Hinkle Ch 46: Assessment and Management of Patients with Diabetes

Which instruction about insulin administration should a nurse give to a client? - "Always follow the same order when drawing the different insulins into the syringe." - "Shake the vials before withdrawing the insulin." - "Store unopened vials of insulin in the freezer at temperatures well below freezing." - "Discard the intermediate-acting insulin if it appears cloudy."

- "Always follow the same order when drawing the different insulins into the syringe." Explanation: The nurse should instruct the client to always follow the same order when drawing the different insulins into the syringe. Insulin should never be shaken because the resulting froth prevents withdrawal of an accurate dose and may damage the insulin protein molecules. Insulin should never be frozen because the insulin protein molecules may be damaged. The client doesn't need to discard intermediate-acting insulin if it's cloudy; this finding is normal.

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: - "The physician wants to be sure your shoes fit properly so you won't develop pressure sores." - "The circulation in your feet can help us determine how severe your diabetes is." - "Diabetes can affect sensation in your feet and you can hurt yourself without realizing it." - "It's easier to get foot infections if you have diabetes."

- "Diabetes can affect sensation in your feet and you can hurt yourself without realizing it." Explanation: The nurse should make the client aware that diabetes affects sensation in the feet and that he might hurt his foot but not feel the wound. Although it's important that the client's shoes fit properly, this isn't the only reason the client's feet need to be checked. Telling the client that diabetes mellitus increases the risk of infection or stating that the circulation in the client's feet indicates the severity of his diabetes doesn't provide the client with complete information.

After teaching a client with type 1 diabetes who is scheduled to undergo an islet cell transplant, which client statement indicates successful teaching? - "This transplant will provide me with a cure for my diabetes." - "I will receive a whole organ with extra cells to produce insulin." - "They'll need to create a connection from the pancreas to allow enzymes to drain." - "I might need insulin later on but probably not as much or as often."

- "I might need insulin later on but probably not as much or as often." Explanation: Transplanted islet cells tend to lose their ability to function over time, and approximately 70% of recipients resume insulin administration in 2 years. However, the amount of insulin and the frequency of its administration are reduced because of improved control of blood glucose levels. Thus, this type of transplant doesn't cure diabetes. It requires the use of two human pancreases to obtain sufficient numbers of islet cells for transplantation. A whole organ transplant requires a means for exocrine enzyme drainage and venous absorption of insulin.

A client is taking glyburide (DiaBeta), 1.25 mg P.O. daily, to treat type 2 diabetes. Which statement indicates the need for further client teaching about managing this disease? - "I always carry hard candy to eat in case my blood sugar level drops." - "I avoid exposure to the sun as much as possible." - "I always wear my medical identification bracelet." - "I skip lunch when I don't feel hungry."

- "I skip lunch when I don't feel hungry." Explanation: The client requires further teaching if he states that he skips meals. A client who is receiving an oral antidiabetic agent should eat meals on a regular schedule because skipping a meal increases the risk of hypoglycemia. Carrying hard candy, avoiding exposure to the sun, and always wearing a medical identification bracelet indicate effective teaching.

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

- "Ketones accumulate in the blood and urine when fat breaks down in the absence of insulin. Ketones signal an insulin deficiency that will cause the body to start breaking down stored fat for energy." Explanation: Ketones (or ketone bodies) are by-products of fat breakdown in the absence of insulin, and they accumulate in the blood and urine. Ketones in the urine signal an insulin deficiency and that control of type 1 diabetes is deteriorating. When almost no effective insulin is available, the body starts to break down stored fat for energy.

A client newly diagnosed with diabetes mellitus asks why he needs ketone testing when the disease affects his blood glucose levels. How should the nurse respond? - "The spleen releases ketones when your body can't use glucose." - "Ketones will tell us if your body is using other tissues for energy." - "Ketones can damage your kidneys and eyes." - "Ketones help the physician determine how serious your diabetes is."

- "Ketones will tell us if your body is using other tissues for energy." Explanation: The nurse should tell the client that ketones are a byproduct of fat metabolism and that ketone testing can determine whether the body is breaking down fat to use for energy. The spleen doesn't release ketones when the body can't use glucose. Although ketones can damage the eyes and kidneys and help the physician evaluate the severity of a client's diabetes, these responses by the nurse are incomplete.

Which instruction should a nurse give to a client with diabetes mellitus when teaching about "sick day rules"? - "Don't take your insulin or oral antidiabetic agent if you don't eat." - "It's okay for your blood glucose to go above 300 mg/dl while you're sick." - "Test your blood glucose every 4 hours." - "Follow your regular meal plan, even if you're nauseous."

- "Test your blood glucose every 4 hours." Explanation: The nurse should instruct a client with diabetes mellitus to check his blood glucose levels every 3 to 4 hours and take insulin or an oral antidiabetic agent as usual, even when he's sick. If the client's blood glucose level rises above 300 mg/dl, he should call his physician immediately. If the client is unable to follow the regular meal plan because of nausea, he should substitute soft foods, such as gelatin, soup, and custard.

A physician orders blood glucose levels every 4 hours for a 4-year-old child with brittle type 1 diabetes. The parents are worried that drawing so much blood will traumatize their child. How can the nurse best reassure the parents? - "Your child will need less blood work as his glucose levels stabilize." - "Your child is young and will soon forget this experience." - "I'll see if the physician can reduce the number of blood draws." - "Our laboratory technicians use tiny needles and they're really good with children."

- "Your child will need less blood work as his glucose levels stabilize." Explanation: Telling the parents that the number of blood draws will decrease as their child's glucose levels stabilize engages them in the learning process and gives them hope that the present discomfort will end as the child's condition improves. Telling the parents that their child won't remember the experience disregards their concerns and anxiety. The nurse shouldn't offer to ask the physician if he can reduce the number of blood draws; the physician needs the laboratory results to monitor the child's condition properly. Although telling the parents that the laboratory technicians are gentle and use tiny needles may be reassuring, it isn't the most appropriate response.

A client with diabetes mellitus has a blood glucose level of 40 mg/dL. Which rapidly absorbed carbohydrate would be most effective? - 1/2 cup fruit juice or regular soft drink - 4 oz of skim milk - 1/2 tbsp honey or syrup - three to six LifeSavers candies

- 1/2 cup fruit juice or regular soft drink Explanation: In a client with hypoglycemia, the nurse uses the rule of 15: give 15 g of rapidly absorbed carbohydrate, wait 15 minutes, recheck the blood sugar, and administer another 15 g of glucose if the blood sugar is not above 70 mg/dL. One-half cup fruit juice or regular soft drink is equivalent to the recommended 15 g of rapidly absorbed carbohydrate. Eight ounces of skim milk is equivalent to the recommended 15 g of rapidly absorbed carbohydrate. One tablespoon of honey or syrup is equivalent to the recommended 15 g of rapidly absorbed carbohydrate. Six to eight LifeSavers candies is equivalent to the recommended 15 g of rapidly absorbed carbohydrate.

An agitated, confused client arrives in the emergency department. The client's history includes type 1 diabetes, hypertension, and angina pectoris. Assessment reveals pallor, diaphoresis, headache, and intense hunger. A stat blood glucose sample measures 42 mg/dl, and the client is treated for an acute hypoglycemic reaction. After recovery, the nurse teaches the client to treat hypoglycemia by ingesting: - 2 to 5 g of a simple carbohydrate. - 10 to 15 g of a simple carbohydrate. - 18 to 20 g of a simple carbohydrate. - 25 to 30 g of a simple carbohydrate.

- 10 to 15 g of a simple carbohydrate. Explanation: To reverse hypoglycemia, the American Diabetes Association recommends ingesting 10 to 15 g of a simple carbohydrate, such as three to five pieces of hard candy, two to three packets of sugar (4 to 6 tsp), or 4 oz of fruit juice. Then the client should check his blood glucose after 15 minutes. If necessary, this treatment may be repeated in 15 minutes. Ingesting only 2 to 5 g of a simple carbohydrate may not raise the blood glucose level sufficiently. Ingesting more than 15 g may raise it above normal, causing hyperglycemia.

A nurse is preparing a continuous insulin infusion for a child with diabetic ketoacidosis and a blood glucose level of 800 mg/dl. Which solution is the most appropriate at the beginning of therapy? - 100 units of regular insulin in normal saline solution - 100 units of neutral protamine Hagedorn (NPH) insulin in normal saline solution - 100 units of regular insulin in dextrose 5% in water - 100 units of NPH insulin in dextrose 5% in water

- 100 units of regular insulin in normal saline solution Explanation: Continuous insulin infusions use only short-acting regular insulin. Insulin is added to normal saline solution and administered until the client's blood glucose level falls. Further along in the therapy, a dextrose solution is administered to prevent hypoglycemia.

Glycosylated hemoglobin reflects blood glucose concentrations over which period of time? - 1 month - 3 months - 6 months - 9 months

- 3 months Explanation: Glycosylated hemoglobin is a blood test that reflects average blood glucose concentrations over a period of 3 months.

What is the duration of regular insulin? - 4 to 6 hours - 3 to 5 hours - 12 to 16 hours - 24 hours

- 4 to 6 hours Explanation: The duration of regular insulin is 4 to 6 hours; 3 to 5 hours is the duration for rapid-acting insulin such as Novolog. The duration of NPH insulin is 12 to 16 hours. The duration of Lantus insulin is 24 hours.

A health care provider prescribes short-acting insulin for a patient, instructing the patient to take the insulin 20 to 30 minutes before a meal. The nurse explains to the patient that Humulin-R taken at 6:30 AM will reach peak effectiveness by: - 8:30 AM. - 10:30 AM. - 12:30 PM. - 2:30 PM.

- 8:30 AM. Explanation: Short-acting insulin reaches its peak effectiveness 2 to 3 hours after administration. See Table 30-3 in the text.

When administering insulin to a client with type 1 diabetes, which of the following would be most important for the nurse to keep in mind? - Duration of the insulin - Accuracy of the dosage - Area for insulin injection - Technique for injecting

- Accuracy of the dosage Explanation: The measurement of insulin is most important and must be accurate because clients may be sensitive to minute dose changes. The duration, area, and technique for injecting should also to be noted.

Which clinical characteristic is associated with type 2 diabetes (previously referred to as non-insulin-dependent diabetes mellitus)? - Blood glucose can be controlled through diet and exercise - Client is usually thin at diagnosis - Client is prone to ketosis - Clients demonstrate islet cell antibodies

- Blood glucose can be controlled through diet and exercise Explanation: Oral hypoglycemic agents may improve blood glucose concentrations if dietary modification and exercise are unsuccessful. Individuals with type 2 diabetes are usually obese at diagnosis. Individuals with type 2 diabetes rarely demonstrate ketosis, except with stress or infection. Individuals with type 2 diabetes do not demonstrate islet cell antibodies.

A client is admitted with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which laboratory finding should the nurse expect in this client? - Arterial pH 7.25 - Plasma bicarbonate 12 mEq/L - Blood glucose level 1,100 mg/dl - Blood urea nitrogen (BUN) 15 mg/dl

- Blood glucose level 1,100 mg/dl Explanation: HHNS occurs most frequently in older clients. It can occur in clients with either type 1 or type 2 diabetes mellitus but occurs most commonly in those with type 2. The blood glucose level rises to above 600 mg/dl in response to illness or infection. As the blood glucose level rises, the body attempts to rid itself of the excess glucose by producing urine. Initially, the client produces large quantities of urine. If fluid intake isn't increased at this time, the client becomes dehydrated, causing BUN levels to rise. Arterial pH and plasma bicarbonate levels typically remain within normal limits.

Which factors will cause hypoglycemia in a client with diabetes? Select all that apply. - Client has not consumed food and continues to take insulin or oral antidiabetic medications. - Client has not consumed sufficient calories. - Client has been exercising more than usual. - Client has been sleeping excessively. - Client is experiencing effects of the aging process.

- Client has not consumed food and continues to take insulin or oral antidiabetic medications. - Client has not consumed sufficient calories. - Client has been exercising more than usual. Explanation: Hypoglycemia can occur when a client with diabetes is not eating at all and continues to take insulin or oral antidiabetic medications, is not eating sufficient calories to compensate for glucose-lowering medications, or is exercising more than usual. Excessive sleep and aging are not factors in the onset of hypoglycemia.

A client's blood glucose level is 45 mg/dl. The nurse should be alert for which signs and symptoms? - Coma, anxiety, confusion, headache, and cool, moist skin - Kussmaul respirations, dry skin, hypotension, and bradycardia - Polyuria, polydipsia, hypotension, and hypernatremia - Polyuria, polydipsia, polyphagia, and weight loss

- Coma, anxiety, confusion, headache, and cool, moist skin Explanation: Signs and symptoms of hypoglycemia (indicated by a blood glucose level of 45 mg/dl) include anxiety, restlessness, headache, irritability, confusion, diaphoresis, cool skin, tremors, coma, and seizures. Kussmaul respirations, dry skin, hypotension, and bradycardia are signs of diabetic ketoacidosis. Excessive thirst, hunger, hypotension, and hypernatremia are symptoms of diabetes insipidus. Polyuria, polydipsia, polyphagia, and weight loss are classic signs and symptoms of diabetes mellitus.

A client is diagnosed with diabetes mellitus. Which assessment finding best supports a nursing diagnosis of Ineffective coping related to diabetes mellitus? - Recent weight gain of 20 lb (9.1 kg) - Failure to monitor blood glucose levels - Skipping insulin doses during illness - Crying whenever diabetes is mentioned

- Crying whenever diabetes is mentioned Explanation: A client who cries whenever diabetes is mentioned is demonstrating ineffective coping. A recent weight gain and failure to monitor blood glucose levels would support a nursing diagnosis of Noncompliance: Failure to adhere to therapeutic regimen. Skipping insulin doses during illness would support a nursing diagnosis of Deficient knowledge related to treatment of diabetes mellitus.

A client with long-standing type 1 diabetes is admitted to the hospital with unstable angina pectoris. After the client's condition stabilizes, the nurse evaluates the diabetes management regimen. The nurse learns that the client sees the physician every 4 weeks, injects insulin after breakfast and dinner, and measures blood glucose before breakfast and at bedtime. Consequently, the nurse should formulate a nursing diagnosis of: - Impaired adjustment. - Defensive coping. - Deficient knowledge (treatment regimen). - Health-seeking behaviors (diabetes control).

- Deficient knowledge (treatment regimen). Explanation: The client should inject insulin before, not after, breakfast and dinner — 30 minutes before breakfast for the a.m. dose and 30 minutes before dinner for the p.m. dose. Therefore, the client has a knowledge deficit regarding when to administer insulin. By taking insulin, measuring blood glucose levels, and seeing the physician regularly, the client has demonstrated the ability and willingness to modify his lifestyle as needed to manage the disease. This behavior eliminates the nursing diagnoses of Impaired adjustment and Defensive coping. Because the nurse, not the client, questioned the client's health practices related to diabetes management, the nursing diagnosis of Health-seeking behaviors isn't warranted.

An obese Hispanic client, age 65, is diagnosed with type 2 diabetes. Which statement about diabetes mellitus is true? - Nearly two-thirds of clients with diabetes mellitus are older than age 60. - Diabetes mellitus is more common in Hispanics and Blacks than in Whites. - Type 2 diabetes mellitus is less common than type 1 diabetes mellitus. - Approximately one-half of the clients diagnosed with type 2 diabetes are obese.

- Diabetes mellitus is more common in Hispanics and Blacks than in Whites. Explanation: Diabetes mellitus is more common in Hispanics and Blacks than in Whites. Only about one-third of clients with diabetes mellitus are older than age 60 and 85% to 90% have type 2. At least 80% of clients diagnosed with type 2 diabetes mellitus are obese.

Which information should be included in the teaching plan for a client receiving glargine, a "peakless" basal insulin? - Administer the total daily dosage in two doses. - Draw up the drug first, then add regular insulin. - It is rapidly absorbed and has a fast onset of action. - Do not mix with other insulins.

- Do not mix with other insulins. Explanation: Because glargine is in a suspension with a pH of 4, it cannot be mixed with other insulins because this would cause precipitation. When administering glargine insulin, it is very important to read the label carefully and to avoid mistaking Lantus insulin for Lente insulin and vice versa.

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

- Elevated blood urea nitrogen (BUN) and creatinine - Rapid onset - More common in type 1 diabetes Explanation: DKA is characterized by an elevated BUN and creatinine, rapid onset, and it is more common in type 1 diabetes. Hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is characterized by the absence of urine and serum ketones and a normal arterial pH level.

Which assessment finding is most important in determining nursing care for a client with diabetes mellitus? - Respirations of 12 breaths/minute - Cloudy urine - Blood sugar 170 mg/dL - Fruity breath

- Fruity breath Explanation: The rising ketones and acetone in the blood can lead to acidosis and be detected as a fruity odor on the breath. Ketoacidosis needs to be treated to prevent further complications such as Kussmaul respirations (fast, labored breathing) and renal shutdown. A blood sugar of 170 mg/dL is not ideal but will not result in glycosuria and/or trigger the classic symptoms of diabetes mellitus. Cloudy urine may indicate a UTI.

During a follow-up visit 3 months after a new diagnosis of type 2 diabetes, a client reports exercising and following a reduced-calorie diet. Assessment reveals that the client has only lost 1 pound and did not bring the glucose-monitoring record. Which value should the nurse measure? - Fasting blood glucose level - Glucose via a urine dipstick test - Glycosylated hemoglobin level - Glucose via an oral glucose tolerance test

- Glycosylated hemoglobin level Explanation: Glycosylated hemoglobin is a blood test that reflects the average blood glucose concentration over a period of approximately 2 to 3 months. When blood glucose is elevated, glucose molecules attach to hemoglobin in red blood cells. The longer the amount of glucose in the blood remains above normal, the more glucose binds to hemoglobin and the higher the glycosylated hemoglobin level becomes.

A nurse is inspecting the feet of a client with diabetes and finds a tack sticking in the sole of one foot. The client denies feeling anything unusual in the foot. Which is the best rationale for this finding? - In diabetes, the autonomic nerves are affected. - Motor neuropathy causes muscles to weaken and atrophy. - High blood sugar decreases blood circulation to nerves. - Nephropathy is a common complication of diabetes mellitus.

- High blood sugar decreases blood circulation to nerves. Explanation: Diabetic neuropathy results from poor glucose control and decreased blood circulation to nerve tissues. The lack of sensitivity increases the potential for soft tissue injury without awareness. Autonomic neuropathy is a complication of diabetes mellitus but not significant with peripheral injuries. Motor neuropathy does occur with poor glucose control but not specific to this injury. Nephropathy is a common complication that directly affects the kidneys.

Which is the best nursing explanation for the symptom of polyuria in a client with diabetes mellitus? - With diabetes, drinking more results in more urine production. - Increased ketones in the urine promote the manufacturing of more urine. - High sugar pulls fluid into the bloodstream, which results in more urine production. - The body's requirement for fuel drives the production of urine.

- High sugar pulls fluid into the bloodstream, which results in more urine production. Explanation: The hypertonicity from concentrated amounts of glucose in the blood pulls fluid into the vascular system, resulting in polyuria. The urinary frequency triggers the thirst response, which then results in polydipsia. Ketones in the urine and body requirements do not affect the production of urine.

A client with diabetes mellitus is receiving an oral antidiabetic agent. The nurse observes for which condition when caring for this client? - Polyuria - Hypoglycemia - Blurred vision - Polydipsia

- Hypoglycemia Explanation: The nurse should observe the client receiving an oral antidiabetic agent for signs of hypoglycemia. The time when the reaction might occur is not predictable and could be from 30 to 60 minutes to several hours after the drug is ingested.

When the nurse is caring for a patient with type 1 diabetes, what clinical manifestation would be a priority to closely monitor? - Hypoglycemia - Hyponatremia - Ketonuria - Polyphagia

- Hypoglycemia Explanation: The therapeutic goal for diabetes management is to achieve normal blood glucose levels (euglycemia) without hypoglycemia while maintaining a high quality of life.

Which combination of adverse effects should a nurse monitor for when administering IV insulin to a client with diabetic ketoacidosis? - Hypokalemia and hypoglycemia - Hypocalcemia and hyperkalemia - Hyperkalemia and hyperglycemia - Hypernatremia and hypercalcemia

- Hypokalemia and hypoglycemia Explanation: Blood glucose needs to be monitored in clients receiving IV insulin because of the risk of hyperglycemia or hypoglycemia. Hypoglycemia might occur if too much insulin is administered. Hypokalemia, not hyperkalemia, might occur because I.V. insulin forces potassium into cells, thereby lowering the plasma level of potassium. Calcium and sodium levels aren't affected by IV insulin administration.

A 60-year-old client comes to the ED reporting weakness, vision problems, increased thirst, increased urination, and frequent infections that do not seem to heal easily. The physician suspects that the client has diabetes. Which classic symptom should the nurse watch for to confirm the diagnosis of diabetes? - Numbness - Increased hunger - Fatigue - Dizziness

- Increased hunger Explanation: The classic symptoms of diabetes are the three Ps: polyuria (increased urination), polydipsia (increased thirst), and polyphagia (increased hunger). Some of the other symptoms include tingling, numbness, and loss of sensation in the extremities and fatigue.

A nurse is assessing a client who is receiving total parenteral nutrition (TPN). Which finding suggests that the client has developed hyperglycemia? - Cheyne-Stokes respirations - Increased urine output - Decreased appetite - Diaphoresis

- Increased urine output Explanation: Glucose supplies most of the calories in TPN; if the glucose infusion rate exceeds the client's rate of glucose metabolism, hyperglycemia arises. When the renal threshold for glucose reabsorption is exceeded, osmotic diuresis occurs, causing an increased urine output. A decreased appetite and diaphoresis suggest hypoglycemia, not hyperglycemia. Cheyne-Stokes respirations are characterized by a period of apnea lasting 10 to 60 seconds, followed by gradually increasing depth and frequency of respirations. Cheyne-Stokes respirations typically occur with cerebral depression or heart failure.

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

- Infuse 0.9% normal saline solution 1 L/hr for 2 hours. Explanation: In addition to treating hyperglycemia, management of DKA is aimed at correcting dehydration, electrolyte loss, and acidosis before correcting the hyperglycemia with insulin. In dehydrated clients, rehydration is important for maintaining tissue perfusion. Initially, 0.9% sodium chloride (normal saline) solution is administered at a rapid rate, usually 0.5 to 1 L/hr for 2 to 3 hours.

A nurse explains to a client that she will administer his first insulin dose in his abdomen. How does absorption at the abdominal site compare with absorption at other sites? - Insulin is absorbed more slowly at abdominal injection sites than at other sites. - Insulin is absorbed rapidly regardless of the injection site. - Insulin is absorbed more rapidly at abdominal injection sites than at other sites. - Insulin is absorbed unpredictably at all injection sites.

- Insulin is absorbed more rapidly at abdominal injection sites than at other sites. Explanation: Subcutaneous insulin is absorbed most rapidly at abdominal injection sites, more slowly at sites on the arms, and slowest at sites on the anterior thigh. Absorption after injection in the buttocks is less predictable.

The nurse is preparing a presentation for a group of adults at a local community center about diabetes. Which characteristic would the nurse inform the group is associated with type 2 diabetes? - Onset most common during adolescence - Insulin resistance or insufficient insulin production - Less common than type 1 diabetes - Little relation to prediabetes

- Insulin resistance or insufficient insulin production Explanation: Type 2 diabetes is characterized by insulin resistance or insufficient insulin production. It is more common in aging adults, and adults aged 45 to 64 years were highest among newly diagnosed age groups for type 2 diabetes in 2018, not adolescents. The absence of insulin production by beta cells in the islets of Langerhans of the pancreas is characteristic of type 1 diabetes mellitus, not type 2. Prediabetes can lead to type 2 diabetes.

NPH is an example of which type of insulin? - Rapid-acting - Short-acting - Intermediate-acting - Long-acting

- Intermediate-acting Explanation: NPH is an intermediate-acting insulin.

The nurse is describing the action of insulin in the body to a client newly diagnosed with type 1 diabetes. Which of the following would the nurse explain as being the primary action? - It carries glucose into body cells. - It aids in the process of gluconeogenesis. - It stimulates the pancreatic beta cells. - It decreases the intestinal absorption of glucose.

- It carries glucose into body cells. Explanation: Insulin carries glucose into body cells as their preferred source of energy. Besides, it promotes the liver's storage of glucose as glycogen and inhibits the breakdown of glycogen back into glucose. Insulin does not aid in gluconeogenesis but inhibits the breakdown of glycogen back into glucose. Insulin does not have an effect on the intestinal absorption of glucose.

A patient is diagnosed with type 1 diabetes. What clinical characteristics does the nurse expect to see in this patient? Select all that apply. - Ketosis-prone - Little or no endogenous insulin - Obesity at diagnoses - Younger than 30 years of age - Older than 65 years of age

- Ketosis-prone - Little or no endogenous insulin - Younger than 30 years of age Explanation: Type I diabetes mellitus is associated with the following characteristics: onset any age, but usually young (<30 y); usually thin at diagnosis, recent weight loss; etiology includes genetic, immunologic, and environmental factors (e.g., virus); often have islet cell antibodies; often have antibodies to insulin even before insulin treatment; little or no endogenous insulin; need exogenous insulin to preserve life; and ketosis prone when insulin absent.

Which type of insulin acts most quickly? - Regular - NPH - Lispro - Glargine

- Lispro Explanation: The onset of action of rapid-acting lispro is within 10 to 15 minutes. The onset of action of short-acting regular insulin is 30 minutes to 1 hour. The onset of action of intermediate-acting NPH insulin is 3 to 4 hours. The onset of action of very long-acting glargine is ~6 hours.

A patient who is diagnosed with type 1 diabetes would be expected to: - Be restricted to an American Diabetic Association diet. - Have no damage to the islet cells of the pancreas. - Need exogenous insulin. - Receive daily doses of a hypoglycemic agent.

- Need exogenous insulin. Explanation: Type 1 diabetes is characterized by the destruction of pancreatic beta cells that require exogenous insulin.

A nurse expects to find which signs and symptoms in a client experiencing hypoglycemia? - Polyuria, headache, and fatigue - Polyphagia and flushed, dry skin - Polydipsia, pallor, and irritability - Nervousness, diaphoresis, and confusion

- Nervousness, diaphoresis, and confusion Explanation: Signs and symptoms associated with hypoglycemia include nervousness, diaphoresis, weakness, light-headedness, confusion, paresthesia, irritability, headache, hunger, tachycardia, and changes in speech, hearing, or vision. If untreated, signs and symptoms may progress to unconsciousness, seizures, coma, and death. Polydipsia, polyuria, and polyphagia are symptoms associated with hyperglycemia.

Which clinical characteristic is associated with type 1 diabetes (previously referred to as insulin-dependent diabetes mellitus)? - Presence of islet cell antibodies - Obesity - Rare ketosis - Requirement for oral hypoglycemic agents

- Presence of islet cell antibodies Explanation: Individuals with type 1 diabetes often have islet cell antibodies and are usually thin or demonstrate recent weight loss at the time of diagnosis. These individuals are prone to experiencing ketosis when insulin is absent and require exogenous insulin to preserve life.

A client who was diagnosed with type 1 diabetes 14 years ago is admitted to the medical-surgical unit with abdominal pain. On admission, the client's blood glucose level is 470 mg/dl. Which finding is most likely to accompany this blood glucose level? - Cool, moist skin - Rapid, thready pulse - Arm and leg trembling - Slow, shallow respirations

- Rapid, thready pulse Explanation: This client's abnormally high blood glucose level indicates hyperglycemia, which typically causes polyuria, polyphagia, and polydipsia. Because polyuria leads to fluid loss, the nurse should expect to assess signs of deficient fluid volume, such as a rapid, thready pulse; decreased blood pressure; and rapid respirations. Cool, moist skin and arm and leg trembling are associated with hypoglycemia. Rapid respirations — not slow, shallow ones — are associated with hyperglycemia.

Lispro (Humalog) is an example of which type of insulin? - Rapid-acting - Intermediate-acting - Short-acting - Long-acting

- Rapid-acting Explanation: Humalog is a rapid-acting insulin. NPH is an intermediate-acting insulin. A short-acting insulin is Humulin-R. An example of a long-acting insulin is Glargine (Lantus).

The nurse is explaining glycosylated hemoglobin testing to a diabetic client. Which of the following provides the best reason for this order? - Provides best information on the body's ability to maintain normal blood functioning - Best indicator for the nutritional state of the client - Is less costly than performing daily blood sugar test - Reflects the amount of glucose stored in hemoglobin over past several months.

- Reflects the amount of glucose stored in hemoglobin over past several months. Explanation: Hemoglobin A1c tests reflect the amount of glucose that is stored in the hemoglobin molecule during its life span of 120 days. This test provides a more accurate picture of overall glucose control in a client. Glycosylated hemoglobin test does not indicate normal blood functioning or nutritional state of the client. Self-monitoring with a glucometer is still encouraged in clients who are taking insulin or have unstable blood glucose levels.

A client is admitted to the unit with diabetic ketoacidosis (DKA). Which insulin would the nurse expect to administer intravenously? - Glargine - Regular - NPH - Lente

- Regular Explanation: Regular insulin is administered intravenously to treat DKA. It is added to an IV solution and infused continuously. Glargine, NPH, and Lente are only administered subcutaneously.

The nurse is administering an insulin drip to a patient in ketoacidosis. What insulin does the nurse know is the only one that can be used intravenously? - NPH - Regular - Lispro - Lantus

- Regular Explanation: Short-acting insulins are called regular insulin (marked R on the bottle). Regular insulin is a clear solution and is usually administered 20 to 30 minutes before a meal, either alone or in combination with a longer-acting insulin. Regular insulin is the only insulin approved for IV use.

A patient has been newly diagnosed with type 2 diabetes, and the nurse is assisting with the development of a meal plan. What step should be taken into consideration prior to making the meal plan? - Making sure that the patient is aware that quantity of foods will be limited - Ensuring that the patient understands that some favorite foods may not be allowed on the meal plan and substitutes will need to be found - Determining whether the patient is on insulin or taking oral antidiabetic medication - Reviewing the patient's diet history to identify eating habits and lifestyle and cultural eating patterns

- Reviewing the patient's diet history to identify eating habits and lifestyle and cultural eating patterns Explanation: The first step in preparing a meal plan is a thorough review of the patient's diet history to identify eating habits and lifestyle and cultural eating patterns.

The client with diabetes asks the nurse why shoes and socks are removed at each office visit. The nurse gives which assessment finding as the explanation for the inspection of feet? - Autonomic neuropathy - Retinopathy - Sensory neuropathy - Nephropathy

- Sensory neuropathy Explanation: Neuropathy results from poor glucose control and decreased circulation to nerve tissues. Neuropathy involving sensory nerves located in the periphery can lead to lack of sensitivity, which increases the potential for soft tissue injury without client awareness. The client's feet are inspected on each visit to ensure no injury or pressure has occurred. Autonomic neuropathy, retinopathy, and nephropathy affect nerves to organs other than feet.

A client with diabetes mellitus has a prescription for 5 units of U-100 regular insulin and 25 units of U-100 isophane insulin suspension (NPH) to be taken before breakfast. At about 4:30 p.m., the client experiences headache, sweating, tremor, pallor, and nervousness. What is the most probable cause of these signs and symptoms? - Serum glucose level of 450 mg/dl - Serum glucose level of 52 mg/dl - Serum calcium level of 8.9 mg/dl - Serum calcium level of 10.2 mg/dl

- Serum glucose level of 52 mg/dl Explanation: Headache, sweating, tremor, pallor, and nervousness typically result from hypoglycemia, an insulin reaction in which serum glucose level drops below 70 mg/dl. Hypoglycemia may occur 4 to 18 hours after administration of isophane insulin suspension or insulin zinc suspension (Lente), which are intermediate-acting insulins. Although hypoglycemia may occur at any time, it usually precedes meals. Hyperglycemia, in which serum glucose level is above 180 mg/dl, causes such early manifestations as fatigue, malaise, drowsiness, polyuria, and polydipsia. A serum calcium level of 8.9 mg/dl or 10.2 mg/dl is within normal range and wouldn't cause the client's symptoms.

Laboratory studies indicate a client's blood glucose level is 185 mg/dl. Two hours have passed since the client ate breakfast. Which test would yield the most conclusive diagnostic information about the client's glucose use? - Fasting blood glucose test - 6-hour glucose tolerance test - Serum glycosylated hemoglobin (Hb A1c) - Urine ketones

- Serum glycosylated hemoglobin (Hb A1c) Explanation: Hb A1c is the most reliable indicator of glucose use because it reflects blood glucose levels for the prior 3 months. Although a fasting blood glucose test and a 6-hour glucose tolerance test yield information about a client's use of glucose, the results are influenced by such factors as whether the client recently ate breakfast. Presence of ketones in the urine also provides information about glucose use but is limited in its diagnostic significance.

A client with a tentative diagnosis of hyperosmolar hyperglycemic nonketotic syndrome (HHNS) has a history of type 2 diabetes that is being controlled with an oral diabetic agent, tolazamide. Which laboratory test is the most important for confirming this disorder? - Serum potassium level - Serum sodium level - Arterial blood gas (ABG) values - Serum osmolarity

- Serum osmolarity Explanation: Serum osmolarity is the most important test for confirming HHNS; it's also used to guide treatment strategies and determine evaluation criteria. A client with HHNS typically has a serum osmolarity of more than 350 mOsm/L. Serum potassium, serum sodium, and ABG values are also measured, but they aren't as important as serum osmolarity for confirming a diagnosis of HHNS. A client with HHNS typically has hypernatremia and osmotic diuresis. ABG values reveal acidosis, and the potassium level is variable.

A client with status asthmaticus requires endotracheal intubation and mechanical ventilation. Twenty-four hours after intubation, the client is started on the insulin infusion protocol. The nurse must monitor the client's blood glucose levels hourly and watch for which early signs and symptoms associated with hypoglycemia? - Sweating, tremors, and tachycardia - Dry skin, bradycardia, and somnolence - Bradycardia, thirst, and anxiety - Polyuria, polydipsia, and polyphagia

- Sweating, tremors, and tachycardia Explanation: Sweating, tremors, and tachycardia, thirst, and anxiety are early signs of hypoglycemia. Dry skin, bradycardia, and somnolence are signs and symptoms associated with hypothyroidism. Polyuria, polydipsia, and polyphagia are signs and symptoms of diabetes mellitus.

Insulin is a hormone secreted by the Islets of Langerhans and is essential for the metabolism of carbohydrates, fats, and protein. The nurse understands the physiologic importance of gluconeogenesis, which refers to the: - Transport of potassium. - Release of glucose. - Synthesis of glucose from noncarbohydrate sources. - Storage of glucose as glycogen in the liver.

- Synthesis of glucose from noncarbohydrate sources. Explanation: Gluconeogenesis refers to the making of glucose from noncarbohydrates. This occurs mainly in the liver. Its purpose is to maintain the glucose level in the blood to meet the body's demands.

Which of the following factors would a nurse identify as a most likely cause of diabetic ketoacidosis (DKA) in a client with diabetes? - The client continues medication therapy despite adequate food intake. - The client has not consumed sufficient calories. - The client has been exercising more than usual. - The client has eaten and has not taken or received insulin.

- The client has eaten and has not taken or received insulin. Explanation: If the client has eaten and has not taken or received insulin, DKA is more likely to develop. Hypoglycemia is more likely to develop if the client has not consumed food and continues to take insulin or oral antidiabetic medications, if the client has not consumed sufficient calories, or if client has been exercising more than usual.

The pancreas continues to release a small amount of basal insulin overnight, while a person is sleeping. The nurse knows that if the body needs more sugar: - The pancreatic hormone glucagon will stimulate the liver to release stored glucose. - Insulin will be released to facilitate the transport of sugar. - Glycogenesis will be decreased by the liver. - The process of gluconeogenesis will be inhibited.

- The pancreatic hormone glucagon will stimulate the liver to release stored glucose. Explanation: When sugar levels are low, glucagon promotes hyperglycemia by stimulating the release of stored glucose. Glycogenolysis and gluconeogenesis will both be increased. Insulin secretion would promote hypoglycemia.

A nurse educator been invited to local seniors center to discuss health-maintaining strategies for older adults. The nurse addresses the subject of diabetes mellitus, its symptoms, and consequences. What should the educator teach the participants about type 1 diabetes? - The participants are unlikely to develop a new onset of type 1 diabetes. - New cases of diabetes are highly uncommon in older adults. - New cases of diabetes will be split roughly evenly between type 1 and type 2. - Type 1 diabetes always develops before the age of 20.

- The participants are unlikely to develop a new onset of type 1 diabetes. Explanation: Type 1 diabetes usually (but not always) develops in people younger than 20. In older adults, an onset of type 2 is far more common. A significant number of older adults develops type 2 diabetes.

A nurse is preparing to administer two types of insulin to a client with diabetes mellitus. What is the correct procedure for preparing this medication? - The short-acting insulin is withdrawn before the intermediate-acting insulin. - The intermediate-acting insulin is withdrawn before the short-acting insulin. - Different types of insulin are not to be mixed in the same syringe. - If administered immediately, there is no requirement for withdrawing one type of insulin before another.

- The short-acting insulin is withdrawn before the intermediate-acting insulin. Explanation: When combining two types of insulin in the same syringe, the short-acting regular insulin is withdrawn into the syringe first and the intermediate-acting insulin is added next. This practice is referred to as "clear to cloudy."

A client with diabetes mellitus develops sinusitis and otitis media accompanied by a temperature of 100.8° F (38.2° C). What effect do these findings have on his need for insulin? - They have no effect. - They decrease the need for insulin. - They increase the need for insulin. - They cause wide fluctuations in the need for insulin.

- They increase the need for insulin. Explanation: Insulin requirements increase in response to growth, pregnancy, increased food intake, stress, surgery, infection, illness, increased insulin antibodies, and some medications. Insulin requirements are decreased by hypothyroidism, decreased food intake, exercise, and some medications.

A client receives a daily injection of glargine insulin at 7:00 a.m. When should the nurse monitor this client for a hypoglycemic reaction? - Between 8:00 and 10:00 a.m. - Between 4:00 and 6:00 p.m. - Between 7:00 and 9:00 p.m. - This insulin has no peak action and does not cause a hypoglycemic reaction.

- This insulin has no peak action and does not cause a hypoglycemic reaction. Explanation: "Peakless" basal or very long-acting insulins are approved by the U.S. Food and Drug Administration for use as a basal insulin; that is, the insulin is absorbed very slowly over 24 hours and can be given once a day. It has is no peak action.

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? - To decrease the possibility of nausea and vomiting - To restore liver glycogen and prevent secondary hypoglycemia - To stimulate her appetite - To decrease the amount of glycogen in her system

- To restore liver glycogen and prevent secondary hypoglycemia Explanation: A client with type 1 diabetes who requires glucagon should be given a complex carbohydrate snack as soon as possible to restore the liver glycogen and prevent secondary hypoglycemia. A complex carbohydrate snack doesn't decrease the possibility of nausea and vomiting or stimulate the appetite, and it increases the amount of glycogen in the system.

The greatest percentage of people have which type of diabetes? - Type 2 - Type 1 - Gestational - Impaired glucose tolerance

- Type 2 Explanation: Type 2 diabetes accounts for 90% to 95% of all diabetes. Type 1 accounts for 5% to 10% of all diabetes. Gestational diabetes has an onset during pregnancy. Impaired glucose tolerance is defined as an oral glucose tolerance test value between 140 mg/dL and 200 mg/dL.

A client with type 2 diabetes asks the nurse why he can't have a pancreatic transplant. Which of the following would the nurse include as a possible reason? - Increased risk for urologic complications - Need for exocrine enzymatic drainage - Underlying problem of insulin resistance - Need for lifelong immunosuppressive therapy

- Underlying problem of insulin resistance Explanation: Clients with type 2 diabetes are not offered the option of a pancreas transplant because their problem is insulin resistance, which does not improve with a transplant. Urologic complications or the need for exocrine enzymatic drainage are not reasons for not offering pancreas transplant to clients with type 2 diabetes. Any transplant requires lifelong immunosuppressive drug therapy and is not the factor.

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

- When mixing insulin, the regular insulin is drawn up into the syringe first. Explanation: When rapid-acting or short-acting insulins are to be given simultaneously with longer-acting insulins, they are usually mixed together in the same syringe; the longer-acting insulins must be mixed thoroughly before being drawn into the syringe. The American Diabetic Association recommends that the regular insulin be drawn up first. The most important issues are that patients (1) are consistent in technique, so the wrong dose is not drawn in error or the wrong type of insulin, and (2) do not inject one type of insulin into the bottle containing a different type of insulin. Injecting cloudy insulin into a vial of clear insulin contaminates the entire vial of clear insulin and alters its action.

A client with diabetes mellitus is receiving an oral antidiabetic agent. When caring for this client, the nurse should observe for signs of: - hypoglycemia - polyuria - blurred vision - polydipsia

- hypoglycemia Explanation: The nurse should observe the client receiving an oral antidiabetic agent for the signs of hypoglycemia. The time when the reaction might occur is not predictable and could be from 30 to 60 minutes to several hours after the drug is ingested.

Which is a characteristic of type 2 diabetes? - insulin resistance - presence of islet antibodies - little or no insulin - ketosis-prone when insulin absent

- insulin resistance Explanation: Type 2 diabetes is characterized by either a decrease in endogenous insulin or an increase accompanied by insulin resistance. Type 1 diabetes is characterized by production of little or no insulin; the client with type 1 diabetes is ketosis-prone when insulin is absent and often has islet cell antibodies.

A client with a history of type 1 diabetes is demonstrating fast, deep, labored breathing and has fruity odored breath. What could be the cause of the client's current serious condition? - ketoacidosis - hyperosmolar hyperglycemic nonketotic syndrome - hepatic disorder - All options are correct.

- ketoacidosis Explanation: Kussmaul respirations (fast, deep, labored breathing) are common in ketoacidosis. Acetone, which is volatile, can be detected on the breath by its characteristic fruity odor. If treatment is not initiated, the outcome of ketoacidosis is circulatory collapse, renal shutdown, and death. Ketoacidosis is more common in people with diabetes who no longer produce insulin, such as those with type 1 diabetes. People with type 2 diabetes are more likely to develop hyperosmolar hyperglycemic nonketotic syndrome because with limited insulin, they can use enough glucose to prevent ketosis but not enough to maintain a normal blood glucose level.

A client has been recently diagnosed with type 2 diabetes, and reports continued weight loss despite increased hunger and food consumption. This condition is called: - polyphagia. - polydipsia. - polyuria. - anorexia.

- polyphagia. Explanation: While the needed glucose is being wasted, the body's requirement for fuel continues. The person with diabetes feels hungry and eats more (polyphagia). Despite eating more, he or she loses weight as the body uses fat and protein to substitute for glucose.

A nurse is assigned to care for a postoperative client with diabetes mellitus. During the assessment interview, the client reports that he's impotent and says he's concerned about the effect on his marriage. In planning this client's care, the most appropriate intervention would be to: - encourage the client to ask questions about personal sexuality. - provide time for privacy. - provide support for the spouse or significant other. - suggest referral to a sex counselor or other appropriate professional.

- suggest referral to a sex counselor or other appropriate professional. Explanation: The nurse should refer this client to a sex counselor or other professional. Making appropriate referrals is a valid part of planning the client's care. The nurse doesn't normally provide sex counseling.