Diabetes Mellitus
An adolescent patient was recently diagnosed with Type 2 DM. The nurse knows that learning has taken place when the child makes which statement related to prevention? "My dad has type 1 DM. This increases my risk of having diabetes." "Being overweight puts me at risk. Even if I lose weight, I cannot change this risk." "Being overweight with abnormal lipid levels increases my risk of having type 2 diabetes." "Being Native American puts me at risk for developing Type 2 DM. I should have HbA1c testing done on an annual basis."
"Being overweight with abnormal lipid levels increases my risk of having type 2 diabetes." Being overweight with two additional risk factors poses a risk. Dyslipidemia is one of those risk factors.
The nurse has taught a patient with type 2 diabetes mellitus about the clinical manifestations and evaluates that learning has occurred if the patient makes which statement? "I can expect that my blood sugars will increase when I am sick or under stress." "If I follow the diabetic diet, I will be able to control my symptoms of both hyperglycemia and hypoglycemia." "This darkening of the skin on the back of my neck is a result of high blood sugars and is nothing to worry about." "I understand that yeast infection, frequent urination, and high levels of energy are common in the diabetic patient."
"I can expect that my blood sugars will increase when I am sick or under stress." Infection, injury, surgery, and times of stress are amon
While meeting with an adolescent to address diabetes management, which statement by the adolescent regarding compliance with insulin usage would be concerning to the nurse? "I don't really understand the risks/complications of hypoglycemia, but I can tell when my blood sugar is low and I need to eat a snack." "I roll out of bed 10 minutes before my ride comes in the morning. Sometimes I don't have time for breakfast." "I used to skip my insulin dose when going out with friends. Now that I am a senior in high school, I understand the risk of letting my blood sugars get too high." "After my freshman orientation yesterday, my mom talked to me about what I think about taking more responsibility with managing my diabetes."
"I roll out of bed 10 minutes before my ride comes in the morning. Sometimes I don't have time for breakfast." Even though adolescent with diabetes mellitus are functionally able to perform diabetes management tasks far sooner than they can cognitively understand the implications of the action or consequences of omitting the action, this behavior is cause for concern as the adolescent does not mention the need for either blood glucose monitoring or the need for breakfast.
A home care nurse is teaching a parent and 16-year-old patient with type 1 diabetes mellitus about insulin administration and rotating sites. Which statement, if made by the patient, would indicate effective teaching? "I rotate sites between areas of my abdomen and arms." "I will use a 90-degree angle of injection with a 1/2-inch needle." "Insulin is given parenterally because the taste of an oral pill is awful." "Since giving injections into my right abdomen is more comfortable to me, I will use that side routinely."
"I rotate sites between areas of my abdomen and arms." Sites are rotated to prevent areas of adipose hypertrophy (fatty lumps), which interfere with insulin absorption and decrease variation in absorption. Preferred sites include back of upper arms, top and outer portion of thighs, abdomen, and hip.
A child has been diagnosed with Type 1 Diabetes Mellitus (DM) and the parent asks the nurse what this means. What is the best response by the nurse? "The child is at risk of DKA because of low blood sugar." "You do not have to worry about hypoglycemia with your child." "It is normal to have a variation in the blood glucose level, but now the sugar will be maintained at an elevated level." "In the absence of insulin, the child is unable to metabolize fats, proteins, and carbohydrates and use them for energy."
"In the absence of insulin, the child is unable to metabolize fats, proteins, and carbohydrates and use them for energy." Because insulin-secreting beta cells of pancreas are destroyed by inflammation, a child with Type I DM is unable to produce and secrete insulin. This response is an appropriate, concise explanation of pathophysiology of DM type 1.
The patient with Type 2 DM receives metformin (Glucophage). What statements would the nurse include when educating the patient about the drug? Select all that apply. "If your BUN level is 20 mg/dL, the metformin will be held." "You can take metformin three times daily without regard to food." "Given that you are taking metformin twice daily, you do not need to follow a diabetic meal plan." "If you have forgotten to take your metformin, you can take 2 doses at the next scheduled time." "Metformin does not cause the body to make more insulin. As such, it rarely causes low blood glucose when used alone." "Side effects like diarrhea, nausea, and upset stomach are mild but common, and should go away after your body gets used to the medications."
"Metformin does not cause the body to make more insulin. As such, it rarely causes low blood glucose when used alone." Since Metformin does not cause the body to make more insulin, it rarely causes low blood glucose (hypoglycemia) when used alone. Hypoglycemia may occur when Glucophage is taken in combination with insulin or other diabetes pills such as repaglinide (Prandin®), nateglinide (Starlix®) or sulfonylureas. Correct "Side effects like diarrhea, nausea, and upset stomach are mild but common, and should go away after your body gets used to the medications." Minor side effects from metformin (including mild diarrhea, nausea, or upset stomach) usually go away after the body gets used to taking the medicine for several weeks.
A pre-school child newly diagnosed with Type 1 DM and parent meet with the nurse. Which statement best explains why play therapy can be effective in dealing with diabetes mellitus when meeting with the patient? "Play therapy with other children helps the child act out frustration." "Play therapy is appropriate for this age for normal development." "Play therapy with dolls and diabetes equipment helps the child express concerns regarding injections and finger sticks." "Play therapy with age-appropriate toys can distract the child from thinking about the need for insulin and special diet."
"Play therapy with dolls and diabetes equipment helps the child express concerns regarding injections and finger sticks." Play therapy can help the child express concerns about insulin injections and being different from the other children and can help the child deal effectively with diabetes mellitus.
The nurse is meeting with an early school-age patient and parent to discuss management of the patient's Type 1 DM. The nurse understands that further teaching is needed when the parent makes which statement about the child's ability to participate in care? "My school-age child is involved in after-school sports. I need to be sure to pack an extra snack to prevent hypoglycemia." "A school nurse can help with testing blood sugars and draw up the appropriate dose of insulin. My child is not yet able to give herself injections." "Since my child is at school most of the day, she and I developed a diabetic management plan and presented it to her home room teacher." "My school-age child is not able to take part in diabetic management tasks yet. I check my child's blood glucose before and after school and give insulin as needed at those times."
"My school-age child is not able to take part in diabetic management tasks yet. I check my child's blood glucose before and after school and give insulin as needed at those times." The school child is able to participate in care. A school nurse or health aide should be identified to supervise before-lunch blood glucose monitoring and assist with insulin. This way the child does not feel singled out as needing special care. Since the parent does not understand this, further teaching is necessary.
The diabetes educator is meeting with a group of parents to discuss diabetes mellitus management. Many parents have questions about the role of the child. Together the diabetes educator and parents discuss ways to improve adherence with medication administration. The diabetes educator evaluates that learning has occurred when one parent makes which statements? "I can have my toddler take part in insulin administration by having them push the plunger on the insulin syringe". "My seventeen-year-old is focused on sports. She understands the need to independently manage her blood sugars to be able to be with her team for every game". "My school-age child is reluctant to take part in after-school activities. Having her bring pre-filled insulin syringes to activities and do the injections as scheduled may encourage her to participate". "My fourteen-year-old daughter is so influenced by her peers. If I get her best friend to talk to her about diabetes and insulin control, I know that she will adhere to the plan of checking blood sugars".
"My seventeen-year-old is focused on sports. She understands the need to independently manage her blood sugars to be able to be with her team for every game". The older adolescent is influenced by current needs, like being with friends, taking part in sports, etc. The older adolescent is able to recognize consequences of behaviors and choices and take charge of decisions.
During an exercise class for patients with type 2 diabetes, the nurse instructs the patients and parents on recommended daily activity. The nurse notes the need to reinforce teaching when a parent makes which statement? "My son spends hours outside drawing and then plays his video games in his room for no more than 40 minutes." "My child likes to play basketball outside with her friends for at least an hour after school. That only leaves her with about 30 minutes of TV time after dinner." "I like to take long walks with my son to the park down the street. We do this every day; it's great! It takes us over an hour, but we have a great time! He doesn't even miss the TV!" "Our daughter is on the school's swimming team. She practices daily from 3-6 p.m. About an hour before bed, we let her wind down with some cartoons or reading."
"My son spends hours outside drawing and then plays his video games in his room for no more than 40 minutes." Light physical activity is not enough activity for prevention and management of Type 2 diabetes mellitus. Recommended is at least 60 minutes of moderate to vigorous physical activity daily and less than 2 hours per day of "screen time" sedentary activities. This is not an appropriate activity level.
A parent calls the nurse line, reporting that the child with diabetes is nauseated and vomiting. What is the priority statement the nurse will include in the instructions to the parent? "Hold the regular dose of insulin." "Allow the child to decide what to eat." "Test the blood glucose level frequently." "Encourage active engagement in activities."
"Test the blood glucose level frequently." The nurse will tell parent to test blood glucose level every 3-4 hours or more often if hypoglycemic or hyperglycemic. Testing blood glucose will help parent monitor child's illness and let them know what actions to take.
When providing education to the parents of a toddler with Type 1 DM, the nurse should include which statement related to hypoglycemia? "The toddler is at great risk for severe hypoglycemia; be sure that you have a predetermined meal plan for every day and stick to it." "The toddler has varied intake from day to day. Better to allow for more food choices and work toward carbohydrate consistency." "The toddler can be fussy with respect to food. Minimize the battle by allowing the toddler to be in charge of selecting what to eat for each meal." "Toddlers are "spur of the moment" patients. Being flexible with checking blood glucose levels and giving insulin will limit the potential of on-going battles with care."
"The toddler has varied intake from day to day. Better to allow for more food choices and work toward carbohydrate consistency." A diet strategy that stresses carbohydrate consistency rather than specific food groups offers more flexibility to encourage adequate intake on the part of the toddler. Achieving consistency in dietary intake can be difficult in the toddler. Inconsistent intake, particularly of carbohydrates, contributes to blood glucose level variability.
The adolescent patient and parent have completed diabetic education. Which statements by the parent would indicate an understanding of the goals of insulin therapy for diabetic management? Select all that apply. "Insulin replenishes the insulin-producing cells, the beta cells." "Insulin decreases insulin resistance and improves insulin sensitivity." "We will schedule the insulin to correspond to the child's usual meal times." "Insulin is used to balance blood glucose, independent of food intake and physical activity." "Insulin replaces the insulin the child is no longer able to make in an acceptable physiologic pattern."
"We will schedule the insulin to correspond to the child's usual meal times." This schedule, to correspond to the child's usual meal times, is in place to minimize the possibility of hypoglycemia. This is a correct goal of insulin therapy. "Insulin replaces the insulin the child is no longer able to make in an acceptable physiologic pattern." The goal of insulin therapy is to replace the insulin the child is no longer able to make in an acceptable physiologic pattern. The beta cells in the pancreas no longer produce/secrete insulin. This is a correct goal of insulin therapy.
The nurse is providing nutrition education to a patient newly diagnosed with Type 1 Diabetes Mellitus. The patient states, "I should have a glass of orange juice with a teaspoon of sugar if I feel lightheaded, cool, and clammy mid-morning." Which statement is the best response by the nurse? "No, 4 oz. of 100% orange juice will not have an immediate effect." "Yes, 4 oz. of 100% orange juice will quickly help to treat hypoglycemia." "Yes, 4 oz. of 100% orange juice is needed for long-term maintenance of blood glucose." "No, 4 oz. of 100% orange juice has too much sugar, a snack of cottage cheese and 7 whole grain crackers is a better option."
"Yes, 4 oz. of 100% orange juice will quickly help to treat hypoglycemia." The choice of 4 oz. of 100% orange juice is a good option when blood glucose falls during day. Hypoglycemia can be treated immediately with 15 g of easily digested (simple) carbohydrates. In 15 minutes, if symptoms are not relieved or blood glucose is 80 mg/dL or lower, repeat treatment.
A patient has type 1 diabetes mellitus and receives insulin. The patient asks the nurse why she cannot take pills instead. What is the best explanation by the nurse? "You will be able to use pills during what we call the honeymoon phase." "Your pancreas is unable to secrete an adequate amount of insulin." "You can take pills, but they are better to reserve for sick days when your blood glucose is variable." "You lost the ability to make insulin because of autoimmune destruction of the insulin-producing cells, the alpha cells."
"Your pancreas is unable to secrete an adequate amount of insulin." The child with Type 1 diabetes mellitus is unable to produce and secrete adequate amount of insulin. Beta cells in pancreas have been destroyed by inflammation. Medications like Metform, a biguanide, do not increase level of insulin in body, but increase sensitivity of muscle to insulin.
Which patient is at highest risk to develop Type 2 Diabetes Mellitus? 10-year-old Caucasian child whose father has Type 1 diabetes mellitus 5'10" 200 lb 18-year-old male taking atenolol daily, who walks 2 miles a day Overweight 16-year-old African American woman taking diphenhydramine daily 1-year-old Asian American female whose parents have Type 2 diabetes mellitus, taking one atorvastatin daily
1-year-old Asian American female whose parents have Type 2 diabetes mellitus, taking one atorvastatin daily This individual has three risk factors: family history (2) of diabetes, race, on antilipid medication (indicating a cardiac condition).
A diabetic patient arrives at the ER with tachycardia, diaphoresis, and unresponsive to voice. Which intervention is the priority action? Administer 50% dextrose IV per protocol Administer oxygen 2 L per nasal cannula Administer prescribed insulin subcutaneous (SQ) Administer naloxone hydrochloride (narcan) per protocol
Administer 50% dextrose IV per protocol Given symptoms, patient needs IV glucose.
The patient is managed with NPH and regular insulin before breakfast, lunch, and dinner. When is the patient most likely to experience a hypoglycemic reaction? Never Mid-day Before lunch Before breakfast
Before lunch Regular insulin peaks in 2-3 hours with duration of 8-10 hours. NPH insulin has onset of 2-4 hours. If too much a.m. insulin or not enough breakfast food is given, most likely time for a hypoglycemic episode is before lunch-regular insulin is at peak and NPH insulin has its onset, breakfast food has been metabolized.
A patient with type 2 diabetes mellitus complains of nausea, vomiting, diaphoresis and headache. Which of the following nursing actions should the nurse perform first? Check the patient's blood glucose level. Instruct the patient to take a Glucophage tablet. Instruct the patient to take 6 units of regular insulin. Provide the patient with 8 oz of orange juice with 1 tsp sugar.
Check the patient's blood glucose level. Checking the patient's blood glucose level will provide objective data of the patient's status. From this data, interventions can be implemented.
A child with type 1 diabetes mellitus who is taking insulin is seen in the school's clinic. The nurse develops a teaching plan for the child regarding food and exercise because the child has told the nurse that she will begin basketball practice. Which instruction should the nurse provide to the child? Withhold insulin on the day of basketball practice. Eat lunch 2 hours earlier on the day of basketball practice. Joining the basketball team should be delayed for 1 more year. Eat an extra snack of carbohydrates before the basketball practice starts.
Eat an extra snack of carbohydrates before the basketball practice starts. Because exercise lowers blood glucose levels, the child must be taught how to prevent hypoglycemia. The extra snack before practice will avert the hypoglycemia.
A child is using regular insulin according to blood glucose monitoring results. At 2 pm, the child has a blood glucose of 185 mg/dl, for which the patient received 8 units of regular insulin. The nurse should expect the dose's onset and peak to be at which times? Onset 2:15 pm and peak 4:00-5:00 pm Onset 2:15:00 pm and peak 2:30-3:30 pm Onset 2:30-3:00 pm and peak 4:00-5:00 pm Onset 2:30-3:00 pm and peak 10:00-11:00 pm
Onset 2:30-3:00 pm and peak 4:00-5:00 pm Onset of regular insulin is 30-60 minutes and peak action is 2-3 hours after injection.
The diabetes educator is meeting with school nurses to discuss ways to increase diabetes management in the schools, allowing for students with diabetes to take part in everyday activities, before, during, and after school. The school nurses provide scenarios of their involvement with diabetes management. Which statement indicates a safe nursing action on the part of the school nurse? I had a 15-year-old diabetic child come to my office last week. She was not able to have breakfast that morning but denied symptoms of hypoglycemia, such as tachycardia or sweating. I assisted her with the a.m. dose of regular insulin. I had a 14-year-old diabetic child come to my office yesterday after school. Her coach asked that she see me because of irritability, pallor, and clammy skin. The child reported that after running 1 mile as warm-up, these symptoms developed. We tested her blood glucose. I had a 12-year-old diabetic child last week come to my office complaining of increased thirst and fatigue. I noticed deep, rapid respirations and a fruity odor to her breath. The child has a management plan that includes self-blood glucose monitoring. She obtained a reading of 104 mg/dL, so I let her go back to class. I had a 16-year-old diabetic child come to my office yesterday morning, asking about managing her diabetes when going out with friends. She wants to be a cheerleader and has to keep her weight down. She told me that skipping her evening dose of insulin would help her achieve that goal. That seemed reasonable, as then the intake would not be metabolized.
I had a 14-year-old diabetic child come to my office yesterday after school. Her coach asked that she see me because of irritability, pallor, and clammy skin. The child reported that after running 1 mile as warm-up, these symptoms developed. We tested her blood glucose. Check the child's blood glucose when the child has symptoms of hypoglycemia after running a mile, midafternoon. This is a safe nursing action as it will give information that can determine what to do next.
A patient with Type 1 diabetes mellitus is admitted to the emergency department in DKA. Which action should the nurse take first? Correct the hypokalemia Determine cause of the ketoacidosis Administer regular insulin intravenously Initiate fluid replacement with 0.9% saline
Initiate fluid replacement with 0.9% saline The nurse will initiate fluid replacement with 0.9% saline IV to restore intravascular volume to raise blood pressure and ensure glomerular perfusion. This is priority.
A patient is admitted with a diagnosis of DKA. What signs and symptoms would the nurse expect to find in the patient? Select all that apply. Slow heart rate Mild disorientation Cool and clammy skin Constantly feeling tired Rapid, shallow respirations
Mild disorientation Altered consciousness in the form of mild disorientation or confusion can occur with DKA. Constantly feeling tired Lethargy, constantly feeling tired, is a common symptom in patients with DKA due to cells not receiving adequate fuel source to produce energy.
The provider writes orders for a patient with Type 1 DM admitted with DKA. Which order should the nurse question? Fluid replacement, 0.9% sodium chloride, initial bolus. Monitor blood glucose every 3-4 hours during IV insulin infusion. Monitor for bradycardia, muscle weakness, hyperreflexia, and cardiac irregularities. Humulin insulin IV, continuous, 6 U/h until blood glucose level drops to less than 180 mg/dL.
Monitor blood glucose every 3-4 hours during IV insulin infusion. It is protocol to monitor blood glucose every hour during IV insulin infusion; therefore, this order should be questioned.
The provider writes orders for a patient with Type 1 DM admitted with elevated blood glucose levels. Which order should the nurse question? Humulin insulin IV, continuous, 6 U/h until the blood glucose level drops to less than 180 mg/dL. Fluid replacement, 0.9% sodium chloride, initial bolus. Monitor blood glucose every 3-4 hours during IV insulin infusion. Monitor for bradycardia, muscle weakness, hyperreflexia, cardiac irregularities.
Monitor blood glucose every 3-4 hours during IV insulin infusion. It is protocol to monitor blood glucose every hour during IV insulin infusion; therefore, this order should be questioned.
A young patient newly diagnosed with diabetes is admitted with a BP of 85/58 mm Hg, pulse of 120 bpm, respirations 42, blood glucose level of 450 mg/dL, pH of 7.07 and bicarbonate level of 13 mEq/L. The patient is lethargic and slow to respond to touch. Which conditions will the nurse need to monitor? Select all that apply. Monitor blood pH Check level of consciousness Monitor level of potassium Maintain Fluid intake and output Monitor for bradycardia
Monitor blood pH Ketosis will put the child into an acidotic state and therefore the nurse will need to monitor the child's pH. Correct Check level of consciousness Since the patient is lethargic, the patient's level of consciousness will need to monitored. Correct Monitor level of potassium The potassium levels in the patient will need to be addressed since the patient is developing DKA. Correct Maintain Fluid intake and output This patient is developing DKA and will need to have fluid intakes and output monitored.
A 19-year-old with Type 1 DM is taking 30 units of NPH insulin each morning and 15 units at night. Because of persistent morning glycosuria with some ketonuria, the evening dose is increased to 20 units. This worsens the morning glycosuria, and now moderate ketones are noted in urine. The patient complains of sweats and headaches at night. The next step in management is: Switch from NPH to regular insulin Decrease morning dose of insulin Increase morning dose of insulin Obtain blood glucose levels at 2 a.m.
Obtain blood glucose levels at 2 a.m. A glucose reading in middle of night will disclose hypoglycemia because of insulin therapy and lead one to consider Somogi phenomenon. Episodic hypoglycemia at night is followed by rebound hyperglycemia. This condition, Somogi phenomenon, develops in response to excessive insulin administration.
The blood glucose of a patient newly diagnosed with Type 1 diabetes mellitus has a blood glucose level of 310 mg/dL. Which type of insulin would the nurse expect to be ordered at this time? NPH Regular Lantus NPH + regular
Regular Regular insulin is short-acting insulin. Onset is 30-60 min. This is correct insulin choice for blood glucose level of 310 mg/dL.
A patient with DKA is given normal saline and intravenous regular insulin. The nurse checks blood glucose level hourly. Which other assessment data is the best indicator of clinical improvement? Pulse 130. Temperature in normal range Patient eats a full meal and respiratory rate is normal Improved level of consciousness and increasing urine output Respiration rate of 12 to 15 and normal BP in the standing position
Respiration rate of 12 to 15 and normal BP in the standing position Respirations in normal range are indicative of normal bicarbonate level. Normal BP indicates adequate circulating fluid volume (resolution of diuresis). This is an indicator of clinical improvement.
