on breath. Diabetic ketoacidosis is suspected. The nurse should anticipate using which of the following types of insulin to treat this client?

Regular (Humulin R)

A nurse is reviewing the labs of a pt with HHS. The nurse should expect which of the following findings?

Serum Osmolarity 350

Serum glucose levels may rise to as much as 2000 mg/dl a. DKA b. HHS

Serum glucose levels may rise to as much as 2000 mg/dl is __HHS__

Serum osmolality less than 350 mOsm/L a. DKA b. HHNS

Serum osmolality less than 350 mOsm/L is __DKA__

A nurse is reviewing lab reports of a client who has hyperglycemic- hyperosmolar state. The nurse should expect which of the following findings Serum pH 7.2 Serum osmolarity 350 Serum potassium 3.8 Serum creatinine 0.8

Serum osmolarity 350 anything above 320

Significant loss of bicarbonate occurs a. DKA b. HHNS

Significant loss of bicarbonate occurs in __DKA__

Slow onset, often several days to weeks a. DKA b. HHS

Slow onset, often several days to weeks is __HHS__

Which of the following statements about fluid shifts associated with elevated glucose levels is correct? (Choose all that apply.) a. Hypervolemia results from fluid shifts from the intracellular to the vascular space. b. Plasma osmolality is decreased. c. Excess intracellular fluid levels stimulate catecholamine production. d. In later stages, hypovolemia occurs, resulting in hypotension.

a. Hypervolemia results from fluid shifts from the intracellular to the vascular space. d. In later stages, hypovolemia occurs, resulting in hypotension.

A patient is admitted with diabetes mellitus, malnutrition, and cellulitis. The patient's potassium level is 5.6 mEq/L. The nurse considers that which of the following could be a contributing factor for this lab result (select all that apply)? a. The level may be increased as a result of dehydration that accompanies hyperglycemia. b. The patient may be excreting extra sodium and retaining potassium because of malnutrition. c. The level is constant with renal insufficiency that can develop with renal nephropathy. d. The level may be raised as a result of metabolic ketoacidosis caused by hyperglycemia.

a. The level may be increased as a result of dehydration that accompanies hyperglycemia. c. The level is constant with renal insufficiency that can develop with renal nephropathy. d. The level may be raised as a result of metabolic ketoacidosis caused by hyperglycemia.

a nurse is caring for a client diagnosed with diabetes and observes mild hand tremors. Which of the following actions should the nurse take after obtaining a glucometer reading of 60 mg/dl?

administer 10-15 g of carbohydrates

Dehydration in DKA leads to: (Choose all that apply.) a. Decreased protein synthesis and negative nitrogen balance. b. Hypotension and decreased renal blood flow. c. Tissue hypoxia and lactic acidosis. d. Polyuria and electrolyte imbalances. e. Increased fat metabolism and metabolic acidosis.

b. Hypotension and decreased renal blood flow. c. Tissue hypoxia and lactic acidosis. d. Polyuria and electrolyte imbalances. e. Increased fat metabolism and metabolic acidosis.

Which of these lab values, noted by the nurse when reviewing the chart of a hospitalized diabetic patient, indicates the need for rapid assessment of the patient? a. Hb A1C of 5.8% b. Noon blood glucose of 52 mg/dL c. HbA1C of 6.9% d. Fasting blood glucose of 130 mg/dL

b. Noon blood glucose of 52 mg/dL

Medical management of DKA includes which of the following? (Choose all that apply.) a. Aggressive potassium replacement upon diagnosis of DKA. b. Rapid infusion of replacement fluids. c. Continuous IV insulin drip. d. Conservative replacement of lost bicarbonate.

b. Rapid infusion of replacement fluids. c. Continuous IV insulin drip. d. Conservative replacement of lost bicarbonate.

A patient is admitted with diabetes mellitus, has a glucose level of 380 mg/dL, and a moderate level of ketones in the urine. As the nurse assesses for signs of ketoacidosis, which of the following respiratory patterns would the nurse expect to find? Explain. a. Central apnea b. Hypoventilation c. Kussmaul respirations d. Cheyne - Stokes respirations

c. Kussmaul respirations

The patient admitted in diabetic ketoacidosis has dry, cracked lips and is begging for something to drink. The nurse's best response would be to a. keep the patient NPO. b. allow the patient a cup of coffee. c. allow the patient water. d. allow the patient to drink anything he chooses.

c. allow the patient water.

A patient with type 1 diabetes mellitus is experiencing elevated blood glucose levels in the morning. Which action is indicated to address this complication? a. Change the evening insulin dose. b. Restrict oral fluids after 1800 hours. c. Measure blood glucose at 0200 hours. d. Limit carbohydrate intake to 45 g with evening meal.

c; Measure blood glucose at 0200 hours.

a nurse is reviewing guidelines to prevent DKA during periods of illness with a client who has T1DM. Which of the following instructions should the nurse include in the teaching

check your urine for ketones when blood glucose levels are greater than 240

The nurse anticipates that during the initial treatment of diabetic ketoacidosis, the provider will order which solution? Why? a. D5W b. D5/0.45% saline c. Lactated Ringer's solution d. 0.9% saline

d. 0.9% saline

A patient with type 2 diabetes mellitus is being evaluated for hyperosmolar hyperglycemic state (HHS). The nurse correlates which finding with this medical diagnosis? a. pH 7.31 b. Diaphoresis c. Blood glucose 250 mg/dL d. Serum bicarbonate 28 mEq/L

d. Serum bicarbonate 28 mEq/

The nurse knows that the dehydration in diabetic ketoacidosis stimulates catecholamine release, which results in a. decreased glucose release. b. increased insulin release. c. decreased cardiac contractility. d. increased gluconeogenesis.

d. increased gluconeogenesis

The nurse provides care to a patient diagnosed with type 1 diabetes mellitus (DM) whose hemoglobin A1c level remains elevated despite the use of the prescribed sliding scale insulin. The healthcare provider prescribes an insulin pump. The patient asks, "Why did my doctor prescribe a pump?" Which response by the nurse is best? a. "The pump is worn continuously." b. "The pump is more convenient for you." c. "The pump provides more precise dosages of insulin." d. "The pump provides better control of your blood sugar."

d; "The pump provides better control of your blood sugar."

A nurse is providing teaching to a client who has type I diabetes mellitus about hypoglycemia. Which of the following manifestations should the nurse include in the teaching? A. Shakiness B. Urinary frequency C. Dry mucous membranes D. Excess thirst

hypOglycemia are shakiness, fatigue, headache, difficulty thinking, sweating, nausea hypERglycemia: polyuria (increased urination), dehydration - dry mucous membranes & sunken eyeballs, polydipsia (excessive thirst)

a nurse is caring for a client with type 1 diabetes mellitus. The nurse finds the client lying in bed, sweating, tachycardic, reporting lightheadedness and palpations. Which of the following complications should the nurse suspect?

hypoglycemia

A nurse is assessing a client who has diabetes mellitus and reports feeling anxious. Which of the following findings should the nurse expect if the client is hypoglycemic?A. Rapid, deep respirationsB. Cool, clammy skinC. Abdominal crampingD. Orthostatic hypotension

hypoglycemia: cool/clammy skin, anxiety, nervousness, tachycardia, confusion, hyperglycemia: Rapid, deep respirations, abdominal cramping, and orthostatic hypotension

a nurse is teaching a client who has diabetes about which dietary source should provide the greatest percentage of her calories. Which of the following statements indicates the client understands the teaching?

i should eat more calories from complex carbohydrates than anything else

a nurse is assessing a client who has diabetes mellitus and is experiencing foot pain. Which of the following are signs and symptoms of infection? Select all that apply.

increased neutrophilslocalized edema

a nurse is preparing to inject insulin lispro to a client who has type 1 diabetes mellitus. which of the following nursing actions is appropriate?

inject the insulin 15 minutes before a meal

a nurse is reinforcing teaching with a client who has diabetes. Which of the following should the nurse include in the teaching? Select all that apply

reduce cholesterol and saturated fat intakeincrease physical activity and daily exerciseenroll in a smoking cessation programmaintain optimal blood pressure to prevent kidney damage

A nurse is a client who is taking metformin XR for type 2 DM. Which of the following instructions should the nurse include in the teaching?

take metformin w/ meal

a school age child who has type 1 diabetes has been vomiting for the past 24 hrs. Which of the following should be the nurse's first action?

test the urine for ketones

a nurse is performing teaching with a client who has newly diagnosed type 2 diabetes. The nurse should recognize that the client understands the teaching when he identifies which of the following manifestations of hypoglycemia? Select all that apply

vertigotachycardiamoist, clammy skin