MS Diabetes Questions, prep U ch 51 med surg diabetes

Once digested, what percentage of carbohydrates is converted to glucose?

100 Explanation: Once digested, 100% of carbohydrates are converted to glucose. However, approximately 40% of protein foods are also converted to glucose, but this has minimal effect on blood glucose levels.

Which intervention is essential when performing dressing changes on a client with a diabetic foot ulcer?

Using sterile technique during the dressing change Explanation: The nurse should perform the dressing changes using sterile technique to prevent infection. Applying heat should be avoided in a client with diabetes mellitus because of the risk of injury. Cleaning the wound with povidone-iodine solution and debriding the wound with each dressing change prevents the development of granulation tissue, which is essential in the wound healing process.

After teaching a client with type 1 diabetes, who is scheduled to undergo an islet cell transplant, which client statement indicates successful teaching?

"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.

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The client diabetic client asks the nurse why it is necessary to maintain blood glucose levels no lower than about 74 mg/dL. What is the nurse's best response?

b."The central nervous system, which cannot store glucose, requires a continuous supply of glucose for fuel." Because the brain cannot synthesize or store significant amounts of glucose, a continuous supply from the body's circulation is needed to meet the fuel demands of the central nervous system.

Common early signs and symptoms of diabetic ketoacidosis include

thirst and drowsiness Diabetic ketoacidosis symptoms include dry mucous membranes and drowsiness leading to coma.

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?

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 of the following medications is considered a glitazone?

Actos Explanation: Pioglitazone (Actos) and rosiglitazone (Avandia) are classified as a glitazone or thiazolidinedione. Metformin (Glucophage, Glucophase) and metformin with glyburide (Glucovance) are classified as biguanides.

A nurse expects to note an elevated serum glucose level in a client with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which other laboratory finding should the nurse anticipate?

Below-normal serum potassium level Explanation: A client with HHNS has an overall body deficit of potassium resulting from diuresis, which occurs secondary to the hyperosmolar, hyperglycemic state caused by the relative insulin deficiency. An elevated serum acetone level and serum ketone bodies are characteristic of diabetic ketoacidosis. Metabolic acidosis, not serum alkalosis, may occur in HHNS.

A client with diabetic ketoacidosis was admitted to the intensive care unit 4 hours ago and has these laboratory results: blood glucose level 450 mg/dl, serum potassium level 2.5 mEq/L, serum sodium level 140 mEq/L, and urine specific gravity 1.025. The client has two I.V. lines in place with normal saline solution infusing through both. Over the past 4 hours, his total urine output has been 50 ml. Which physician order should the nurse question?

Change the second I.V. solution to dextrose 5% in water. Explanation: The nurse should question the physician's order to change the second I.V. solution to dextrose 5% in water. The client should receive normal saline solution through the second I.V. site until his blood glucose level reaches 250 mg/dl. The client should receive a fluid bolus of 500 ml of normal saline solution. The client's urine output is low and his specific gravity is high, which reveals dehydration. The nurse should expect to hold the insulin infusion for 30 minutes until the potassium replacement has been initiated. Insulin administration causes potassium to enter the cells, which further lowers the serum potassium level. Further lowering the serum potassium level places the client at risk for life-threatening cardiac arrhythmias.

An obese Hispanic client, age 65, is diagnosed with type 2 diabetes. Which statement about diabetes mellitus is true?

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 of the following would be included in the teaching plan for a patient diagnosed with diabetes mellitus?

Elevated blood glucose levels contribute to complications of diabetes, such as diminished vision. Explanation: When blood glucose levels are well controlled, the potential for complications of diabetes is reduced. Several types of foods contain sugar, including cereals, sauces, salad dressing, fruit, and fruit juices. It is not feasible, nor is it advisable, to remove all sources of sugar from the diet. If the diabetes had been well controlled without insulin prior to the period of acute stress causing the need for insulin, the patient may be able to resume previous methods for control of diabetes when the stress is resolved.

Which of the following would the nurse most likely assess in a client with diabetes who is experiencing autonomic neuropathy?

Erectile dysfunction Explanation: Autonomic neuropathy affects organ functioning. According the American Diabetes Association, up to 50% of men with diabetes develop erectile dysfunction when nerves that promote erection become impaired. Skeletal deformities and soft tissue ulcers may occur with motor neuropathy. Paresthesias are associated with sensory neuropathy.

For a client with hyperglycemia, which assessment finding best supports a nursing diagnosis of Deficient fluid volume?

Increased urine osmolarity Explanation: In hyperglycemia, urine osmolarity (the measurement of dissolved particles in the urine) increases as glucose particles move into the urine. The client experiences glucosuria and polyuria, losing body fluids and experiencing deficient fluid volume. Cool, clammy skin; jugular vein distention; and a decreased serum sodium level are signs of fluid volume excess, the opposite imbalance.

Which of the following statements is correct regarding glargine (Lantus) insulin?

It cannot be mixed with any other type of insulin. Explanation: Because this insulin is in a suspension with a pH of 4, it cannot be mixed with other insulins because this would cause precipitation. There is not a peak in action. It is approved to give once daily

Which of the following are byproducts of fat breakdown, which accumulate in the blood and urine?

Ketones Explanation: Ketones are byproducts of fat breakdown, and they accumulate in the blood and urine. Creatinine, hemoglobin, and cholesterol are not byproducts of fat breakdown.

On the second postoperative day after a subtotal thyroidectomy, the client tells the nurse that he feels numbness and tingling around the mouth. What is the nurse's best first action?

Notify the physician.

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?

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.

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

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.

A client with diabetes is receiving an oral antidiabetic agent that acts to help the tissues use available insulin more efficiently. Which of the following agents would the nurse expect to administer?

Metformin Explanation: Metformin is a biguanide and along with the thiazolidinediones (rosiglitazone and pioglitazone) are categorized as insulin sensitizers; they help tissues use available insulin more efficiently. Glyburide and glipizide which are sulfonylureas, and repaglinide, a meglitinide, are described as being insulin releasers because they stimulate the pancreas to secrete more insulin.

A group of students are reviewing the various types of drugs that are used to treat diabetes mellitus. The students demonstrate understanding of the material when they identify which of the following as an example of an alpha-glucosidase inhibitor?

Miglitol Explanation: Alpha-glucosidase inhibitors include drugs such as miglitol and acarbose. Metformin is a biguanide. Glyburide is a sulfonylurea. Rosiglitazone is a thiazolidinedione.

What intervention should the nurse teach the client with diabetes who uses an insulin infusion pump to prevent the complication of infection?

d."Change the needle every 3 days." Having the same needle remain in place through the skin for longer than 3 days drastically increases the risk for infection within or through the delivery system.

The client has a deficiency of all the following pituitary hormones. Which one should be addressed first?

Thyroid-stimulating hormone A deficiency of thyroid-stimulating hormone (TSH) is the most life-threatening deficiency of the hormones listed in this question. TSH is needed to ensure proper synthesis and secretion of the thyroid hormones, whose functions are essential for life.

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 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 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 enhances transport of glucose across the cell wall. 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.

What is the priority nursing diagnosis for the client in thyroid crisis (storm)?

a.Potential for Ineffective Breathing Pattern Thyroid crisis is a life-threatening emergency that has a 25% mortality rate, even with intervention. Maintaining a patent airway and providing adequate ventilation are the primary concerns for clients in thyroid crisis.

During a class on exercise for clients with diabetes mellitus, a client asks the nurse educator how often to exercise. To meet the goals of planned exercise, the nurse educator should advise the client to exercise:

at least three times per week. Explanation: Clients with diabetes must exercise at least three times per week to meet the goals of planned exercise — lowering the blood glucose level, reducing or maintaining the proper weight, increasing the serum high-density lipoprotein level, decreasing serum triglyceride levels, reducing blood pressure, and minimizing stress. Exercising once per week wouldn't achieve these goals. Exercising more than three times per week, although beneficial, would exceed the minimum requirement.

The client who had a transsphenoidal hypophysectomy 2 days ago now has nuchal rigidity. What is the nurse's best first action?

c.Take the client's temperature. Nuchal rigidity is a major manifestation of meningitis, a potential postoperative complication associated with this surgery. Meningitis is an infection, and usually the client also will have a fever.

A long-term complication of diabetes mellitus is

renal failure. Long-term complications of diabetes include blindness, cardiovascular problems, and renal failure

Which action should the nurse suggest to reduce insulin needs in the client with diabetes mellitus?

d.Walking 1 mile each day Moderate exercise, such as walking, helps regulate blood glucose levels on a daily basis and results in lowered insulin requirements for clients with type 1 diabetes.

A patient has asked why she needs to exercise. The nurse tells her that if the diabetic patient exercises, then the insulin requirement

decreases. The patient with diabetes should exercise regularly. Exercise can reduce insulin resistance and increase glucose uptake for as long as 72 hours as well as reducing blood pressure and lipid levels. However, exercise can carry some risks for patients with diabetes, including hypoglycemia.

The nurse is providing information about foot care to a client with diabetes. Which of the following would the nurse include?

"Be sure to apply a moisturizer to feet daily." Explanation: The nurse should advise the client to apply a moisturizer to the feet daily. The client should use warm water not hot water to bathe his feet. Razors to remove corns or calluses must be avoided to prevent injury and infection. The client should wear well-fitting comfortable shoes, avoiding shoes made of rubber, plastic or vinyl which would cause the feet to perspire.

Which statement made by the client newly diagnosed with type 2 diabetes mellitus indicates a need for clarification regarding diet therapy?

"I should try to keep my diet free from carbohydrates." Carbohydrates are an extremely important source of energy and should compose at least 50% to 60% of the diabetic person's total caloric intake.

Which statement made by the client who is going home after a transsphenoidal hypophysectomy indicates an adequate understanding of actions to prevent complications from this treatment?

"I will keep the cat food bowl on my counter so that I do not have to bend over." After this surgery, the client must take care to avoid activities that can increase intracranial pressure. They should avoid bending from the waist and should not bear down, cough, or lay flat.

The family of a client with SIADH asks the nurse if the water restriction is a punishment for the client's uncooperative behavior. What is the nurse's best response?

"No, limiting fluid intake keeps the client's blood from becoming more dilute and causing other complications." The increased water reabsorption that occurs with SIADH causes a fluid overload and can dilute serum electrolyte concentrations, especially sodium, to dangerously low levels. Appropriate therapy aims to reduce the overhydration by limiting fluids and increasing urine output.

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:

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.

The primary care physician has ordered a glycosylated hemoglobin for a patient who has recently been diagnosed with diabetes mellitus. Which of the following results would indicate to the nurse that the patient's diabetes is under poor control?

10%

The human insulin whose onset of action occurs within ____ minutes is Humalog (Lispro).

15 Humalog begins to take effect in less than half the time of regular, fast-acting insulin. The new formula can be injected 15 minutes before a meal.

A nurse is teaching a client with diabetes mellitus about self-management of his condition. The nurse should instruct the client to administer 1 unit of insulin for every:

15 g of carbohydrates. Explanation: The nurse should instruct the client to administer 1 unit of insulin for every 15 g of carbohydrates

A client is receiving insulin lispro at 7:30 AM. The nurse ensures that the client has breakfast by which time?

7:35 AM Explanation: Insulin lispro has an onset of 10 to 15 minutes. Therefore, the nurse would need to ensure that the client has his breakfast by 7:35 AM. Otherwise, the client may experience hypoglycemia.

A client with type 1 diabetes is scheduled to receive 30 units of 70/30 insulin. There is no 70/30 insulin available. As a substitution, the nurse may give the client:

9 units regular insulin and 21 units neutral protamine Hagedorn (NPH). Explanation: A 70/30 insulin preparation is 70% NPH and 30% regular insulin. Therefore, a correct substitution requires mixing 21 units of NPH and 9 units of regular insulin. The other choices are incorrect dosages for the ordered insulin.

The patient is a newly diagnosed diabetic. Until he has his diabetes under control, which test will furnish valuable immediate feedback information?

BS Diabetics should do a fingerstick blood glucose level test before each meal and at bedtime each day until their disease is under control. HgbA1c serum test reveals the effectiveness of diabetes therapy for preceding 8-12 weeks.

A nurse educates a group of clients with diabetes mellitus on the prevention of diabetic nephropathy. Which of the following suggestions would be most important?

Control blood glucose levels. Explanation: Controlling blood glucose levels and any hypertension can prevent or delay the development of diabetic nephropathy. Drinking plenty of fluids does not prevent diabetic nephropathy. Taking antidiabetic drugs regularly may help to control blood glucose levels, but it is the control of these levels that is most important. A high-fiber diet is unrelated to the development of diabetic nephropathy

Which action should the nurse teach the diabetic client as being most beneficial in delaying the onset of microvascular and macrovascular complications?

Controlling hyperglycemia The Diabetes Control and Complications Trial, a prospective study involving 29 medical centers and more than 1400 people with type 1 diabetes, provides convincing evidence that hyperglycemia is a critical factor in the pathogenesis of long-term diabetic complications.

A client is diagnosed with diabetes mellitus. Which assessment finding best supports a nursing diagnosis of Ineffective coping related to diabetes mellitus?

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.

Which diagnostic test for diabetes mellitus provides a measure of glucose levels for the previous 8 to 12 weeks?

Glycosylated hemoglobin (HbA1c) Glycosylated hemoglobin (HbA1c)—This blood test measures the amount of glucose that has become incorporated into the hemoglobin within an erythrocyte. Because glycosylation occurs constantly during the 120-day life span of the erythrocyte, this test reveals the effectiveness of diabetes therapy for the preceding 8 to 12 weeks.

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 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.

Which of the following categories of oral antidiabetic agents exert their primary action by directly stimulating the pancreas to secrete insulin?

Sulfonylureas Explanation: A functioning pancreas is necessary for sulfonylureas to be effective. Thiazolidinediones enhance insulin action at the receptor site without increasing insulin secretion from the beta cells of the pancreas. Biguanides facilitate insulin's action on peripheral receptor sites. Alpha glucosidase inhibitors delay the absorption of glucose in the intestinal system, resulting in a lower postprandial blood glucose level.

What is the major hormone secreted by the adrenal medulla?

b. Epinephrine The adrenal medulla secretes norepinephrine and epinephrine in proportions of 15% and 85%, respectively.

Which statement made by the diabetic client who has a urinary tract infection indicates correct understanding regarding antibiotic therapy?

c. "Even if I feel completely well, I should take the medication until it is gone." Antibiotic therapy is most effective when the client takes the prescribed medication for the entire course and not just when symptoms are present

Which safety measure should the nurse use for a client who has Cushing's disease?

c. Use a lift sheet to change the client's position. Cushing's syndrome or disease greatly increases the serum levels of cortisol, which contributes to excessive bone demineralization and increases the risk for pathologic bone fractures.

What safety measure should the nurse use for the adult client who has growth hormone deficiency?

c. Use a lift sheet to reposition the client. In adults, growth hormone is necessary to maintain bone density and strength. Adults with growth hormone deficiency have thin, fragile bones.

What is the physiologic basis for the polyuria manifested by individuals with untreated diabetes mellitus?

d. Hyperosmolarity of the extracellular fluids secondary to hyperglycemia Polyuria results from an osmotic diuresis caused by excess excretion of glucose in the urine.

What instruction should the nurse emphasize when teaching the diabetic client about how to alter diabetes management during a period of illness that includes nausea and vomiting.

d. "Monitor your blood glucose levels at least every 4 hours." Treatment decisions and alterations will be made on the basis of blood glucose levels and the presence of ketone bodies in the urine.

Which change in clinical manifestations in a client with long-standing diabetes mellitus alerts the nurse to the possibility of renal dysfunction?

d. A sustained increase in blood pressure from 130/84 to 150/100 Hypertension is both a cause of renal dysfunction and a result of renal dysfunction.

A client tells the nurse that she has been working hard for the past 3 months to control her type 2 diabetes with diet and exercise. To determine the effectiveness of the client's efforts, the nurse should check:

glycosylated hemoglobin level. Explanation: Because some of the glucose in the bloodstream attaches to some of the hemoglobin and stays attached during the 120-day life span of red blood cells, glycosylated hemoglobin levels provide information about blood glucose levels during the previous 3 months. Fasting blood glucose and urine glucose levels give information only about glucose levels at the point in time when they were obtained. Serum fructosamine levels provide information about blood glucose control over the past 2 to 3 weeks.

A 32-year-old client has an appointment at the weight loss clinic where you practice nursing. She has gained 55 lbs. in the last three years and is concerned about developing Type 2 diabetes mellitus, especially since her parents both have developed the disorder. What are the conditions which contribute to developing metabolic syndrome? Choose all correct options.

• Abdominal obesity • Elevated blood glucose levels Explanation: Some experts believe that diabetes in adults is one consequence of metabolic syndrome, which includes elevated blood glucose levels, hypertension, hypercholesterolemia, and abdominal obesity.

The client with diabetes who is just starting on insulin therapy wants to know why more than one injection of insulin each day will be required. What is the nurse's best response?

"A single dose of insulin each day would not match your blood insulin levels and your food intake patterns closely enough."

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." 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.

Which statement made by the client after a bilateral adrenalectomy indicates a need for further clarification regarding medications?

"If I have nausea or vomiting, I will skip the medication until I am better." Cortisol replacement after bilateral adrenalectomy must continue daily for the rest of the client's life. Skipping doses could cause adrenal crisis and death. If the client cannot take the drugs orally, arrangements must be made for the client to receive the drug parenterally.

A client with type 1 diabetes has a highly elevated glycosylated hemoglobin (Hb) test result. In discussing the result with the client, the nurse is most accurate in stating:

"It tells us about your sugar control for the last 3 months." Explanation: The nurse is providing accurate information to the client when she states that the glycosylated Hb test provides an objective measure of glycemic control over a 3-month period. The test helps identify trends or practices that impair glycemic control, and it doesn't require a fasting period before blood is drawn. The nurse can't conclude that the result occurs from poor dietary management or inadequate insulin coverage.

Which instruction should a nurse give to a client with diabetes mellitus when teaching about "sick day rules"?

"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 nurse is caring for a client with type 1 diabetes who exhibits confusion, light-headedness, and aberrant behavior. The client is conscious. The nurse should first administer:

15 to 20 g of a fast-acting carbohydrate such as orange juice. Explanation: This client is experiencing hypoglycemia. Because the client is conscious, the nurse should first administer a fast-acting carbohydrate, such as orange juice, hard candy, or honey. If the client has lost consciousness, the nurse should administer I.M. or subcutaneous glucagon or an I.V. bolus of dextrose 50%. The nurse shouldn't administer insulin to a client who's hypoglycemic; this action will further compromise the client's condition

What is the duration of regular insulin?

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.

As a nurse educator, you have been invited to your local senior center to discuss health-maintaining strategies for older adults. During your education session on nutrition, you approach the subject of diabetes mellitus, its symptoms and consequences. What is the prevalence of Type I diabetes?

5% to 10% of all diagnosed cases Explanation: Type 1 diabetes accounts for approximately 5% to 10% of all diagnosed cases of diabetes (National Institute of Diabetes and Digestive and Kidney Diseases [NIDDK], 2008).

A hospitalized client is found to be comatose and hypoglycemic with a blood sugar of 50 mg/dL. Which of the following would the nurse do first?

Administer 50% glucose intravenously. Explanation: The unconscious, hypoglycemic client needs immediate treatment with IV glucose. If the client does not respond quickly and the blood glucose level continues to be low, glucagon, a hormone that stimulates the liver to release glycogen, or 20 to 50 mL of 50% glucose is prescribed for IV administration. A dose of 1,000 mL D5W over a 12-hour period indicates a lower strength of glucose and a slow administration rate. Checking the client's urine for the presence of sugar and acetone is incorrect because a blood sample is easier to collect and the blood test is more specific and reliable. An unconscious client cannot be given a drink. In such a case glucose gel may be applied in the buccal cavity of the mouth.

A client with type 1 diabetes must undergo bowel resection in the morning. How should the nurse proceed while caring for him on the morning of surgery?

Administer half of the client's typical morning insulin dose as ordered. Explanation: If the nurse administers the client's normal daily dose of insulin while he's on nothing-by-mouth status before surgery, he'll experience hypoglycemia. Therefore, the nurse should administer half the daily insulin dose as ordered. Oral antidiabetic agents aren't effective for type 1 diabetes. I.V. insulin infusions aren't necessary to manage blood glucose levels in clients undergoing routine surgery.

Insulin is secreted by which of the following types of cells?

Beta cells Explanation: Insulin is secreted by the beta cells, in the islets of Langerhans of the pancreas. In diabetes, cells may stop responding to insulin, or the pancreas may decrease insulin secretion or stop insulin production completely. Melanocytes are what give the skin its pigment. Neural cells transmit impulses in the brain and spinal cord. Basal cells are a type of skin cell.

The nurse is reviewing the initial laboratory test results of a client diagnosed with DKA. Which of the following would the nurse expect to find?

Blood pH of 6.9 Explanation: With DKA, blood glucose levels are elevated to 300 to 1000 mg/dL or more. Urine contains glucose and ketones. The blood pH ranges from 6.8 to 7.3. The serum bicarbonate level is decreased to levels from 0 to 15 mEq/L. The compensatory breathing pattern can lower the partial pressure of carbon dioxide in arterial blood (PaCO2) to levels of 10 to 30 mm Hg.

Which of the following clinical manifestations of type 2 diabetes occurs if glucose levels are very high?

Blurred vision Explanation: Blurred vision occurs when the blood glucose levels are very high. The other clinical manifestations are not consistent with type 2 diabetes.

Lispro (Humalog) is an example of which type of insulin?

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).

Which of the following clinical characteristics is associated with type 2 diabetes (previously referred to as non-insulin dependent diabetes mellitus [NIDDM])?

Can control blood glucose through diet and exercise Explanation: Oral hypoglycemic agents may improve blood glucose levels 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.

Which of the following factors should the nurse take into consideration when planning meals and selecting the type and dosage of insulin or oral hypoglycemic agent for an elderly client with diabetes mellitus?

Client's eating and sleeping habits. Explanation: The eating and sleeping habits of older adults differ from those of young or middle-aged persons. The nurse should take into consideration when planning meals and selecting the proper type and dosage of insulin or oral hypoglycemic agent.

What is the only insulin that can be given intravenously?

Regular Explanation: Insulins other than regular are in suspensions that could be harmful if administered IV.

A nurse is preparing a client with type 1 diabetes for discharge. The client can care for himself; however, he's had a problem with unstable blood glucose levels in the past. Based on the client's history, he should be referred to which health care worker?

Dietitian Explanation: The client should be referred to a dietitian, who will help him gain better control of his blood glucose levels. The client can care for himself, so a home health agency isn't necessary. The client shows no signs of needing a psychiatric referral, and referring the client to a psychiatrist isn't in the nurse's scope of practice. Social workers help clients with financial concerns; the scenario doesn't indicate that the client has a financial concern warranting a social worker at this time.

After teaching a group of students about diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic nonketotic syndrome (HHNKS), the instructor determines that additional teaching is needed when the students identify which of the following as characteristic of HHNKS?

Elevated serum potassium levels Explanation: With HHNKS, blood glucose are significantly increased, well over 500 mg/dL, blood pH remains within the normal range of 7.35 to 7.45, and serum potassium and sodium levels are low.

Which of the following is the most rapid acting insulin?

Humalog Explanation: The onset of action of rapid-acting Humalog 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 is 3 to 4 hours. The onset of action of long-acting Ultralente is 6 to 8 hours.

A nurse is assessing a client who is receiving total parenteral nutrition (TPN). Which finding suggests that the client has developed hyperglycemia?

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.

The client who has used insulin for diabetes control for 20 years has a spongy swelling at the site used most frequently for insulin injection. What is the nurse's best action?

Instruct the client to use a different site for insulin injection. The client has hypertrophic lipodystrophy as a result of repeated injections at the same site. Avoiding this site for an extended period of time allows the dystrophic changes to regress or at least not to become worse.

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 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 of the following would the nurse include as associated with type 2 diabetes?

Insulin production insufficient Explanation: Type 2 diabetes is characterized by insulin resistance or insufficient insulin production. It is more common in aging adults, and now accounts for 20% of all newly diagnosed cases. Type 1 diabetes is more likely in childhood and adolescence although it can occur at any age. It accounts for approximately 5% to 10% of all diagnosed cases of diabetes. Pre-diabetes can lead to type 2 diabetes.

A 53-year-old client is brought to the ED, via squad, where you practice nursing. He is demonstrating fast, deep, labored breathing and has a fruity odor to his breath. He has a history of type 1 diabetes. What could be the cause of his current serious condition?

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.

Which of the following factors is the focus of nutrition intervention for clients with type 2 diabetes?

Weight loss Explanation: Weight loss is the focus of nutrition intervention for clients with Type 2 diabetes. A low-calorie diet may improve clinical symptoms; even a mild to moderate weight loss such as 10 to 20 lb may lower blood glucose levels and improve insulin action.

Which medication should the nurse be prepared to administer to a client with bradycardia as a result of hypothyroidism?

Levothyroxine sodium

A client with diabetes mellitus is prescribed to switch from animal to synthesized human insulin. Which of the following factors should the nurse monitor when caring for the client?

Low blood glucose levels Explanation: Clients who switch from animal to synthesized human insulin should be monitored for low blood glucose levels initially because the human form of insulin is used more effectively.

Which of the following factors should the nurse take into consideration when planning meals and selecting the type and dosage of insulin or oral hypoglycemic agent for an elderly patient with diabetes mellitus?

Patient's eating and sleeping habits Explanation: The eating and sleeping habits of older adults differ from those of young or middle-aged persons. The nurse should take this into consideration when planning meals and selecting the proper type and dosage of insulin or oral hypoglycemic agent. The nurse should evaluate the patient's ability to self-administer insulin before developing a teaching program. Cognitive problems and patient history may not be taken into consideration when planning meals and selecting the proper type and dosage of insulin or oral hypoglycemic agent.

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 (Tolinase). Which laboratory test is the most important for confirming this disorder?

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 patient with diabetes mellitus is receiving an oral antidiabetic agent. The nurse observes for which of the following symptoms when caring for this patient?

Signs of hypoglycemia Explanation: The nurse should observe the patient 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. Polyuria, polydipsia, and blurred vision are the symptoms of diabetes mellitus.

After taking glipizide (Glucotrol) for 9 months, a client experiences secondary failure. What should the nurse expect the physician to do?

Switch the client to a different oral antidiabetic agent. Explanation: The nurse should anticipate that the physician will order a different oral antidiabetic agent. Many clients (25% to 60%) who take glipizide respond to a different oral antidiabetic agent. Therefore, it wouldn't be appropriate to initiate insulin therapy at this time. However, if a new oral antidiabetic agent is unsuccessful in keeping glucose levels at an acceptable level, insulin may be used in addition to the antidiabetic agent. Restricting carbohydrate intake isn't necessary.

Which clinical manifestation indicates to the nurse that treatment for the client with hypothyroidism is effective?

The client has had a bowel movement every day for 1 week. Hypothyroidism decreases gastrointestinal motility significantly. One of the parameters that clients can use to determine if changes in the dose of thyroid replacement should be adjusted is the frequency of bowel movements. A bowel movement every day is a strong indication that the dose of thyroid replacement hormone is adequate.

The client on an intensified insulin regimen consistently has a fasting blood glucose between 70 and 80 mg/dL, a postprandial blood glucose level below 200 mg/dL, and a hemoglobin A1c level of 5.5%. What is the nurse's interpretation of these findings?

The client is demonstrating good control of blood glucose. The client is maintaining blood glucose levels within the defined ranges for goals in an intensified regimen (fasting blood glucose 60 to 120 mg/dL; postprandial blood glucose less than 200 mg/dL; hemoglobin A1c 4% to 6%).

A male client, aged 42, is diagnosed with diabetes mellitus. He visits the gym regularly and is a vegetarian. Which of the following factors is important when assessing the client?

The client's consumption of carbohydrates Explanation: While assessing a client, it is important to note the client's consumption of carbohydrates because he has high blood sugar. Although other factors such as the client's mental and emotional status, history of tests involving iodine, and exercise routine can be part of data collection, they are not as important to information related to the client's to be noted in a client with high blood sugar.

Which of the following may be a potential cause of hypoglycemia in the patient diagnosed with diabetes mellitus?

The patient has not consumed food and continues to take insulin or oral antidiabetic medications. Explanation: Hypoglycemia occurs when a patient with diabetes is not eating at all and continues to take insulin or oral antidiabetic medications. Hypoglycemia does not occur when the patient has not been compliant with the prescribed treatment regimen. If the patient has eaten and has not taken or received insulin, DKA is more likely to develop.

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 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 nurse is explaining the action of insulin to a client with diabetes mellitus. During client teaching, the nurse reviews the process of insulin secretion in the body. The nurse is correct when she states that insulin is secreted from the:

beta cells of the pancreas. Explanation: The beta cells of the pancreas secrete insulin. The adenohypophysis, or anterior pituitary gland, secretes many hormones, such as growth hormone, prolactin, thyroid-stimulating hormone, corticotropin, follicle-stimulating hormone, and luteinizing hormone, but not insulin. The alpha cells of the pancreas secrete glucagon, which raises the blood glucose level. The parafollicular cells of the thyroid secrete the hormone calcitonin, which plays a role in calcium metabolism.

Which assessment finding in the client with diabetes mellitus indicates that the disease is damaging the kidneys?

c.The presence of protein in the urine during a random urinalysis Urine should not contain protein, and the presence of proteinuria in a diabetic marks the beginning of renal problems known as diabetic nephropathy, which progresses eventually to end-stage renal disease. Chronically elevated blood glucose levels cause renal hypertension and excess kidney perfusion with leakage from the renal vasculature. The excess leakiness allows larger substances, such as proteins, to be filtered into the urine.

The physician orders an 1,800-calorie diabetic diet and 40 units of (Humulin N) insulin U-100 subcutaneously daily for a patient with diabetes mellitus. A mid-afternoon snack of milk and crackers is given to

prevent an insulin reaction. Humulin N insulin starts to peak in 4 hours. The nurse should be alert for signs of hypoglycemia (a less-than-normal amount of glucose in the blood, usually caused by administration of too much insulin, excessive secretion of insulin by the islet cells of the pancreas, or dietary deficiency) at the peak of action of whatever type of insulin the patient is taking.

A nurse is developing a teaching plan for a client with diabetes mellitus. A client with diabetes mellitus should:

wash and inspect the feet daily. Explanation: A client with diabetes mellitus should wash and inspect his feet daily and should wear nonconstrictive shoes. Corns should be treated by a podiatrist — not with commercial preparations. Nails should be filed straight across. Clients with diabetes mellitus should never walk barefoot.

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 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 statement regarding diabetes mellitus is true?

Diabetes increases the risk for development of cardiovascular disease. Diabetes mellitus is a major risk factor for morbidity and mortality caused by coronary artery disease, cerebrovascular disease, and peripheral vascular disease.

Which intervention for self-monitoring of blood glucose levels should the nurse teach the client with diabetes to prevent bloodborne infections?

"Do not share your monitoring equipment." Small particles of blood can adhere to the monitoring device and infection can be transported from one user to another.

The client who is taking corticosteroids daily for severe asthma now has an elevated blood glucose level. He asks the nurse if he is now considered diabetic. What is the nurse's best response?

"No, the blood glucose level is elevated because corticosteroids increase the synthesis of glucose." Corticosteroids cause a "pseudodiabetes" with increased blood glucose levels by stimulating liver synthesis of glucose and suppressing glucose use by cells. The ability of the pancreas to synthesize insulin is unaffected.

A client is admitted with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which laboratory finding should the nurse expect in this client?

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.

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 Explanation: Signs and symptoms of hypoglycemia (indicated by a blood glucose level of 45 mf/dl) include anxiety, restlessness, headache, irritability, confusion, diaphoresis, cool skin, tremors, coma, and seizures. Kussmaul's 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 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:

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.

What is the priority nursing diagnosis in a 45-year-old man with Cushing's syndrome?

Disturbed Body Image related to change in appearance Excessive amounts of prolactin can cause galactorrhea in men or women. In addition, the excessive blood levels of prolactin inhibit gonadotropin-releasing hormone, suppressing testosterone production. Low circulating levels of testosterone allow breast development in men (gynecomastia).

While assessing the client who has had diabetes for 15 years, the nurse notes that the client has decreased tactile sensation in both feet. What is the nurse's best first action?

Examine the client's feet for signs of injury. Diabetic neuropathy is common when the disease is long-standing. It cannot be reversed and the client is at great risk for injury in any area with decreased sensation, because he or she is less able to feel injurious events.

A nurse is teaching a client with type 1 diabetes how to treat adverse reactions to insulin. To reverse hypoglycemia, the client ideally should ingest an oral carbohydrate. However, this treatment isn't always possible or safe. Therefore, the nurse should advise the client to keep which alternate treatment on hand?

Glucagon Explanation: During a hypoglycemic reaction, a layperson may administer glucagon, an antihypoglycemic agent, to raise the blood glucose level quickly in a client who can't ingest an oral carbohydrate. Epinephrine isn't a treatment for hypoglycemia. Although 50% dextrose is used to treat hypoglycemia, it must be administered I.V. by a skilled health care professional. Hydrocortisone takes a relatively long time to raise the blood glucose level and therefore isn't effective in reversing hypoglycemia.

Which combination of adverse effects should a nurse monitor for when administering I.V. insulin to a client with diabetic ketoacidosis?

Hypokalemia and hypoglycemia Explanation: Blood glucose needs to be monitored in clients receiving I.V. 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 I.V. insulin administration.

Which of the following clinical characteristics is associated with Type 1 diabetes (previously referred to as insulin-dependent diabetes mellitus [IDDM])?

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

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 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.

How does a tropic hormone differ from other hormones?

Tropic hormones stimulate other endocrine glands to secrete hormones. The target tissues for tropic hormones are other endocrine glands. The effect of these agents is to stimulate another endocrine gland to secrete its hormone. Tropic hormones are involved in more complex negative feedback regulatory loops.

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?

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.

Which client responses demonstrate to the nurse that treatment for diabetes insipidus is effective?

Urine output is decreased; specific gravity is increased. Diabetes insipidus causes urine output to be greatly increased, with a low urine osmolarity, as evidenced by a low specific gravity. Effective treatment results in a decreased urine output that is more concentrated, as evidenced by an increased specific gravity.

The home care nurse administers ½ cup of orange juice to the client with diabetes who is experiencing symptoms of a mild hypoglycemic episode. The client's clinical manifestations have not changed 5 minutes later. What is the nurse's best next action?

a. Administer an additional ½ cup of orange juice. For mild hypoglycemic manifestations, if the symptoms do not resolve immediately, repeat the treatment.

The client with type 1 diabetes has a blood glucose level of 160 mg/dL on arrival at the operating room. What is the nurse's best action?

a. Document the finding as the only action. Clients who have type 1 diabetes and are having surgery have been found to have fewer complications, lower rates of infection, and better wound healing if blood glucose levels are maintained between 120 mg/dL and 200 mg/dL throughout the perioperative period.

The client getting ready to engage in a 30-minute, moderate-intensity exercise program performs a self-assessment. Which data indicate that exercise should be avoided at this time?

a. Ketone bodies in the urine The presence of ketone bodies in the urine is a contraindication to exercise because it indicates that the amount of insulin available is inadequate to promote intracellular glucose transport and utilization. Exercise would lead to further elevations in blood glucose levels.

The client who has been taking the oral antidiabetic agent pioglitazone (Actos) for 6 months reports to the nurse that his urine is darker than it used to be. What is the nurse's best action?

a. Notify the physician. The "glitazone" drugs, including pioglitazone, have been reported to affect liver function, and there have been some cases of liver failure. Dark urine is one indicator of liver impairment because bilirubin increases in the blood and is excreted in the urine.

The client who has diabetes is prescribed to take insulin glargine once daily and regular insulin four times daily. The first dose of regular insulin occurs at the same time of day as the insulin glargine dose. How should the nurse teach the client to take these two medications?

a."Draw up and inject the insulin glargine first and then draw up and inject the dose of regular insulin." mixed with any other insulin or solution. Mixing results in an unpredictable alteration in the onset of action and time to peak action.

The client is receiving an antithyroid medication to treat hyperthyroidism. Which of the following should be included in client education regarding the initiation of this therapy?

a."Increased need for sleepy or not tolerating cold like you used to can occur when taking this medication. If it does, notify your physician." Antithyroid medication may result in hypothyroidism, which is manifested by sleepiness and intolerance to cold. The client must be closely monitored to determine the need for drug regimen changes. B is a side effect of the medication. C does not give the client specific parameters for "fast pulse." D uses medical terminology which the client may not understand.

The 30-year-old woman whose father has type 1 diabetes mellitus asks the nurse what her chances are of developing diabetes because of her father's disease. What is the nurse's best response?

a."You have a greater susceptibility for developing the disease, with a 1 in 20 to a 1 in 50 chance." Although type 1 diabetes does not follow any specific genetic pattern of inheritance, clients who have one parent with type 1 diabetes are at an increased risk for development. The incidence of diabetes in people who have a parent with type 1 diabetes ranges between 1 in 20 to 1 in 50, compared with 1 in 400 to 1 in 1000 in people who do not have one parent with type 1 diabetes.

What precaution should the nurse teach the client who has type 2 diabetes and is prescribed to take an oral sulfonylurea agent to maintain control of blood glucose levels?

b. "Avoid taking nonsteroidal anti-inflammatory agents." Nonsteroidal anti-inflammatory agents potentiate the hypoglycemic effects of sulfonylurea agents.

The client with type 2 diabetes had been taking the oral antidiabetic agents glyburide and metformin. These medications have been discontinued and he has now been prescribed to take Glucovance. He asks why he only needs one medication. What is the nurse's best response?

b. "Glucovance contains a combination of glyburide and metformin." Glucovance is composed of glyburide and metformin in commonly used doses to increase the convenience of antidiabetic therapy with glyburide and metformin.

The client scheduled to have a radioimmunoassay to determine blood hormone levels asks the nurse how long she will be radioactive. What is the nurse's best response?

b. "The radioisotope is added to the blood sample after it is drawn from you, so you are never radioactive." The client is not exposed to radiation during a radioimmunoassay. The radioisotope is added to the client's specimen after it is obtained from the client.

The client newly diagnosed with type 2 diabetes tells the nurse that since he has increased his intake of fiber, he is having loose stools, flatulence, and abdominal cramping. What is the nurse's best response?

b."Decrease your intake of fiber now and gradually add high-fiber foods back into your diet." Many people experience these side effects when first increasing dietary fiber. Gradually incorporating high-fiber foods into the diet can minimize abdominal cramping, discomfort, loose stools, and flatulence.

For which client with hyperthyroidism is radioactive iodine therapy contraindicated

b.28-year-old woman who is pregnant Radioactive iodine therapy is contraindicated in pregnant women because 131I crosses the placenta and can adversely affect the fetal thyroid gland.

What symptoms or problems should the nurse expect in a client who is receiving a treatment that has a side effect of increasing the synthesis and release of aldosterone?

b.Hypertension, hypokalemia Aldosterone increases reabsorption of water and sodium, causing hypertension, and increases renal excretion of potassium, resulting in hypokalemia.

The client is being admitted with acute adrenal insufficiency (addisonian crisis). What medication should the nurse be prepared to administer?

c. Hydrocortisone sodium succinate Addisonian crisis results from insufficient secretion of glucocorticoids and mineralocorticoids. Intravenous infusion of hydrocortisone sodium succinate supplies the missing glucocorticoid.

Three hours after surgery, the nurse note that the breath of the client who is a type 1 diabetic has a "fruity" odor. What is the nurse's best first action?

c. Test the urine for ketone bodies. The stress of surgery increases the action of counterregulatory hormones and suppresses the action of insulin, predisposing the client to ketoacidosis and metabolic acidosis.

Why is ketosis rare in clients with type 2 diabetes, even when blood glucose levels are very high (higher than 900 mg/dL)?

c. There is enough insulin produced by type 2 diabetes to prevent fat catabolism but not enough to prevent hyperglycemia. Ketosis occurs as a result of fat catabolism when intracellular glucose is unavailable for energy production. The client with type 1 diabetes becomes ketotic because he or she produces no insulin and blood glucose cannot enter the cells. In type 2 diabetes, natural insulin production continues, although at a greatly reduced level. This level is not sufficient to keep blood glucose levels in the normal range but permits just enough glucose to enter cells for energy production so that fats are not catabolized for this purpose.

The client with hypothyroidism as a result of Hashimoto's thyroiditis asks the nurse how long she will have to take thyroid medication. What is the nurse's best response?

c."You will need thyroid replacement hormone therapy for the rest of your life because the thyroid gland function will not return." Hashimoto's thyroiditis results in a permanent loss of thyroid function.

A nurse is providing dietary instructions to a client with hypoglycemia. To control hypoglycemic episodes, the nurse should recommend:

consuming a low-carbohydrate, high-protein diet and avoiding fasting. Explanation: To control hypoglycemic episodes, the nurse should instruct the client to consume a low-carbohydrate, high-protein diet, avoid fasting, and avoid simple sugars. Increasing saturated fat intake and increasing vitamin supplementation wouldn't help control hypoglycemia.

The client scheduled for a partial thyroidectomy for hyperthyroidism asks the nurse why she is being given an iodine preparation before surgery. What is the nurse's best response?

d. "To decrease the blood vessels in the thyroid and prevent excessive bleeding during surgery." Iodine preparations decrease the size and vascularity of the thyroid gland, reducing the risk for hemorrhage and the potential for thyroid storm during surgery.

The client has been taking an oral cortisol preparation for 2 years to manage an autoimmune disease. What effects does the nurse expect this therapy to have on this client's circulating levels of ACTH and aldosterone?

d. Decreased ACTH, decreased aldosterone Taking exogenous cortisol increases the blood levels of cortisol, causing the negative feedback loops to be inhibited. The elevated cortisol levels will suppress hypothalamic secretion of corticotropin-releasing hormone (CRH). Low levels of CRH suppress the anterior pituitary production of adrenocorticotropic hormone (ACTH). Elevated blood levels of cortisol cause increased sodium retention and water reabsorption, inhibiting aldosterone synthesis.

The 45-year-old diabetic client has proliferative retinopathy, nephropathy, and peripheral neuropathy. What should the nurse teach this client about exercise?

d."Swimming or water aerobics 30 minutes each day would be the safest exercise routine for you." Exercise is not contraindicated for this client, although modifications are necessary based on existing pathology to prevent further injury. A person with nephropathy and peripheral neuropathy should avoid jogging or any activity that increases blood pressure or jars kidneys and joints. Swimming, or, if the client does not know how to swim, dancing or doing exercises in water, provides support for joints and muscles, greatly reducing the risk for injury while increasing the uptake of glucose and promoting cardiovascular health.

Which client is at greatest risk for the development of the syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

d.68-year-old man with chronic emphysema SIADH is neither gender- nor age-related. Of the many disorders causing increased secretion of antidiuretic hormone (ADH) or ectopic synthesis of ADH, pulmonary disorders, including emphysema and other chronic lung diseases, are the most common.

What is the priority intervention for the client having Kussmaul respirations as a result of diabetic ketoacidosis?

d.Administration of intravenous insulin The rapid, deep respiratory efforts of Kussmaul respiration is the body's attempt to reduce the acids produced by using fat rather than glucose for fuel. The client who is in ketoacidosis and who does not also have a respiratory impairment does not need additional oxygen. Only the administration of insulin will reduce this type of respiration by assisting glucose to move into cells and to be used for fuel instead of fat.

Twelve hours after a total thyroidectomy, the client develops stridor on exhalation. What is the nurse's best first action?

d.Call for emergency assistance. Stridor on exhalation is a hallmark of respiratory distress, usually caused by obstruction resulting from edema. One emergency measure is to remove the surgical clips to relieve the pressure. In some settings, this may be a nursing action; in other settings, this is a physician function. Emergency intubation also may be necessary.

When taking the blood pressure of a client after a parathyroidectomy, the nurse notes that the client's hand has gone into flexion contractions. What is the nurse's interpretation of this observation?

d.Hypocalcemia Hypocalcemia destabilizes excitable membranes and can lead to muscle twitches, spasms, and tetany. This effect of hypocalcemia is enhanced in the presence of tissue hypoxia. The flexion contractions (Trousseau's sign) occurring during blood pressure measurement are indicative of hypocalcemia.

A patient has type 1 diabetes (IDDM). The nurse is teaching her early signs and symptoms of insulin reaction, which include

perspiration and a trembling sensation. The patient should be instructed to notify a member of the nursing staff if any signs of hypoglycemic (low insulin) reaction occur: excessive perspiration or trembling.