Metabolism

When assessing the patient experiencing the onset of symptoms of type 1 diabetes, which question should the nurse ask? a. "Have you lost any weight lately?" b. "Do you crave fluids containing sugar?" c. "How long have you felt anorexic?" d. "Is your urine unusually dark-colored?"

A "Have you lost any weight lately?" Rationale: Weight loss occurs because the body is no longer able to absorb glucose and starts to break down protein and fat for energy. The patient is thirsty but does not necessarily crave sugar- containing fluids. Increased appetite is a classic symptom of type 1 diabetes. With the classic symptom of polyuria, urine will be very dilute.

The nurse has been teaching the patient to administer a dose of 10 units of regular insulin and 28 units of NPH insulin. The statement by the patient that indicates a need for additional instruction is, a. "I need to rotate injection sites among my arms, legs, and abdomen each day." b. "I will buy the 0.5-ml syringes because the line markings will be easier to see." c. "I should draw up the regular insulin first after injecting air into the NPH bottle." d. "I do not need to aspirate the plunger to check for blood before I inject the insulin."

A. "I need to rotate injection sites among my arms, legs, and abdomen each day." Rationale: Rotating sites is no longer necessary because all insulin is now purified human insulin, and the risk for lipodystrophy is low. The other patient statements are accurate and indicate that no additional instruction is needed.

A nurse is caring for a client admitted to the ER with DKA. In the acute phase the priority nursing action is to prepare to: A. Administer regular insulin intravenously B. Administer 5% dextrose intravenously C. Correct the acidosis D. Apply an electrocardiogram monitor

A. Administer regular insulin intravenously

A 36-year-old male is newly diagnosed with Type 2 diabetes. Which of the following treatments do you expect the patient to be started on initially? A. Diet and exercise regime B. Metformin BID by mouth C. Regular insulin subcutaneous D. None, monitoring at this time is sufficient enough

A. Diet and exercise regime

A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the ER. Which finding would a nurse expect to note as confirming this diagnosis? A. Elevated blood glucose level and a low plasma bicarbonate B. Decreased urine output C. Increased respiration and an increase in pH D. Comatose state

A. Elevated blood glucose level and a low plasma bicarbonate

An external insulin pump is prescribed for a client with DM. The client asks the nurse about the functioning of the pump. The nurse bases the response on the information that the pump: A. Gives a small continuous dose of regular insulin subcutaneously, and the client can self-administer a bolus with an additional dosage from the pump before each meal. B. It is timed to release programmed doses of regular or NPH insulin into the bloodstream at specific intervals. C. It is surgically attached to the pancreas and infuses regular insulin into the pancreas, which in turn releases the insulin into the bloodstream. D. It continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels.

A. Gives a small continuous dose of regular insulin subcutaneously, and the client can self-administer a bolus with an additional dosage from the pump before each meal.

A nurse is preparing a plan of care for a client with diabetes mellitus who has hyperglycemia. The priority nursing diagnosis would be: A. High risk for deficient fluid volume B. Deficient knowledge: disease process and treatment C. Imbalanced nutrition: less than body requirements D. Disabled family coping: compromised

A. High risk for deficient fluid volume

The nurse is admitting a patient diagnosed with type 2 diabetes mellitus. The nurse should expect the following symptoms during an assessment, except: A. Hypoglycemia B. Frequent bruising C. Ketonuria D. Dry mouth

A. Hypoglycemia

A 63-year-old patient is newly diagnosed with type 2 diabetes. When developing an education plan, the nurse's first action should be to: a. assess the patient's perception of what it means to have type 2 diabetes. b. demonstrate how to check glucose using capillary blood glucose monitoring. c. ask the patient's family to participate in the diabetes education program. d. discuss the need for the patient to actively participate in diabetes management.

A. assess the patient's perception of what it means to have type 2 diabetes.Rationale: Before planning education, the nurse should assess the patient's interest in and ability to self-manage the diabetes. After assessing the patient, the other nursing actions may be appropriate, but planning needs to be individualized to each patient.

The nurse is teaching an in-service about metabolic disorders. Which person is at the greatest risk for malnutrition as a result of hypermetabolism? A) A client with chronic obstructive pulmonary disease B) A client with osteoporosis C) A client who is a vegetarian D) A client who has dysphagia

Answer: A Explanation: A) The client with chronic obstructive pulmonary disease often is malnourished because of the increased caloric need associated with breathing efforts. The client with dysphagia is at risk for malnutrition because of the inability to eat adequate amounts of foods. Patients with osteoporosis do not have higher metabolic rates. There is no connection between hypermetabolism and vegetarianism.

The client with diabetes mellitus reports having difficulty cutting his toenails because they are thick and ingrown. What should the nurse recommend to this client? A) Make an appointment with a podiatrist. B) Offer to file the tops of the nails to reduce thickness after cutting. C) Cut the nails straight across with a clipper after the bath. D) Make an appointment with a nail shop for a pedicure.

Answer: A Explanation: A) The toenails of the client with diabetes require close care. If the nails are thick or ingrown, they require the attention of a podiatrist. Cutting the nails across after the bath is correct for toenails that do not demonstrate the complications listed. The client with diabetes is at an increased risk for infection and should avoid situations in which this risk is increased, such as the nail shop pedicure. The nurse should not cut the client's toenails.

The nurse expects that a type 1 diabetic may receive how much of his or her morning dose of insulin preoperatively? A. 10-20% B. 25-40% C. 50-60% D. 85-90%

C. 50-60%

The nurse, teaching a class to a group of community members about the importance of weight loss in decreasing the risk of type 2 diabetes mellitus, is asked why weight loss reduces the risk associated with the development of this health problem. Which response by the nurse is most correct? A) "Excess body weight impairs the body's release of insulin." B) "The amount of food taken in by those who are overweight requires more insulin to adequately metabolize them, resulting in diabetes." C) "The physical inactivity associated with obesity causes a reduced ability by the body to produce insulin." D) "Thin people are less likely to become diabetic."

Answer: A) "Excess body weight impairs the body's release of insulin." Explanation: A) Beta cells of the body release insulin. Their actions are hindered as the amount of adipose tissue in the body increases. The amount of food taken in is not the issue as much as the excess body weight. The body does require more insulin with a greater food intake, but that does not necessarily result in diabetes. While obesity is a risk factor for the development of diabetes, this does not meet the question posed by the client. Inactivity is directly linked to obesity, but it does not present a direct tie to the production of insulin

The nurse is concerned that a school-age child has undiagnosed type 1 diabetes mellitus and is experiencing diabetic ketoacidosis. What did the nurse assess in the client to come to this conclusion? Select all that apply. A) Blurred vision B) Irregular heartbeat C) Sunken eye sockets D) Sluggish bowel sounds E) Dry mucous membranes

Answer: A, B, C, E A) Blurred vision B) Irregular heartbeat C) Sunken eye sockets E) Dry mucous membranes Explanation: The clinical manifestations of all forms of diabetes in children include blurred vision. The clinical hallmarks of diabetic ketoacidosis are dehydration and electrolyte imbalance. An irregular heartbeat can occur with an electrolyte imbalance. Sunken eye sockets and dry mucous membranes are seen in dehydration. Sluggish bowel sounds are not an indication of diabetes or diabetic ketoacidosis.

A client is experiencing health problems related to alterations in adrenal medulla function. On which areas should the nurse focus when assessing this client? Select all that apply. A) Heart rate B) Weight C) Respiratory rate D) Skin integrity E) Blood pressure

Answer: A, B, C, E A) Heart rate B) Weight C) Respiratory rate E) Blood pressure

The nurse is planning care for an 86-year-old client with type 2 diabetes mellitus. Which nursing diagnosis would be most appropriate for this client? A) Risk for Falls B) Risk for Infection C) Ineffective Tissue Perfusion: Cardiac D) Impaired Tissue Integrity

Answer: B) Risk for Infection Explanation: A client with diabetes mellitus is at risk for infection. No other information is given in the question with regard to risk for falls, ineffective tissue perfusion, or impaired tissue integrity as potential nursing diagnoses.

The Intensive Care nurse is preparing to admit a school-age child for treatment of diabetic ketoacidosis. On what should the nurse focus for this client's care? Select all that apply. A) Peripheral perfusion B) Fluid volume overload C) Frequent blood glucose monitoring D) Intravenous fluid infusions E) Insulin infusion

Answer: B, C, D, E Explanation: A) For the child experiencing diabetic ketoacidosis, frequent blood sugar monitoring, IV fluids, and insulin drips for treatment mandate that the child be cared for in an Intensive Care environment until stabilized. The child will be dehydrated and most likely will not need treatment for fluid volume overload. The child has not lost any blood volume, so peripheral perfusion will most likely not be a concern.

An older client is diagnosed with disorders of fat metabolism, reduced absorption of fat-soluble vitamins, and slightly elevated blood glucose level. When caring for this client, on which endocrine organ should the nurse focus interventions? A) Pituitary B) Thyroid C) Pancreas D) Adrenal medulla

Answer: C

The healthcare provider prescribes sitagliptin (Januvia) for a client with type 2 diabetes mellitus. For which potential side effect should the nurse monitor in this client? A) Elevated blood lipid levels B) Hyperglycemia C) Pancreatitis D) Renal insufficiency

Answer: C Explanation: A potential side effect of sitagliptin (Januvia) is pancreatitis, and the client must be monitored for this. Sitagliptin (Januvia) does not cause elevated blood lipids, hyperglycemia, or renal insufficiency.

A 58-year-old client who is newly diagnosed with type 2 diabetes has smoked for 30 years. When teaching the client on ways to optimize health outcomes, what should the nurse explain about the effects of smoking and diabetes? A) Smoking is a major factor in the development of diabetic neuropathy. B) Smoking increases insulin resistance. C) Smoking accelerates arteriosclerotic changes in blood vessels. D) Smoking promotes weight gain.

Answer: C)Smoking accelerates arteriosclerotic changes in blood vessels Explanation: A) Smoking is especially unhealthy for diabetic clients because smoking accelerates the arteriosclerotic effects that occur in blood vessels from elevated levels of blood glucose. Smoking is not associated with weight gain; in fact, people use weight gain as an excuse not to quit smoking. Poor glycemic control in diabetics is associated with the development of complications including diabetic neuropathy. Smoking does not affect insulin resistance.

The nurse is completing an assessment interview with a client being seen for a yearly physical examination. Which client statement would indicate a possible diagnosis of diabetes? A) "I'm slightly winded when I walk up a flight of stairs, but it passes quickly." B) "I feel a bit tired by mid-afternoon and take a 30-minute nap most days." C) "I sometimes have muscle aches in my upper legs at night." D) "I've been experiencing increased thirst during the past several months."

Answer: D) "I've been experiencing increased thirst during the past several months." Explanation: Excessive thirst can be associated with high glucose levels and may be a symptom of undiagnosed diabetes mellitus. Fatigue that responds to a short nap, having some muscle aches at night, and being slightly short of breath after walking up a flight of stairs with a quick recovery may be within the normal functioning of a healthy older client.

A client newly diagnosed with type 1 diabetes mellitus tells the nurse that the diagnosis must be wrong because the client is not overweight, eats all of the time, and is thin. What should the nurse respond to the client? A) "Thin people can be diabetic, too." B) "Your condition makes it impossible for you to gain weight." C) "Your lab tests indicate the presence of diabetes." D) "You are eating large quantities because your condition makes it difficult for your body to obtain energy from the foods taken in."

Answer: D) "You are eating large quantities because your condition makes it difficult for your body to obtain energy from the foods taken in." Explanation: The diabetic client is unable to obtain the needed glucose for the body's cells, due to the lack of insulin. Patients diagnosed with type 1 diabetes mellitus experience polyphagia, and are often thin. While the statement about diabetics being thin is correct, it does not answer the client. It is not impossible for diabetics to gain weight. Although the laboratory tests might indicate the presence of diabetes, this does not meet the client's needs for teaching

The nurse is preparing to teach a client who is newly diagnosed with type 1 diabetes mellitus on the preferred area to self-inject insulin. On which area should the nurse focus based upon insulin absorption rates? A) Deltoid B) Thigh C) Hip D) Abdomen

Answer: D) Abdomen Explanation: The rate of absorption and peak of action of insulin differ according to the site. The site that allows the most rapid absorption is the abdomen, followed by the deltoid muscle, then the thigh, and then the hip. Because of the rapid absorption, the abdomen is the recommended site.

Albert, a 35-year-old insulin-dependent diabetic, is admitted to the hospital with a diagnosis of pneumonia. He has been febrile since admission. His daily insulin requirement is 24 units of NPH. Every morning Albert is given NPH insulin at 0730. Meals are served at 0830, 1230, and 1830. The nurse expects that the NPH insulin will reach its maximum effect (peak) between the hours of: A. 1130 and 1330 B. 1330 and 1930 C. 1530 and 2130 D. 1730 and 2330

B. 1330 and 1930 The peak time of insulin is the time it is working the hardest to lower the blood glucose. NPH insulin is an intermediate-acting insulin that has an onset of 1 to 3 hours after injection, peaks 4 to 12 hours later, and is effective for about 12 to 16 hours.

A patient receives a daily injection of 70/30 NPH/regular insulin premix at 7:00 AM. The nurse expects that a hypoglycemic reaction is most likely to occur between a. 8:00 and 10:00 AM. b. 4:00 and 6:00 PM. c. 7:00 and 9:00 PM. d. 10:00 PM and 12:00 AM.

B. 4:00 and 6:00 PM. Rationale: The greatest insulin effect with this combination occurs mid afternoon. The patient is not at a high risk at the other listed times, although hypoglycemia may occur.

Glycosylated hemoglobin (HbA1C) test measures the average blood glucose control of an individual over the previous three months. Which of the following values is considered a diagnosis of pre-diabetes? A. 6.5-7% B. 5.7-6.4% C. 5-5.6% D. >5.6%

B. 5.7-6.4%

A client is taking NPH insulin daily every morning. The nurse instructs the client that the most likely time for a hypoglycemic reaction to occur is: A. 2-4 hours after administration B. 6-14 hours after administration C. 16-18 hours after administration D. 18-24 hours after administration

B. 6-14 hours after administration

A clinical feature that distinguishes a hypoglycemic reaction from a ketoacidosis reaction is: A. Blurred vision B. Diaphoresis C. Nausea D. Weakness

B. Diaphoresis

A patient with diabetes has a morning glucose of 50. The patient is sweaty, cold, and clammy. Which of the following nursing interventions is the MOST important? A. Recheck the glucose level B. Give the patient ½ cup (4 oz) of fruit juice C. Call the doctor D. Keep the patient nothing by mouth

B. Give the patient ½ cup (4 oz) of fruit juice

A nurse went to a patient's room to do routine vital signs monitoring and found out that the patient's bedtime snack was not eaten. This should alert the nurse to check and assess for: A. Elevated serum bicarbonate and decreased blood pH B. Signs of hypoglycemia earlier than expected C. Symptoms of hyperglycemia during the peak time of NPH insulin D. Sugar in the urine

B. Signs of hypoglycemia earlier than expected

An adult patient with diabetes is admitted with ketoacidosis and the health care provider writes all of the following orders. Which order should the nurse implement first? a. Start an infusion of regular insulin at 50 U/hr. b. Give sodium bicarbonate 50 mEq IV push. c. Infuse 1 liter of normal saline per hour. d. Administer regular IV insulin 30 U.

C. Infuse 1 liter of normal saline per hour.Rationale: The most urgent patient problem is the hypovolemia associated with DKA, and the priority is to infuse IV fluids. The other actions can be accomplished after the infusion of normal saline is initiated.

A patient who has just been diagnosed with type 2 diabetes is 5 ft 4 in (160 cm) tall and weighs 182 pounds (82 kg). A nursing diagnosis of imbalanced nutrition: more than body requirements is developed. Which patient outcome is most important for this patient? a. The patient will have a diet and exercise plan that results in weight loss. b. The patient will state the reasons for eliminating simple sugars in the diet. c. The patient will have a glycosylated hemoglobin level of less than 7%. d. The patient will choose a diet that distributes calories throughout the day.

C. The patient will have a glycosylated hemoglobin level of less than 7%. Rationale: The complications of diabetes are related to elevated blood glucose, and the most important patient outcome is the reduction of glucose to near-normal levels. The other outcomes are also appropriate but are not as high in priority.

During a clinic visit 3 months following a diagnosis of type 2 diabetes, the patient reports following a reduced-calorie diet. The patient has not lost any weight and did not bring the glucose-monitoring record. The nurse will plan to obtain a(n) a. fasting blood glucose level. b. urine dipstick for glucose. c. glycosylated hemoglobin level. d. oral glucose tolerance test.

C. glycosylated hemoglobin level. Rationale: The glycosylated hemoglobin (Hb A1C) test shows the overall control of glucose over 90 to 120 days. A fasting blood level indicates only the glucose level at one time. Urine glucose testing is not an accurate reflection of blood glucose level and does not reflect the glucose over a prolonged time. Oral glucose tolerance testing is done to diagnose diabetes, but is not used for monitoring glucose control once diabetes has been diagnosed.

A diagnosis of hyperglycemic hyperosmolar nonketotic coma (HHNC) is made for a patient with type 2 diabetes who is brought to the emergency department in an unresponsive state. The nurse will anticipate the need to a. administer glargine (Lantus) insulin. b. initiate oxygen by nasal cannula. c. insert a large-bore IV catheter. d. give 50% dextrose as a bolus.

C. insert a large-bore IV catheter. Rationale: HHNC is initially treated with large volumes of IV fluids to correct hypovolemia. Regular insulin is administered, not a long-acting insulin. There is no indication that the patient requires oxygen. Dextrose solutions will increase the patient's blood glucose and would be contraindicated.

A patient with type 1 diabetes has received diet instruction as part of the treatment plan. The nurse determines a need for additional instruction when the patient says, a. "I may have an occasional alcoholic drink if I include it in my meal plan." b. "I will need a bedtime snack because I take an evening dose of NPH insulin." c. "I will eat meals as scheduled, even if I am not hungry, to prevent hypoglycemia." d. "I may eat whatever I want, as long as I use enough insulin to cover the calories."

D. "I may eat whatever I want, as long as I use enough insulin to cover the calories." Rationale: Most patients with type 1 diabetes need to plan diet choices very carefully. Patients who are using intensified insulin therapy have considerable flexibility in diet choices but still should restrict dietary intake of items such as fat, protein, and alcohol. The other patient statements are correct and indicate good understanding of the diet instruction.

A diabetic patient is started on intensive insulin therapy. The nurse will plan to teach the patient about mealtime coverage using _____ insulin. a. NPH b. lispro c. detemir d. glargine

Diabetes Practice Answer B. lispro Rationale: Rapid or short acting insulin is used for mealtime coverage for patients receiving intensive insulin therapy. NPH, glargine, or detemir will be used as the basal insulin.

While hospitalized and recovering from an episode of diabetic ketoacidosis, the patient calls the nurse and reports feeling anxious, nervous, and sweaty. Based on the patient's report, the nurse should a. obtain a glucose reading using a finger stick. b. administer 1 mg glucagon subcutaneously. c. have the patient eat a candy bar. d. have the patient drink 4 ounces of orange juice.

a. obtain a glucose reading using a finger stick Rationale: The patient's clinical manifestations are consistent with hypoglycemia and the initial action should be to check the patient's glucose with a finger stick or order a stat blood glucose. If the glucose is low, the patient should ingest a rapid-acting carbohydrate, such as orange juice. Glucagon might be given if the patient's symptoms become worse or if the patient is unconscious. Candy bars contain fat, which would slow down the absorption of sugar and delay the response to treatment.

A patient screened for diabetes has a fasting plasma glucose level of 120 mg/dl (6.7 mmol/L). The nurse will plan to teach the patient about a. use of low doses of regular insulin. b. self-monitoring of blood glucose. c. oral hypoglycemic medications. d. maintenance of a healthy weight.

d. maintenance of a healthy weight. Rationale: The patient's impaired fasting glucose indicates prediabetes and the patient should be counseled about lifestyle changes to prevent the development of type 2 diabetes. The patient with prediabetes does not require insulin or the oral hypoglycemics for glucose control and does not need to self-monitor blood glucose.