Med Surg Study Session 3
The nurse is caring for a newly admitted older adult who has a blood glucose of 300mg/dL (16.7mmol/L), a urine output of 185mL in the past 8 hours, and a blood urea nitrogen (BUN) of 44mg/dL (15.7mmol/L). What diabetic complication does the nurse suspect?
Hyperglycemic-hyperosmolar state (HHS)
The nurse assesses a client with diabetic ketoacidosis. Which assessment finding would the nurse correlate with this condition?
Increased rate and depth of respiration.
A nurse cares for a client with diabetes mellitus who asks "why do I need to administer more than one injection of insulin each day?" How would the nurse respond?
"A single dose of insulin each day would not match your blood insulin levels and your food intake patterns"
A nurse teaches a client with type 2 diabetes mellitus who is prescribed glipizide (Glucotrol). Which statement would the nurse include in this client's teaching?
"Avoid taking nonsteroidal anti-inflammatory drugs (NSAIDs)"
The nurse is planning teaching for a client who is starting acarbose for diabetes mellitus type 2. Which statement will the nurse include in the teaching?
"Be sure to take the drug with each meal"
A nurse teaches a client with diabetes mellitus about foot care. Which statements would the nurse include in this client's teaching? (select all that apply)
"Do not walk around barefoot", "Trim toenails straight across with a nail clipper"
After teaching a client who is newly diagnosed with type 2 diabetes mellitus, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching?
"I should decrease my intake of protein and eliminate carbohydrates from my diet"
After teaching a client who has diabetes mellitus with retinopathy, nephropathy, and peripheral neuropathy, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the teaching?
"I should look into swimming or water aerobics to get my exercise"
After teaching a patient with type 2 diabetes mellitus who is prescribed nateglinide, the nurse assesses the client's understanding. Which statement made by the patient indicates a correct understanding of the prescribed therapy?
"I will take this medicine immediately before I eat"
After teaching a client who is recovering from pancreas transplantation, the nurse assesses the client's understanding. Which statement made by the client indicates a need for further teaching?
"If I develop an infection, I should stop taking my corticosteroid"
A nurse teaches a client who is diagnosed with diabetes mellitus. Which statement would the nurse include in this client's plan of care to delay the onset of microvascular and macrovascular complications?
"Maintain tight glycemic control and prevent hyperglycemia"
A nurse teaches a client with diabetes mellitus about sick day management. Which statement would the nurse include in this client's teaching?
"Monitor your blood glucose levels at least every 4 hours while sick"
When teaching a client recently diagnosed with type 1 diabetes mellitus, the client states. "I will never be able to stick myself with a needle." How would the nurse respond?
"Tell me what it is about the injections that are concerning you"
After teaching a client with diabetes mellitus to inject insulin, the nurse assesses the client's understanding. Which statement made by the client indicates a need for further teaching?
"The lower abdomen is the best location because it is closest to the pancreas"
A nurse teaches a client with diabetes mellitus who is experiencing numbness and reduced sensation. Which statement would the nurse include in this client's teaching to prevent injury?
"Use a bath thermometer to test the water temperature"
A nurse teaches a client with type 1 diabetes mellitus. Which statement would the nurse include in this client's teaching to decrease the client's insulin needs?
"Walk at a moderate pace for 1 mile daily."
The nurse is caring for a client who has diabetes mellitus. The nurse administers 6 units of regular insulin and 10 units of NPH insulin at 7am (0700). At which time would the nurse assess the client for potential hypoglycemia related to the NPH insulin?
4pm (1600)
A nurse reviews the laboratory test values for a client with a new diagnosis of diabetes mellitus type 2. Which A1c value would the nurse expect?
7.4%
A nurse assesses adults at a health fair. Which adults would the nurse counsel to be tested for diabetes? (select all that apply)
A 56 year old African-American male, A 48 year old female with a sedentary lifestyle, A 50 year old male with a body mass index greater than 25kg/m, A 28 year old female who gave birth to a baby weighing 9.2lb (4.2kg)
A nurse assesses clients who are at risk for diabetes mellitus. Which client is at greatest risk?
A 58 year old American Indian
A nurse assesses a patient who is experiencing diabetic ketoacidosis (DKA). For which assessment findings would the nurse monitor the client? (select all that apply)
Orthostatic hypotension, tachycardia, deep and fast respirations
The nurse is assessing a client for risk of developing metabolic syndrome. Which risk factor is associated with this health condition?
Abdominal obesity
A nurse assesses a client who has diabetes mellitus and notes that the client is awake and alert, but shaky, diaphoretic, and weak. Five minutes after administering a half cup (120mL) of orange juice, the client's signs and symptoms have not changes. What action would the nurse take next?
Administer another half cup (120mL) of orange juice
A nurse cares for a client experiencing diabetic ketoacidosis who presents with Kussmaul respirations. What action would the nurse take?
Administration of intravenous insulin.
The nurse is caring for a client who has severe hypoglycemia and is experiencing a seizure. What actions will the nurse take at this time? (select all that apply)
Be sure the bed side rails are in the upright position, Notify the primary health care provider immediately, Monitor the client's blood glucose level, Administer glucagon 1mg subcutaneously
A nurse provides diabetic education at a public health fair. Which disorders would the nurse include as complications of diabetes mellitus? (select all that apply)
Blindness, kidney failure, stroke
A nurse collaborates with the interprofessional team to develop a plan of care for a client who is newly diagnosed with diabetes mellitus. Which team members would the nurse include in this interprofessional team meeting? (select all that apply)
Clinical pharmacist, registered dietician nutritionist, primary health care provider
The nurse is caring for a newly admitted client who is diagnosed with hyperglycemic-hyperosmolar state (HHS). What is the nurse's priority action at this time?
Establish intravenous access to provide flushes
A nurse assesses a client who has a 15 year history of diabetes and notes decreased tactile sensation in both feet. What action would the nurse take first?
Examine the client's feet for signs of injury
A nurse assesses a client with diabetes mellitus who self-administers subcutaneous insulin. The nurse notes a spongey, swelling area at the site the client uses most frequently for insulin injection. What action would the nurse take?
Instruct the client to rotate sites for insulin injection.
The nurse is caring for a client who has diabetes mellitus type 1 and is experiencing hypoglycemia. Which assessment findings will the nurse expect? (select all that apply)
Nervousness, blurred vision
A nurse assesses a client with diabetes mellitus. Which assessment finding would alert the nurse to decreased kidney function in this client?
Presence of protein in urine.
A nurse develops a dietary plan for a client with diabetes mellitus and new onset microalbuminuria. Which component of the client's diet would the nurse decrease?
Proteins
A nurse reviews the laboratory results of a client who is receiving intravenous insulin. Which would alert the nurse to intervene immediately?
Serum potassium level of 2.5 mEq/L (2.5mmol/L)
A nurse assesses a client who has diabetes mellitus. Which arterial blood gas values would the nurse identify as potential ketoacidosis in this client?
pH7.28, HCO2-18mEq/L (18mmol/L), PCO2-28mmHg, PO2-98mmHg
After teaching a young adult client who is newly diagnosed with type 1 diabetes mellitus, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the need for eye examination?
"Diabetes can cause blindness, so I should see the ophthalmologist yearly"
A nurse teaches a patient about self monitoring of blood glucose levels. Which statement would the nurse include in this clients teaching to prevent bloodborne infections?
"Do not share your monitoring equipment"
The nurse is planning teaching for a client who is starting exenatide extended release (ER) for diabetes mellitus type 2. Which statement will the nurse include in the teaching?
"Give your drug injection the same day every week"
A nurse cares for a patient who is prescribed pioglitazone. After 6 months of therapy, the client reports that he has a new onset of ankle edema. What assessment question would the nurse take?
"Have you gained unexpected weight this week?"
1. A nurse is teaching a client with diabetes mellitus who asks, "why is it necessary to maintain my blood glucose levels no lower than about 60 mg/dL?" How would the nurse respond?
"Your brain needs a constant supply of glucose because it cannot store it"
A nurse cares for a client who has a family history of diabetes mellitus. The client states, "my father has type 1 diabetes mellitus. Will I develop this disease as well?" How would the nurse respond?
"Your risk of diabetes is higher than the general population, but it may not occur"
A nurse reviews laboratory results for a client with diabetes mellitus who is prescribed an intensified insulin regimen: Fasting blood glucose: 75mg/dL (4.2mmol/L) Postprandial blood glucose: 200mg/dL (11.1mmol/L) Hemoglobin A1c level: 5.5% How would the nurse interpret these laboratory findings?
Good control of blood glucose