Diabetes Prep U

A client with type 1 diabetes presents with a decreased level of consciousness and a fingerstick glucose level of 39 mg/dl (2.2 mmol/L). His family reports that he has been skipping meals in an effort to lose weight. Which nursing intervention is most appropriate? A. Administering 1 ampule of 50% dextrose solution, per physician's order B. Administering a 500-ml bolus of normal saline solution C. Observing the client for 1 hour, then rechecking the fingerstick glucose level D. Inserting a feeding tube and providing tube feedings

A. Administering 1 ampule of 50% dextrose solution, per physician's order

The best indicator that the client has learned how to give an insulin self-injection correctly is when the client can: A. explain all steps of the procedure correctly. B. critique the nurse's performance of the procedure. C. obtain 100% correct answers on a posttest. D. perform the procedure safely and correctly.

D. perform the procedure safely and correctly.

The laboratory comes to draw an Hgb AIc. The client asks the nurse what this test represents. Which statement would be correct? A. "This test reflects the average blood glucose over a period of approximately 2-3 months." B. "This blood test is done to measure hyperglycemia in your system for 3 to 4 days after you were diagnosed with diabetic ketoacidosis (DKA)." C. "This test is needed to determine which insulin will be needed to prevent another diabetic ketoacidosis (DKA) episode." D. "This test is done to determine length of time that will be needed to correct the diabetic ketoacidosis (DKA) state."

A. "This test reflects the average blood glucose over a period of approximately 2-3 months."

The nurse is teaching the client about home blood glucose monitoring. Which blood glucose measurement indicates hypoglycemia? A. 59 mg/dL (3.3 mmol/L) B. 108 mg/dL (6.0 mmol/L) C. 119 mg/dL (6.6 mmol/L) D. 75 mg/dL (4.2 mmol/L)

A. 59 mg/dL (3.3 mmol/L)

Which of the following clinical manifestations of type 2 diabetes occurs if glucose levels are very high? A. Blurred vision B. Oliguria C. Increased energy D. Hyperactivity

A. Blurred vision

A patient with type 1 diabetes complains about waking up in the middle of the night nervous and confused, with tremors, sweating, and a feeling of hunger. Morning fasting blood sugar readings have been 110 to 140 mg/dL; the patient admits to exercising excessively and skipping meals over the past several weeks. Based on these symptoms, the nurse will plan to instruct the patient to do which of the following? A. Check blood glucose at 3:00 in the morning. B. Skip the evening NPH insulin dose on days when exercising and skipping meals. C. Administer an increased dose of neutral protamine Hagedorn (NPH) insulin in the evening. D. Eat a complex carbohydrate snack in the evening before bed.

A. Check blood glucose at 3:00 in the morning.

Which of the following is a characteristic of diabetic ketoacidosis (DKA)? Select all that apply. A. Elevated blood urea nitrogen (BUN) and creatinine B. More common in type 1 diabetes C. Absent ketones D. Rapid onset E. Normal arterial pH level

A. Elevated blood urea nitrogen (BUN) and creatinine B. More common in type 1 diabetes D. Rapid onset

A nurse is providing education to a client who is newly diagnosed with diabetes mellitus. Which of the following symptoms would she include when reviewing classic symptoms associated with diabetes? A. Increased thirst, increased hunger, and increased urination B. Increased weight loss, increased dehydration, and increased fatigue C. Loss of appetite, increased urination, and dehydration D. Increased weight gain, increased appetite, and increased thirst

A. Increased thirst, increased hunger, and increased urination

A patient is admitted with diabetic ketoacidosis (DKA). The physician writes all of the following orders. Which order should the nurse implement first? A. Infuse 0.9% normal saline solution 1 L/hr for 2 hours. B. Start an infusion of regular insulin at 50 U/hr. C. Administer sodium bicarbonate 50 mEq IV push. D. Administer regular insulin 30 U IV push.

A. Infuse 0.9% normal saline solution 1 L/hr for 2 hours.

NPH is an example of which type of insulin? A. Intermediate-acting B. Long-acting C. Short-acting D. Rapid-acting

A. Intermediate-acting

What important considerations would the nurse make when teaching and caring for a newly diagnosed client with diabetes mellitus? A. Involving the client in the development of the teaching plan and encouraging questions and active participation B. Informing the client about complications that could occur if the client is noncompliant C. Having the client work closely with a peer who has diabetes to learn about the condition and control D. Allowing the client to develop the teaching plan and assess readiness to learn about different aspects of the disease

A. Involving the client in the development of the teaching plan and encouraging questions and active participation

A patient with diabetes mellitus is receiving an oral antidiabetic agent. The nurse observes for which of the following symptoms when caring for this patient? A. Polydipsia B. Blurred vision C. Polyuria D. Hypoglycemia

B. Blurred vision

After being sick for 3 days, a client with a history of diabetes mellitus is admitted to the hospital with diabetic ketoacidosis (DKA). The nurse should evaluate which diagnostic test results to prevent arrhythmias? A. Serum chloride level B. Serum potassium level C. Serum calcium level D. Serum sodium level

B. Serum potassium level

When teaching the diabetic client about foot care, the nurse should instruct the client to: A. buy shoes a half size larger. B. avoid going barefoot. C. use heating pads for sore feet. D. cut toenails at angles.

B. avoid going barefoot.

To confirm an acid-base imbalance, it is necessary to assess which findings from the results of a client's arterial blood gas (ABG) results? Select all that apply. A. Na+ B. pH C. PaCO2 D. HCO3 E. K+ F. Nitrogen

B. pH C. PaCO2 D. HCO3

A client with diabetes begins to cry and says, "I just cannot stand the thought of having to give myself a shot every day." What would be the best response by the nurse? A. "If you do not give yourself your insulin shots, you will be at greater risk for complications." B. "We can teach a family member to give the shots so you will not have to do it." C. "What is it about giving yourself the insulin shots that bothers you?" D. "I can arrange to have a home care nurse give you the shots every day."

C. "What is it about giving yourself the insulin shots that bothers you?"

During a follow-up visit 3 months following a new diagnosis of type 2 diabetes, a patient reports exercising and following a reduced-calorie diet. Assessment reveals that the patient has only lost 1 pound and did not bring the glucose-monitoring record. Which of the following tests will the nurse plan to obtain? A. Urine dipstick for glucose B. Oral glucose tolerance test C. Glycosylated hemoglobin level D. Fasting blood glucose level

C. Glycosylated hemoglobin level

A client with diabetes mellitus is receiving an oral antidiabetic agent. Which of the following aspects should the nurse observe when caring for this client? A. Polyuria B. Blurred vision C. Signs of hypoglycemia D. Polydipsia

C. Signs of hypoglycemia

Which of the following categories of oral antidiabetic agents exert their primary action by directly stimulating the pancreas to secrete insulin? A. Thiazolidinediones B. Alpha glucosidase inhibitors C. Sulfonylureas D. Biguanides

C. Sulfonylureas

A nurse is teaching a patient recovering from diabetic ketoacidosis (DKA) about management of "sick days." The patient asks the nurse why it is important to monitor the urine for ketones. Which of the following statements is the nurse's best response? A. Excess glucose in the blood is metabolized by the liver and turned into ketones, which are an acid. B. Ketones are formed when insufficient insulin leads to cellular starvation. As cells rupture, they release these acids into the blood. C. When the body does not have enough insulin hyperglycemia occurs. Excess glucose is broken down by the liver, causing acidic byproducts to be released. D. Ketones accumulate in the blood and urine when fat breaks down. Ketones signal a deficiency of insulin that will cause the body to start to break down stored fat for energy.

D. Ketones accumulate in the blood and urine when fat breaks down. Ketones signal a deficiency of insulin that will cause the body to start to break down stored fat for energy.

What is the only insulin that can be given intravenously? A. NPH B. Lantus C. Ultralente D. Regular

D. Regular

Which of the following may be a potential cause of hypoglycemia in the patient diagnosed with diabetes mellitus? A. The patient has not been exercising. B. The patient has not been compliant with the prescribed treatment regimen. C. The patient has consumed food and has not taken or received insulin. D. The patient has not consumed food and continues to take insulin or oral antidiabetic medications.

D. The patient has not consumed food and continues to take insulin or oral antidiabetic medications.

A client has type 1 diabetes. Her husband finds her unconscious at home and administers glucagon, 0.5 mg subcutaneously. She awakens in 5 minutes. Why should her husband offer her a complex carbohydrate snack as soon as possible? A. To stimulate her appetite B. To decrease the possibility of nausea and vomiting C. To decrease the amount of glycogen in her system D. To restore liver glycogen and prevent secondary hypoglycemia

D. To restore liver glycogen and prevent secondary hypoglycemia

A client with diabetes mellitus asks the nurse to recommend something to remove corns from his toes. The nurse should advise the client to: A. soak the feet in borax solution to peel off the corns. B. apply iodine to the corns before peeling them off. C. apply a high-quality corn plaster to the area. D. consult a health care provider (HCP) about removing the corns.

D. consult a health care provider (HCP) about removing the corns.

An adolescent with type 1 diabetes is monitoring her blood glucose level at home. Which action indicates that the client understands appropriate care management strategies for a blood glucose level of 250 mg/dL (13.9 mmol/L)? The client will: A. eat a high-carbohydrate meal. B. skip the next dose of insulin. C. inject glucagon. D. take insulin.

D. take insulin.

Which of the following is the most rapid acting insulin? A. Humalog B. NPH C. Regular D. Ultralente

A. Homalog

The nurse has been assigned to a client who has had diabetes for 10 years. The nurse gives the client's usual dose of regular insulin at 7 a.m. At 10:30 a.m., the client has light-headedness and sweating. The nurse should contact the physician, report the situation, background, and assessment, and recommend intervention for: A. Ketoacidosis. B. Hyperglycemia. C. Hypoglycemia. D. Metabolic acidosis.

C. Hypoglycemia.

Assessment of the diabetic client for common complications should include examination of the: A. pharynx. B. lymph glands. C. eyes. D. abdomen.

C. eyes.

A client newly diagnosed with type 1 diabetes asks the nurse, "Why do I have to take two shots of insulin? One shot is not enough?" The nurse should tell the client: A. "A single shot of long-acting insulin would be preferable." B. "Two shots will give you better control and decrease complications." C. "You might be able to change to oral medications soon." D. "I will ask the health care provider to change your insulin schedule."

B. "Two shots will give you better control and decrease complications."

A nurse is caring for a client with diabetes mellitus. The client has a blood glucose level of 40 mg/dL. Which of the following rapidly absorbed carbohydrate would be most effective? A. 1/2 tbsp honey or syrup B. 1/2 cup fruit juice or regular soft drink C. Three to six LifeSavers candies D. 4 oz of skim milk

B. 1/2 cup fruit juice or regular soft drink

A nurse working in a community clinic is discussing lifestyle modifications with a client. The client has been advised to lose weight because of a BMI greater than 25. Which of the following statements by the nurse would be most therapeutic in helping the client? A. "Just skipping your between-meal snacking is the solution." B. "There are herbal preparations for weight loss that are very effective." C. "I can offer you some information outlining a variety of ways to lose weight." D. "I know it is hard. I needed to lose weight last year, too."

C. "I can offer you some information outlining a variety of ways to lose weight."

A client is evaluated for type 1 diabetes. Which client comment correlates best with this disorder? A. "I noticed that my urine has a foul odor." B. "I have been experiencing nausea and vomiting." C. "I'm thirsty all the time. I just can't get enough to drink." D. "My skin appears drier than usual."

C. "I'm thirsty all the time. I just can't get enough to drink."

An 8-year-old with diabetes is placed on an intermediate acting insulin and regular insulin before breakfast and before dinner. She will receive a snack of milk and cereal at bedtime. The snack will: A. help her regain lost weight. B. provide carbohydrates for immediate use. C. prevent late night hypoglycemia. D. help her stay on her diet.

C. prevent late night hypoglycemia.

The nurse is administering lispro (Humalog) insulin. Based on the onset of action, how soon should the nurse administer the injection prior to breakfast? A. 1 to 2 hours B. 30 to 40 minutes C. 3 hours D. 10 to 15 minutes

D. 10 to 15 minutes

Which of the following clinical characteristics is associated with type 2 diabetes (previously referred to as non-insulin dependent diabetes mellitus [NIDDM])? A. Ketosis-prone B. Demonstrate islet cell antibodies C. Usually thin at diagnosis D. Can control blood glucose through diet and exercise

D. Can control blood glucose through diet and exercise

Which of the following should be included in the teaching plan for a patient receiving glargine (Lantus),"peakless" basal insulin? A. It is rapidly absorbed, has a fast onset of action. B. Draw up the drug first, then add regular insulin. C. Administer the total daily dosage in two doses. D. Do not mix with other insulins.

D. Do not mix with other insulins.

Which of the following factors is the focus of nutrition intervention for patients with type 2 diabetes? A. Carbohydrate intake B. Blood glucose level C. Protein metabolism D. Weight loss

D. Weight loss

Which of the following are byproducts of fat breakdown, which accumulate in the blood and urine? A. Creatinine B. Ketones C. Hemoglobin D. Cholesterol

B. Ketones

The nurse is instructing the client on insulin administration. The client is performing a return demonstration for preparing the insulin. The client's morning dose of insulin is 10 units of regular and 22 units of NPH. The nurse checks the dose accuracy with the client. The nurse determines that the client has prepared the correct dose when the syringe reads how many units? Record your answer using a whole number.

32

A nurse is discussing nutrition and weight control with clients during a class about diabetes. Which statement best reflects the purpose of nutritional management of diabetes? A. To maintain blood glucose levels as close as possible to the normal range to reduce the risk for long-term complications" B. To monitor weight gain and recognize that 11-22 pounds (5-10 kg) is acceptable and treatable with all diabetic clients C. To meet energy needs by eating all foods that keep blood glucose within a relatively normal range D. To maintain or have moderately high serum lipid levels to reduce the risk for macrovascular complications

A. To maintain blood glucose levels as close as possible to the normal range to reduce the risk for long-term complications"

Once digested, what percentage of carbohydrates is converted to glucose? A. 80 B. 100 C. 90 D. 70

B. 100

A nurse is caring for a client with type 1 diabetes who exhibits confusion, light-headedness, and aberrant behavior. The client is conscious. The nurse should first administer: A. 10 units of fast-acting insulin. B. 15 to 20 g of a fast-acting carbohydrate such as orange juice. C. I.M. or subcutaneous glucagon. D. I.V. bolus of dextrose 50%.

B. 15 to 20 g of a fast-acting carbohydrate such as orange juice.

A 14-year-old adolescent with type 1 diabetes checks his blood glucose level at 9:00 p.m. (2100) before going to bed. It has been 4 hours since his dinner and his regular insulin dose. His blood glucose level is 60 mg/dl (3.3 mmol/L), and he states that he feels a little shaky. What should the nurse suggest? A. Doing nothing because the glucose level is unreliable because the adolescent measured it himself B. A bedtime snack of an 8-oz (240 mL) glass of milk and graham crackers with peanut butter C. Going to sleep to decrease the metabolic demands on the body D. Taking a dose of glucagon

B. A bedtime snack of an 8-oz (240 mL) glass of milk and graham crackers with peanut butter

Which of the following factors is the focus of nutrition intervention for clients with type 2 diabetes? A. Blood glucose level B. Carbohydrate intake C. Protein metabolism D. Weight loss

D. Weight loss

The nurse is teaching a patient about self-administration of insulin and mixing of regular and neutral protamine Hagedorn (NPH) insulin. Which of the following is important to include in the teaching plan? A. There is no longer a need to inject air into the bottle of insulin before insulin is withdrawn. B. If two different types of insulin are ordered, they need to be given in separate injections. C. When mixing insulin, the NPH insulin is drawn up into the syringe first. D. When mixing insulin, the regular insulin is drawn up into the syringe first.

D. When mixing insulin, the regular insulin is drawn up into the syringe first.

Which statement indicates that a client with diabetes mellitus understands proper foot care? A. "I'll wear cotton socks with well-fitting shoes." B. "I'll go barefoot around the house to avoid pressure areas on my feet." C. "I'll rotate insulin injection sites from my left foot to my right foot." D. "I'll schedule an appointment with my physician if my feet start to ache."

A. "I'll wear cotton socks with well-fitting shoes."

A 53-year-old client is brought to the ED, via squad, where you practice nursing. He is demonstrating fast, deep, labored breathing and has a fruity odor to his breath. He has a history of type 1 diabetes. What could be the cause of his current serious condition? A. Ketoacidosis B. Hepatic disorder C. All options are correct D. Hyperosmolar hyperglycemic nonketotic syndrome

A. Ketoacidosis

When referred to a podiatrist, a client newly diagnosed with diabetes mellitus asks, "Why do you need to check my feet when I'm having a problem with my blood sugar?" The nurse's most helpful response to this statement is: A. "Diabetes can affect sensation in your feet and you can hurt yourself without realizing it." B. "It's easier to get foot infections if you have diabetes." C. "The physician wants to be sure your shoes fit properly so you won't develop pressure sores." D. "The circulation in your feet can help us determine how severe your diabetes is."

A. "Diabetes can affect sensation in your feet and you can hurt yourself without realizing it."

A client with type 1 diabetes mellitus has influenza. The nurse should instruct the client to: A. increase the frequency of self-monitoring (blood glucose testing). B. reduce food intake to diminish nausea. C. take half of the normal dose of insulin. D. discontinue that dose of insulin if unable to eat.

A. increase the frequency of self-monitoring (blood glucose testing).

Which of the following is included as a dietary guideline for a patient who has had bariatric surgery? A. Eat four small meals a day. B. Make sure to drink liquids while eating. C. Limit soda to 1 can per day. D. Restrict total meal size to less than 1 cup.

D. Restrict total meal size to less than 1 cup.