Glucose EAQ
The nurse suspects that the client has diabetes mellitus. Which statement made by the client would be most appropriate in helping the nurse reach this conclusion? SELECT ALL THAT APPLY A. "I am 55 years old." B. "I quite often feel thirsty." C. "I eat food every 2 hours." D. "I have excessive sweating."
A, B, C Rationale: Clients with diabetes mellitus may feel excessive thirst due to frequent urination and may also experience excessive hunger. Excessive sweating and respiratory disorders are mostly observed in clients with hyperthyroidism.
An increase in which blood component is responsible for the acidosis related to untreated diabetes mellitus? A. Ketones B. Glucose C. Lactic acid D: Glutamic acid
A. Ketones Rationale: The ketones produce excessively in diabetes are a byproduct of the breakdown of body fats and proteins for energy; This occurs when insulin is not secreted or is unable to be used to transport glucose across the cell membranes into cells. The major ketone acetoacetic acid is an alpha C to acid that lowers the blood pH, resulting in acidosis. Glucose does not change the pH. Lactic acid is produced as a result of muscle contraction; It is not unique to diabetes. Glutamic acid is a product of protein metabolism.
Which statement would a nurse make about older adults and type 2 diabetes? A. Older adults seldom develop ketoacidosis B. Older adults secret no endogenous insulin C. Older adults have a lower risk of complications D. Older adults develop a sudden onset of symptoms
A. Older adults seldom develop ketoacidosis Rationale: Lipolysis is not a common response to meeting the metabolic needs of those with type 2 diabetes; therefore, ketones are not present in large enough amounts to cause ketoacidosis. Adults with type 2 diabetes do secrete endogenous insulin, but secretion is slow and in smaller than adequate amounts. The incidence of chronic complications depends on the level of glucose control, not developmental level. The onset of type 2 diabetes is usually gradual, whereas in type 1 diabetes, it is sudden and dramatic.
The health care provider prescribes daily fasting blood glucose levels for a client with diabetes mellitus. The goal of treatment is that the client will have glucose levels within the range of: A. 40 to 60 mg/dL B. 70 to 105 mg/dL C. 110 TO 145 mg/dL D. 150 to 175 mg/dL
B. 70 to 105 mg/dL Rationale: The range of 70 to 105 mg/dL of blood is the expected range for blood glucose.
A client's breath has a sweet, fruity odor. Which condition is likely affecting this client? A. Gum disease B. Uremic acidosis C. Diabetic acidosis D. Infection inside a cast
C. diabetic acidosis Rationale: A client with diabetic acidosis has a sweet, fruity odor to the breath. Gum disease is marked by halitosis. A stale urine smell indicates uremic acidosis. An infection inside a cast is accompanied by a musty odor of the casted body part.
The nurse is testing newborns' heel blood for the level of glucose. Which newborn does the nurse anticipate will experience hypoglycemia? Select all that apply. A. Preterm infant B. Infant with Down syndrome C. Small-for-gestational-age infant D. Large-for-gestational-age infant E. Appropriate-for-gestational-age infant
A, C, D Rationale: (Preterm infants have low glycogen stores. Small-for-gestational-age infants also have low glycogen stores. Large-for-gestational-age infants are prone to hyperinsulinemia; often they are born to mothers who have diabetes, meaning that they are exposed to a high circulating glucose level while in utero. After prolonged exposure to a high glucose level, hyperplasia of the pancreas occurs, resulting in hyperinsulinemia. Infants with Down syndrome are not at risk for hypoglycemia but are at risk for congenital cardiac defects. Appropriate-for-gestational-age infants are not at risk for hypoglycemia.)
When obtaining the history of a client recently diagnosed with type 1 diabetes, what will the nurse expect to discover? A. Edema B. Anorexia C. Weight loss D. Hypoglycemic episodes
C. Weight loss Rationale: Protein and lipid catabolism occur because carbohydrates cannot be used by the cells; this results in weight loss and muscle wasting. Dehydration not edema is more likely to occur because of polyurea associated with hyperglycemia. Polyphagia not anorexia occurs with diabetes as client attempts to meet metabolic needs. Hyperglycemia not hypoglycemia is present in both type one and type 2 diabetes.
Which responses should a nurse expect a client experiencing hypoglycemia to exhibit? SELECT ALL THAT APPLY A. nausea B. palpitations C. tachycardia D. nervousness E. warm, dry skin F. increase respirations
B, C, D Rationale: palpitations are of neurogenic origin associated with hypoglycemia; The sympathetic nervous system is stimulated by the decline in blood glucose. Tachycardia occurs with low serum glucose levels because of sympathetic nervous system activity. Nervousness anxiety and shakiness occur as a result of sympathetic nervous system stimulation associated with hypoglycemia. Nausea vomiting and abdominal cramps are associated with hyperglycemia. Warm dry skin is a sign of hyperglycemia caused by dehydration associated with osmotic diarrhea sis related to glycosuria. The skin will be cool moist with hypoglycemia. Increased respirations are signs of hyperglycemia in diabetic ketoacidosis from insufficient insulin to prevent fat breakdown for energy. There is no change in respirations with hypoglycemia.
A 15-year-old adolescent is found to have type 1 diabetes. What should the nurse include when teaching the adolescent about type 1 diabetes? A. It does not always require insulin. B. It involves early vascular changes. C. It occurs more often in obese adolescents. D. It has a more rapid onset than does type 2 diabetes.
D. It has a more rapid onset than does type 2 diabetes. Rationale: A characteristic difference between type one and type 2 diabetes is the rapid onset of type one diabetes. Type one diabetes often is first diagnosed during an episode of acute ketoacidosis. Children adolescents and adults with type one are insulin dependent. Vascular changes are complications associated with long standing diabetes. Maturity onset diabetes of the young similar to type 2 diabetes is often seen in obese teenagers. Adolescents with type one diabetes tend to be at or below the expected weight for their height and bone structure.
An adolescent with a history of type 1 diabetes is admitted in ketoacidosis. What does the nurse suspect as a precipitating cause of this episode of ketoacidosis? A. Infection B. Increased exercise C. Recent weight loss D. Overdose of insulin
A. Infection Rationale: The stress of infection increases the body's metabolism; the presence of glucocorticoids results in hyperglycemia. Exercise causes a decrease in insulin needs that results in hypoglycemia, not hyperglycemia and ketoacidosis. Rapid weight loss causes a decrease in insulin needs that results in hypoglycemia, not hyperglycemia and ketoacidosis. Excessive insulin results in hypoglycemia, not hyperglycemia and ketoacidosis.
A nurse is caring for a client with type 1 diabetes who is experiencing a fluid imbalance. Which fluid shift associated with diabetes should the nurse take into consideration when assessing this client? A. Intravascular to interstitial as a result of glycosuria B. Extracellular to interstitial as a result of hypoproteinemia C. Intracellular to intravascular as a result of hyperosmolarity D. Intercellular to intravascular as a result of increased hydrostatic pressure
B. Intracellular to intravascular as a result of hyperosmolarity Rationale: The osmotic effect of hyperglycemia pulls fluid from the cells, resulting in cellular dehydration. Hyperglycemia pulls fluid from the interstitial compartment to the intravascular compartment. Interstitial fluid is part of the extracellular compartment; the osmotic pull of glucose exceeds that of other osmotic forces. An increase in hydrostatic pressure results in an intravascular-to-interstitial shift.
Which laboratory results support the nurse's suspicion that a client diagnosed with type 1 diabetes is experiencing ketoacidosis? A. Blood glucose of 40 mg/100 mL, blood pH of 7.37 B. Blood glucose of 130 mg/100 mL, blood pH of 7.35 C. Blood glucose of 650 mg/100 mL, blood pH of 7.42 D. Blood glucose of 300 mg/100 mL, blood pH of 7.20
D. Blood glucose of 300 mg/100 mL, blood pH of 7.20 Rationale: The blood glucose level of 300 mg/100 mL is above the expected range of individuals with type 1 diabetes, indicating hyperglycemia . The normal serum pH is 7.35 to 7.45; therefore, 7.20 indicates acidosis. The blood glucose level of 40 mg/100 mL is below the expected range for all individuals, indicating hypoglycemia; the serum pH of 7.37 is within the expected range for pH. The blood glucose level of 130 mg/100 mL is within the expected range for individuals with type 1 diabetes and the pH of 7.35 is within the expected range for pH. The blood glucose level of 650 mg/100 mL indicates hyperglycemia but the serum pH is within the expected range for pH
Which common cause of diabetes ketoacidosis would the nurse consider when caring for a postoperative client with diabetes? A. Emotional stress B. Presence of infection C. Increased insulin dose D. Inadequate food intake
B. Presence of infection Rationale: Infection increases the body's metabolic rate and insulin is not available for increased demands. Although emotional stress will affect glucose levels diabetic ketoacidosis will rarely result. Increased insulin dose will lead to hypoglycemia if diet is not increased as well. Inadequate food intake will result in hypoglycemia
Which complication associated with type 1 diabetes should the nurse include in the teaching plan for parents of a newly diagnosed child? A. obesity B. ketoacidosis C. resistance to treatment D. hypersensitivity to other medications
B Rationale: Ketoacidosis is a complication of type one diabetes; Children require close blood glucose monitoring because of the demands of growth and their erratic diets. Obesity is more often associated with children who have type 2 diabetes. Resistance to treatment during the school age years is not common; Problems are related to the changing requirements associated with growth period hypersensitivity to other medications is unrelated to either type one or type 2 diabetes
A nurse is caring for a client with a diagnosis of type 1 diabetes who has developed diabetic coma. Which element excessively accumulates in the blood to precipitate the signs and symptoms associated with this condition? A. Sodium bicarbonate, causing alkalosis B. Ketones as a result of a rapid fat breakdown, causing acidosis C. Nitrogen from protein catabolism, causing ammonia intoxication D. Glucose from rapid carbohydrate metabolism, causing drowsiness
B. Ketones as a result of a rapid fat breakdown, causing acidosis Rationale: Ketones are produced when fat is broken down for the energy. Although rarely use, sodium bicarbonate may be administered to correct the acid base imbalance resulting from ketoacidosis; Acidosis is caused by excess acid not excess base bio carbonate. Diabetes does not interfere with removal of nitrogenous wastes. Carbohydrate metabolism is impaired in the client with diabetes.
Which cause of tremors, pallor and diaphoresis would be suspected in a client with type one diabetes? A. overeating B. viral infection C. aerobic exercise D. missed insulin dose
C. Aerobic exercise Rationale: these responses are indicative of hypoglycemia which can be caused by increased activity in clients who take insulin. Overreacting causes hyperglycemia. Infections cause hyperglycemia because of the release of stress related hormones. Missing an insulin dose causes hyperglycemia.
Which eye problem is the leading cause of blindness in clients with diabetes? A. Cataracts B. Glaucoma C. Retinopathy D. Astigmatism
C. Retinopathy Rationale: Diabetic retinopathy is a leading cause of blindness in diabetics. Glaucoma and cataracts also are associated with diabetes, but retinopathy is the most common eye problem. Astigmatism is not associated with diabetes.
Which clinical findings supports the diagnosis of diabetic ketoacidosis (DKA)? A. Nervousness and tachycardia B. Erythema toxicum rash and pruritus C. Diaphoresis and altered mental state D. Deep respirations and fruity odor to the breath
D. Deep respirations and fruity odor to the breath Rationale: Deep respirations in a fruity odor to the breath are classic signs of DKA, due to respiratory system's attempt to compensate by blowing off excess carbon monoxide, a component of carbonic acid. Nervousness and tachycardia are indicative of an insulin reaction (diabetic hypoglycemia). When the blood glucose level decreases, the sympathetic nervous system is stimulated, resulting in an increase in epinephrine and norepinephrine. This causes clinical findings such as nervousness tachycardia palpitation sweating tremors and hunger. Erythema talk some toxicum rash and pruritus are unrelated to diabetes; They indicate a hypersensitivity reaction. Although an altered mental state is associated with both hypoglycemia and DKA, diaphoresis is associated only with hypoglycemia. Diaphoresis occurs when the blood glucose level decreases and stimulates an increase in epinephrine and norepinephrine.
When teaching a client with diabetes about monitoring for episodes of hypoglycemia, which symptom would the nurse include in the teaching plan? A. Thirst B. Nausea C. Anorexia D. Sweating
D. Sweating Rationale: When serum glucose decreases, the sympathetic nervous system is stimulated, resulting in a surge of epinephrine and norepinephrine; this response causes sweating, tremors, tachycardia, palpitations, nervousness, and hunger. Increased thirst (polydipsia) occurs in response to the osmotic diuresis associated with hyperglycemia. The ketosis and acidosis of diabetic ketoacidosis lead to gastrointestinal problems such as nausea, anorexia, vomiting, and abdominal cramping.
Which physiological changes would the nurse expect to find in a client with a 20-year history of type 2 diabetes? A. Blurry, spotty, or hazy vision B. Arthritic changes in the hands C. Hyperactive knee and ankle jerk reflexes D. Dependent pallor of the feet and lower legs
A Blurry spotty or hazy vision; Floaters or cobwebs in the visual field; and cataracts or complete blindness can occur as a result of diabetes. Diabetic retinopathy is characterized by an abnormal growth of new blood vessels in the retina. More than 60% of clients with type 2 diabetes have some degree of retinopathy after 20 years. Arthritic changes of the hands are not a usual complication associated with diabetes mellitus. Clients who are diabetic have peripheral neuropathy, which is characterized by hypoactive not hyperactive reflexes. Peripheral vascular disease is indicated by dependent rubor with pallor on elevation, not dependent pallor.
A nurse is assessing a client with diabetic ketoacidosis. Which clinical manifestations should the nurse expect? Select all that apply. A. Dry skin B. Abdominal pain C. Kussmaul respirations D. Absence of ketones in the urine E. Blood glucose level of less than 72 mg/dL (3.3 mmol/L)
A, B, C Rationale: Dry skin is a sign of dehydration in response to polyuria associated with the osmotic effect of an elevated serum glucose level. Abdominal pain is associated with diabetic ketoacidosis. In the absence of insulin, glucose cannot enter the cell or be converted to glycogen, so it remains in the blood. Breakdown of fats as an energy source causes an accumulation of ketones, which results in acidosis. The lungs, in an attempt to compensate for lowered pH, will blow off CO 2 (Kussmaul respirations). An absence of ketones in the urine indicates adequate production of glucose for energy. Insulin deficiency stimulates production of ketones as a by-product of fat oxidation for energy. Blood glucose level of less than 72 mg/dL (4 mmol/L) indicates hypoglycemia, not ketoacidosis.
Which client is at risk for developing type 2 diabetes mellitus (DM)? Select all that apply. o 15-year-old male who plays video games 6 hours per day o 36-year-old female with a history of gestational diabetes o 47-year-old male who weighs 250 pounds and is 5' 9" tall o 28-year-old female with polycystic ovarian syndrome (POS) o 60-year-old male of Native American descent who abuses alcohol
ALL Rationale: · A sedentary lifestyle, such as that of a teenage client who plays video games 6 hours per day, can lead to obesity. Obesity increases the risk for type 2 DM. Clients with a history of gestational diabetes and/or a body mass index (BMI) greater than 25 kg/m 2 are at increased risk for type 2 DM. Clients with POS are at increased risk because the condition can affect insulin resistance. Clients of Native American ancestry are already at increased risk because of their ethnicity, and abusing alcohol further increases the risk.
While obtaining the client's health history, which factor does the nurse identify that predisposes the client to type 2 diabetes? A. Having diabetes insipidus B. Eating low-cholesterol foods C. Being 20 pounds (9 kilograms) overweight D. Drinking a daily alcoholic beverage
C Rationale: Excessive body weight is a known predisposing factor to type 2 diabetes; the exact relationship is unknown. Diabetes insipidus is caused by too little antidiuretic hormone (ADH) and has no relationship to type 2 diabetes. High-cholesterol diets and atherosclerotic heart disease are associated with type 2 diabetes. Alcohol intake is not known to predispose a person to type 2 diabetes.
A client feeling increasingly tired seeks medical care. Type 1 diabetes is diagnosed. What causes increased fatigue with type 1 diabetes? A. Increased metabolism at the cellular level B. Increased glucose absorption from the intestine C. Decreased production of insulin by the pancreas D. Decreased glucose secretion into the renal tubules
C. Decreased production of insulin by the pancreas Rationale: Insulin facilitates transport of glucose across the cell membrane to meet metabolic needs and prevent fatigue. With diabetes there is decreased cellular metabolism because of the decrease in glucose entering the cells. Glucose is not absorbed from the intestinal tract by the cells; fatigue is caused by decreased, not increased, cellular levels of glucose. Filtration and excretion of glucose by the kidneys do not regulate energy levels; if insulin production is adequate, glucose does not spill into the urine.
Which Laboratory test would the nurse expect to be prescribed that will reveal the effectiveness of a diabetic regimen for a child with type 1 diabetes? A. Serum glucose B. Glucose tolerance C. Fasting blood sugar D. Glycosylated hemoglobin
D. Glycosylated hemoglobin Rationale: The glycosylated hemoglobin test provides an accurate long-term index of the average blood glucose level for 100 to 120 days before the test period the test is not affected by short term variations. A result of less than 8% for this child indicates that the diabetic regiment is effective. Serum glucose reflects short-term (hours) variations in blood glucose. Glucose tolerance reveals carbohydrates have list in response to a glucose. Fasting blood sugar is a screening test to rule out diabetes mellitus.
A mother asks the neonatal nurse why her infant must be monitored so closely for hypoglycemia when her type 1 diabetes was in excellent control during the entire pregnancy. How should the nurse best respond? "A newborn's glucose level drops after birth, so we're being especially cautious with your baby because of your diabetes." "A newborn's pancreas produces an increased amount of insulin during the first day of birth, so we're checking to see whether hypoglycemia has occurred." "Babies of mothers with diabetes do not have large stores of glucose at birth, so it's difficult for them to maintain the blood glucose level within an acceptable range." "Babies of mothers with diabetes have a higher-than-average insulin level because of the excess glucose received from the mothers during pregnancy, so the glucose level may drop."
"Babies of mothers with diabetes have a higher-than-average insulin level because of the excess glucose received from the mothers during pregnancy, so the glucose level may drop." (The infant of a diabetic mother (IDM) produces a higher level of insulin in response to the increased maternal glucose level; after birth it takes several hours for the newborn to adjust to the loss of the maternal glucose. A healthy newborn's glucose level does not drop significantly after birth. A newborn's pancreas usually produces more insulin as a response to the maternal glucose level, but this response is not specific to the IDM. IDMs have the same glucose stores as other newborns; their responses to the loss of maternal glucose levels differ.)
Which complication of diabetes would the nurse assess for in a client with a long history of diabetes? Select all that apply A. Leg ulcers B. loss of visual acuity C. increase creatine clearance D. prolonged capillary refill and toes E. decrease sensation in the lower extremities
A, B, D, E rationale: ulcers of the legs are common response to the microvascular and macrovascular changes associated with diabetes. Retinopathy damage to the micro vascular system of the retina (edema excaudate and local hemorrhage) occurs as a result of occlusion of the small vessels, causing microaneurysms in the capillary walls. Macrovascular changes in the distal capillary beds interfere with blood flow to the distal extremity. Decreased sensation in the lower extremities is complication of diabetes. Consistent hyperglycemia causes a buildup of sorbitol and fructose in the nerves that leads to impairment via an unknown process. Creatine clearance decreases not increases as renal function deteriorates in response to microvascular damage to the small blood vessels that supply the glomeruli
The nurse is providing instructions about foot care for a client with diabetes mellitus. What should the nurse include in the instructions? Select all that apply. A. Wear shoes when out of bed. B. Soak the feet in warm water daily. C. Dry between the toes after bathing. D. Remove corns as soon as they appear. E. Use a heating pad when the feet feel cold.
A, C Rationale: Wearing shoes protects the feet from trauma; They should fit well and should be worn over clean socks. Drawing between the toes after bathing prevents maceration and skin breakdown thus maintaining skin integrity. Soaking the feet is contradicted because it can cause macerations and skin breakdown which allow a portal of entry for pathogenic organisms. Client should not self treat corns calluses warts or ingrown toenails because of the potential for trauma and skin breakdown; These conditions should be treated by a podiatrist. use of heating pad hot water bottle or hot water is contradicted because of the potential for burns diabetic neuropathy is president does not allow the client to accurately evaluate the extremes of temperatures
A client is taught how to recognize indications of a hypoglycemic reaction. Which signs and symptoms identified by the client indicate to the nurse that the teaching was effective? SELECT ALL THAT APPLY A. Fatigue B. Nausea C. Weakness D. Nervousness E. Increased thirst F. Increased perspiration
A, C, D, F Rationale: Fatigue is related to hypoglycemia. Weaknesses related to a decrease in glucose within the central nervous system. Nervousness is caused by increased adrenergic activity and increase accretion of catecholamines. Increase perspiration is related to adrenergic activity and increased catecholamines. Nausea is related to hyperglycemia, not hypoglycemia. Increased thirst with an excessive oral fluid intake (polydipsia) is associated with hyperglycemia and is one of the cardinal signs of diabetes mellitus
Which child would the nurse recommend screening for type 2 diabetes mellitus during a local health screening? SELECT ALL THAT APPLY A. the child who recently turned 10 years old has not yet entered puberty and has no other risk factors B. 7-year-old child body mass index in the 80th percentile and no other risk factors C. African American child, BMI is in the 87th percentile, family history of diabetes D. 9-year-old Hispanic child BMI in the 90th percentile, no other risk factors E. Caucasian child BMI in the 96 percentile signs of insulin resistance
A, C, E Rationale: all children should be screened at 10 or onset of puberty for type 2 diabetes. A child with a BMI of the 85th to the 95th percentile and presence of other risk factors (family history of diabetes, belonging to a racial minority group, or with signs of insulin resistance) should be screened for type 2 diabetes. Any child with a BMI above the 95th percentile should be screened for type two. A BMI in the 80th percentile does not support recommendation for type 2 diabetes screening. A BMI in the 90th percentile with only one other risk factor does not warrant a recommendation for type 2 diabetes screening.
Which laboratory value supports the presence of diabetic ketoacidosis? A. Increased serum lipids B. Decreased hematocrit level C. Increased serum calcium levels D. Decreased blood urea
A. With DKA, serum lipid levels are high because of the increased breakdown of fat. They are so high that the serum appears opalescent and creamy. With DKA the hematocrit level generally is increased because of dehydration. The calcium level is unrelated to DKA. The blood urea nitrogen level is usually increased due to dehydration, in DKA.
What unique response associated with diabetic ketoacidosis that is not exhibited with hyperglycemic hyperosmolar nonketotic syndrome (HHNS) should the nurse identify when assessing this client? A. Fluid loss B. Glycosuria C. Kussmaul respirations D. Increased blood glucose level
C. Kussmaul respirations Rationale: Kussmaul respirations occur in diabetic ketoacidosis as the body attempts to correct a low pH caused by accumulation of ketones. HHNS effects people with type 2 diabetes who will have some insulin production; The insulin prevents the breakdown of fats into ketones. Fluid loss is common to both because and increased blood glucose level ultimately leads to polyurea. Glycosuria is common in both conditions. Hyperglycemia is common in both conditions
Which manifestation would the nurse include when teaching a client about ketoacidosis? SELECT ALL THAT APPLY A. Confusion B. Hyperactivity C. Excessive thirst D. Fruity scented breath E. Decreased urinary output
A. Confusion C. Excessive thirst D. Fruity- scented breath Rationale: Diabetic ketoacidosis signs and symptoms often develop quickly sometimes within 24 hours. Diabetic ketoacidosis is a serious complication of diabetes that occurs when the body produces high levels of ketones (blood acids). It develops when the body is unable to produce enough insulin without enough insulin the body begins to breakdown fat as an alternative fuel. This process produces a buildup of key stones which are toxic acids in the bloodstream, eventually leading to diabetic ketoacidosis if untreated. Signs and symptoms include confusion excess thirst fruity scented breath, frequent urination, nausea and vomiting, abdominal pain, weakness, or fatigue joints of breath. Weakness or fatigue not hyperactivity is a symptom. Frequent urination not decreased urination is symptom.
Which is the priority concern of a 10 year old child who was recently diagnosed with type 2 diabetes? A. How much school might be missed B. whether the diabetes can be controlled C. how a parent will react to the diagnosis D. whether having diabetes means future sterility
A. How much school might be missed Rationale: school age children are most concerned about school if not for academics, for the social aspects. School age children generally live in the present there is little concern about the future period the parents reaction may be of some concern but not as much as school is.
The nurse is assessing the client admitted with diabetic ketoacidosis. Which statement made by the client indicates a need for further education on sick day management? A. I will stop taking my insulin when I am ill because I am not eating. B. I will check my urine for ketones when my blood sugar is over 250. C. I will alternate drinking Gatorade and water throughout the day while ill. D. I will continue all my insulin including my glargine when I am sick.
A. I will stop taking my insulin when I am ill because I am not eating. Rationale: The diabetic client's metabolic needs will require the same amount of insulin and sometimes more when in a stressed state, including illness. The client checking the urine for ketones when blood sugar is over 250, alternating water and Gatorade intake, and continuing insulin indicate that the client has an understanding of the basic sick day rules. Alternating the intake of water and Gatorade throughout the day provides noncarbohydrate water and fluids containing glucose and electrolytes while reducing the risk of consuming too much sugar.
A client with type 1 diabetes has dry, hot, flushed skin and a fruity odor to the breath and is having Kussmaul respirations. Which complication does the nurse suspect that the client is experiencing? A. Ketoacidosis B. Somogyi phenomenon C. hypo hypoglycemic reaction D. hyperosmolar nonketotic coma
A. Ketoacidosis Rationale: Ketoacidosis occurs when insulin is lacking, and carbohydrates cannot be used for energy; this increases the breakdown of protein and fat, causing deep, rapid respirations (Kussmaul respirations), decreased alertness, decreased circulatory volume, metabolic acidosis, and an acetone breath. This Somogyi phenomenon is a rebound hyperglycemia induced by severe hypoglycemia there are not enough data to determine where this occurred. Hypoglycemia is manifested by cool moist skin, not hot dry skin; Kussmaul respirations do not occur with hypoglycemia. Hyperosmolar nonketotic coma usually occurs in clients with type 2 diabetes because available insulin prevents the breakdown of fat.
A nurse is caring for a client who has had type 1 diabetes for 25 years. The client states, "I have been really bad for the last 15 years. I have not paid attention to my diet and have done little to control my diabetes." What common complications of diabetes might the nurse expect to identify when assessing this client? SELECT ALL THAT APPLY A. Leg ulcers B. Loss of visual acuity C. Thick yellow toe nails D. Increased growth of body hair E. Decreased sensation in the feet
A. Leg ulcers B. Loss of visual acuity C. Thick yellow toe nails E. Decreased sensation in the feet Rationale: Leg ulcers are a common response to the microvascular and macrovascular changes associated with diabetes. Retinopathy damaged to the micro vascular system of the retina (edema, exudate and local hemorrhage), occurs as a result of the occlusion of the small vessels in the eyes causing micro aneurysms in the capillary walls. Thick yellow toenails result from prolonged inadequate arterial circulation to the feet. Pedal pulses diminish which can result in gangrene, necessitating amputation. Diabetic neuropathies effects 60% to 70% of the people with diabetes. It is theorized that consistent hyperglycemia causes a buildup of sorbitol and fructose in the nerves that result in the impairment via an unknown process. Inadequate arterial circulation to the hair follicles results in lack of hair on the feet and ankles. The skin becomes dry and cracks, predisposing it to leg ulcers man infection.
The nurse is teaching a newly diagnosed with type 1 diabetes about self-care. Which is the primary long-term goal? A. Maintaining normoglycemia B. Complying with the diabetic diet C. Adhering to an exercise program D. Developing a non-stressful lifestyle
A. Maintaining normoglycemia Rationale: Maintaining normoglycemia is a realistic goal because it decreases the risk of complications such as neuropathy, retinopathy, and atherosclerosis. A regimen of insulin, exercise, and diet will help the adolescent achieve this goal. Compliance with a diabetic diet is an objective because it will help the adolescent achieve the long-term goal; diet alone is insufficient to achieve normoglycemia. Adherence to an exercise program is an objective because it will help the adolescent achieve the long-term goal; exercise alone is insufficient to achieve normoglycemia. Development of a nonstressful lifestyle is a worthwhile goal, but it is not realistic.
For a pregnant client with type 1 diabetes, which action is most likely to reduce the risks of disease-related complications? A. Monitor and control blood glucose levels. B. Limit pregnancy weight gain to an average of 25 pounds. C. Preplan for a cesarean section. D. Attend all prenatal office visits.
A. Monitor and control blood glucose levels. Rationale: In a pregnant client with type one diabetes monitoring and controlling blood glucose levels are the most important interventions to optimize maternal and fetal health. Uncontrolled glucose levels and pregnancy are associated with fetal malformations macrosomia difficult deliveries with increased risk of hemorrhage and fetal death. A woman who is average weight before getting pregnant can gain 25 to 35 pounds after becoming pregnant. Underweight women can gain 28 to 40 pounds overweight women should gain no more than 15 to 25 pounds during pregnancy and obese women can gain 11 to 20 pounds. Pre planning for cesarean section may be appropriate in some cases but is not a risk reducing factor during the pregnancy. Prenatal office visits will help the mother monitor and identify early interventions that can be implemented to maintain blood glucose control.
Why does the nurse teach the parents of a young child with type 1 diabetes how to test the child's urine at home during periods of stress or illness, even though blood glucose testing is being done four times a day? A. Urine should be tested for acetone during illness and when the blood glucose level is increased. B. Blood glucose testing before meals and at bedtime may be stopped once the child is stabilized on insulin. C. Urine testing remains the most accurate way to check for a high glucose level if double-voided specimens are used. D. The short-term glucose level is more accurately reflected in a urine specimen than in a blood specimen, especially in children.
A. Urine should be tested for acetone during illness and when the blood glucose level is increased. Rationale: Urine testing is primarily helpful in detecting ketones, which are most likely to be present during illness and hyperglycemia. Because of the complexity of the diabetic regimen and the variety of factors that influence the serum glucose level (e.g., food ingested, exercise, medications, and the stresses of growth and development), serum glucose levels in children can fluctuate; therefore the serum glucose level should be checked before meals and at bedtime. Blood, not urine, is the best specimen with which to determine the glucose level.
A student with type one diabetes asks the nurse which primary hormone causes the blood glucose level to rise. Which hormone would the nurse report? A. Insulin B. Glucagon C. Epinephrine Adrenocorticotropic
B. Glucagon Rationale: Rationale: Glucagon promotes the liver glycogenolysis, resulting in the release of glucose into the blood. Insulin production is not directly related to glycogenolysis; It will decrease blood glucose levels. In healthy individuals the level of insulin will increase as the glucose levels increases. While epinephrine can cause the glucose level to rise it is not the primary hormone and is not directly related to glucose glycogenolysis; It is released from the adrenal medulla and sympathetic nerve endings. ACTH is not directly related to glycogenolysis; It is released from the anterior pituitary.
A client with diabetes mellitus complains of difficulty seeing. The nurse concludes that the causative factor is: A. Lack of glucose in the retina B. The growth of new retina blood vessels or "Neovascularization" C. Inadequate glucose supply to rods and cones D. Destructive effect of ketones on retinal metabolism
B. The growth of new retina blood vessels or "Neovascularization Rationale: Proliferative diabetic retinopathy is the growth of new retinal blood vessels, also known as neovascularization. When retinal blood flow is poor and hypoxia develops, retinal cells secrete growth factors which stimulate the formation of new blood cells vessels in the eye. These new vessels are thin fragile and bleed easily leading to eye hemorrhage and vision loss. Hemorrhages in the eyes precipitates retinal detachment resulting in blindness. There is an increase in serum glucose in clients with diabetes mellitus; Thickening of the capillary basement membranes can occur even if the glucose level is maintained with normal limits. Ketones do not affect retinal metabolism retinopathy is a result of vascular changes retinal detachment and hemorrhage within the eye.
Which factors can predispose a client with type 1 diabetes to a diabetic ketoacidotic coma? SELECT ALL THAT APPLY A. Taking too much insulin B. Getting too much exercise C. Excessive emotional stress D. Running fever with infection E. Eating fewer calories than prescribed
C, D Rationale: Emotional stress stimulates the sympathetic nervous system, which releases glucocorticoids, ultimately increasing the blood glucose level. The stress of infection increases metabolism and the production of glucocorticoids, resulting in an increased blood glucose level. Too much insulin will precipitate insulin coma (hypoglycemia). Exercise uses glucose for muscle contraction, decreasing the blood glucose level; This may precipitate insulin coma (hypoglycemia). Not eating enough calories in relation to the amount of insulin received may precipitate insulin coma (hypoglycemia).
Which assessment findings would the nurse associate with a client with diabetic ketoacidosis? SELECT ALL THAT APPLY A. Sweating B. Retinopathy C. Acetone breath D. Increased arterial bicarbonate level E. Decreased arterial carbon dioxide level
C, E Rationale: A fruity odor to the breath acetone breath occurs when the keto level is elevated in ketoacidosis. Metabolic acidosis initiates respiratory compensation in the form of Kussmaul respirations to counteract the effect of ketone buildup resulting in a decreased arterial carbon dioxide level. As the glucose level decreases in hypoglycemia the sympathetic nervous system is activated, and the epinephrine and norepinephrine are secreted, causing diaphoresis. Retinopathy is a long term complication of diabetes caused by microvascular changes in the retina; It is not a sign of ketoacidosis. With ketoacidosis, the serum biocarbonate level is decreased not increase in an effort to neutralize ketones when seeking acid base balance.
A nurse is caring for two clients newly diagnosed with diabetes. One client has type 1 diabetes, and the other client has type 2 diabetes. When determining the main difference between type 1 and type 2 diabetes, the nurse recognizes what clinical presentation about type 1? A. Onset of the disease is slow. B. Excessive weight is a contributing factor. C. Complications are not present at the time of diagnosis. D. Treatment involves diet, exercise, and oral medications.
C. Rationale: Clinical presentation of type 1 diabetes is characterized by acute onset, and therefore there is no time to develop the long-term complications that are common with long-standing disease; 20% of newly diagnosed clients with type 2 diabetes demonstrate complications because the diabetes has gone undetected for an extended period of time. Clinical presentation of type 1 diabetes is rapid, not slow, as pancreatic beta cells are destroyed by an autoimmune process; in type 2 diabetes, the body is still producing some insulin, and therefore the onset of signs and symptoms is slow. In type 1 diabetes, clients are generally lean or have an ideal weight; 80% to 90% of clients with type 2 diabetes are overweight. Type 1 diabetes requires diet control, exercise, and subcutaneous administration of insulin, not oral medications; oral medications are used for type 2 diabetes because some insulin is still being produced.
Which laboratory value supports the presence of diabetic ketoacidosis in a client with type 1 diabetes? A. Decreased serum glucose levels B. Decreased serum calcium levels C. Increased blood urea nitrogen levels D. Increased serum bicarbonate levels
C. Increased blood urea nitrogen (BUN) levels Rationale: With diabetic ketoacidosis blood urea nitrogen level generally is increased because of dehydration. With diabetic ketoacidosis the serum glucose levels are generally greater than 300MG/DL (16 point 7MMOL/L). The calcium level is unrelated to diabetic ketoacidosis. Serum biocarbonate levels are less than 15 mEq/L.
Which result would the nurse expect to find when assessing laboratory values of a client with type 2 diabetes? A. Ketones in the blood but not in the urine B. Glucose in the urine but not hyperglycemia. C. Urine negative for ketones and hyperglycemia. D. Blood and urine positive for both glucose and ketone
C. Urine negative for ketones and hyperglycemia Rationale: The reason for lack of ketonuria in type 2 is unknown. Ketones in the blood but not in the urine do not occur with type 2. Glucose in the urine but not hyperglycemia is impossible; if glycosuria is present, the level of glucose in the blood first must exceed the renal threshold of 160 to 180 mg/dL. Blood and urine positive for both glucose and ketones is expected in uncontrolled type 1 diabetes.
Which initial response would the nurse make to a 67 year old man with type 2 diabetes who sadly confides in the nurse that he is been unable to have an erection for several years? A.)"At your age sex isn't that important." B.)"Sex isn't everything it's cracked up to be." C.)"You sound upset about not being able to have an erection." D.)"Maybe it's time for you to speak to your primary healthcare provider about this."
C.)"You sound upset about not being able to have an erection." Rationale: When a client reveals something, it is important for the nurse to gather more information. The response "You sound upset about not being able to have an erection" promotes further communication. Assessment is the first step of the nursing process. "At your age sex isn't that important" is a subjective, judgmental response that reflects the nurse's view of sexuality in older adults. "Sex isn't everything it's cracked up to be" interjects the nurse's view and violates the concept of neutrality when counseling clients. Having the client speak to his primary healthcare provider may be indicated eventually, but first the nurse must obtain more information.
Based on laboratory values, which client's needs would the nurse address first? Client A: A1C%: 5.6 Fasting plasma glucose level (mg/dL): 110 Two-hour plasma glucose level (mg/dL): 150 Client B: A1C%: 6.8 Fasting plasma glucose level (mg/dL): 130 Two-hour plasma glucose level (mg/dL): 200 Client C: A1C%: 6.0 Fasting plasma glucose level (mg/dL): 120 Two-hour plasma glucose level (mg/dL): 130 Client D: A1C%: 6.1 Fasting plasma glucose level (mg/dL): 100 Two-hour plasma glucose level (mg/dL): 140
Client B Rationale: The client with an HbA1c percentage level of less than 7%, fasting plasma glucose above 126 mg/dL, And two-hour plasma glucose greater than 200MG/DL indicates diabetes mellitus. Client B has increased values for A1c percentage, fasting plasma glucose and two-hour plasma glucose. Client B should be treated first. clients A C&D have normal values for diabetes mellitus and therefore can be treated after client B.
A nurse teaches a client with type 2 diabetes how to provide self-care to prevent infections of the feet. Which statement made by the client shows that teaching was effective? A. I should massage my feet and legs with oil or lotion B. I should apply heat intermittently to my feet and legs C. I should eat foods high in protein and carbohydrate kilocalories D. I should control my blood glucose with diet exercise and medication
D. I should control my blood glucose with diet exercise and medication Rationale: controlling the diabetes decreases the risk of infection; This is the best prevention. Oil or lotion that is not completely absorbed may provide a warm moist environment for bacterial growth. Coexisting neuropathy may result injury from heat application. Protein carbohydrates and fats must be in an appropriate balance; High carbohydrate intake can provide too many calories.
