N153: Endocrine. questions
A client has been newly diagnosed with diabetes mellitus. Which statement made by the client indicates a need for further teaching regarding nutrition therapy?
"I should try to keep my diet free from carbohydrates."
Which statement made by a client with type 2 diabetes taking nateglinide (Starlix) indicates understanding this therapy?
"I'll take this medicine right before I eat."
Which statement made by a client getting ready for discharge after pancreas transplantation indicates a need for further teaching about the prescribed drug regimen?
"If I develop an infection, I should stop taking my corticosteroid."
A client with a 20-year history of diabetes mellitus is reviewing his medications with the nurse. The client holds up the bottle of duloxetine (Cymbalta) and states, "My cousin has depression and is on this drug. Do you think I'm depressed?" What is the nurse's best response?
"It's for peripheral neuropathy. Do you have burning pain your feet and hands?"
Two months after a simultaneous pancreas-kidney transplantation (SPK_, a client is diagnosed as being in acute rejection. The client states, "I was doing so well with my new organs, and the thought of having to go back to living on hemodialysis and taking insulin is so depressing." Which is the nurse's best response?
"One acute rejection episode does not mean that you will lose the new organs."
A client has been taught to inject insulin. Which statement made by the client indicates a need for further teaching?
"The abdominal site is best because it is closest to the pancreas."
A client with diabetes is visually impaired and wants to know whether syringes can be prefilled and stored for later use. Which is the nurse's best response?
"Yes. Prefilled syringes can be stored for 3 weeks in the refrigerator in a vertical position with the needle pointing up."
A client with diabetes asks the nurse why it is necessary to maintain blood glucose levels no lower than about 60mg/dL. Which is the nurse's best response?
"Your brain needs a constant supply of glucose because it cannot store it."
In preparing a staff in-service presentation about diabetes mellitus, the nurse includes which information?
Diabetes increases the risk for development of cardiovascular disease
A client with type 1 diabetes has a blood glucose level of 160 mg/dL on arrival at the operating room. Which is the nurse's best action?
Document the finding in the client's chart
During assessment of a client with a 15-year history of diabetes, the nurse notes that the client has decreased tactile sensation in both feet. Which action does the nurse take first?
Examine the client's feet for signs of injury.
To reduce complications of diabetes, the nurse teaches a client with normal kidney function to modify intake of which nutritional group?
Fats
The home care nurse finds a client who has diabetes awake and alert, but shaky, diaphoretic, and weak. The nurse gives the client a cupo of orange juice. The client's clinical manifestations have not changed 5 minutes later. Which is the nurs's best next action?
Give the client another cup of orange juice.
A client on an intensified insulin regimen consistently has a fasting blood glucose level between 70 and 80 mg/dL., a postprandial blood glucose level below 200 mg/dL., and a hemoglobin A1c level of 5.5%. Which is the nurse's interpretation of these findings?
Good control of blood glucose.
The nurse is teaching a client with diabetes about exercise. Which statement by the client indicates a need for further teaching?
If my blood glucose is over 200, I should not exercise
A client in the emergency department has been diagnosed with ketoacidosis. Which manifestation does the nurse correlate with this condition?
Increased rate and depth of respiration
The nurse is monitoring a client with hypoglycemia. Glucagon provides which function?
It prevents hypoglycemia by promoting release of glucose from liver storage sites.
A client is learning to inject insulin. Which action is important for the nurse to teach the client?
Keep the vial you are using in the pantry or the bedroom drawer
The home care nurse visits an older client with diabetes. For which nutritional problem does the nurse monitor this client?
Malnutrition
The nurse is teaching a client about sick day management. Which statement by the nurse is most accurate?
Monitor your blood glucose levels at least every 4 hours.
The nurse has been teaching a client about a new diagnosis of diabetes mellitus. Which statement by the client indicates a good understanding of self-management?
My medical alert bracelet is important to identify me as having diabetes if I am unconscious.
A client with a history of diabetes mellitus has new onset of microalbuminuria. Which component of the diet must the client reduce?
Percentage of total calories derived from proteins
The nurse has given a client an injection of glucagon. Which action does the nurse take next?
Position the client ton his or her side.
A client with diabetes has a serum creatinine of 1.9 mg/dL. The nurse correlates which urinalysis finding with this client?
Protein in the urine during a random urinalysis
A client who has been taking pioglitazone (Actos) for 6 months reports to the nurse that his urine has become darker since starting the medication. Which is the nurse's first action?
Review results of liver enzyme studies.
A client is being treated for hyperglycemic-hyperosmolar state (HHS). Which clinical manifestation indicates to the nurse that the therapy needs to be adjusted?
Score on the Glasgow Coma Scale is unchanged from 3 hours ago.
A client is receiving IV insulin for hyperglycemia. Which laboratory value requires immediate intervention by the nurse?
Serum potassium level of 2.5 mmol/L
A client has long-standing diabetes mellitus. Which finding alerts the nurse to decreased kidney function in this client?
Sustained elevation in blood pressure
A client was admitted with diabetic ketoacidosis (DKA). Which manifestations does the nurse monitor the client most closely for?
Tachycardia and orthostatic hypotension
A client recently diagnosed with type 1 diabetes tells the nurse, "I will never be able to stick myself with a needle." Which is the nurse's best response?
Tell me what it is about the injections that is concerning you.
Three hours after surgery, the nurse notes that the breath of the client with type 1 diabetes has a "fruity" odor. Which is the nurse's best first action?
Test the serum for ketone bodies
A diabetic client has numbness and reduced sensation. Which intervention does the nurse teach this client to prevent injury?
Use a bath thermometer to test the water temperature.
The nurse is teaching a client with diabetes about self0care. Which activity does the nurse teach that can decrease insulin needs?
Walking 1 mile each day
A client's father has type I diabetes mellitus. The client asks if she is in danger of developing the disease as well. Which is the nurse's best response?
Your risk of diabetes is higher than that of the general population, but it may not occur."
The nurse administers 6 units of regular insulin and 10 units NPH insulin at 7 AM. At what time does the nurse assess the client for problems related to the NPH insulin.
4 PM
A client how has type 2 diabetes is prescribed glipizide (Glucotrol). Which precautions does the nurse include in the teaching plan related to this medicine?
"Avoid taking nonsteroidal anti-inflammatory drugs."
In mixing regular and NPH insulin, the nurse completes the following actions. Place these actions in the correct order.
1) Wash your hands 2) Inspect bottles for expiration dates 3) Gently roll bottle of NPH in hands 4) Clean rubber stoppers with an alcohol swab 5) Inject air into the NPH bottle 6) Inject air into the regular insulin 7) Withdraw the regular insulin 8) Withdraw the NPH insulin.
A client has diabetic ketoacidosis and manifests Kussmaul reparations. What action by the nurse takes priority?
Administration of intravenous insulin.
A client with diabetes has frequent blood glucose readings higher than 300 mg/dL. Which action does the nurse teach the client about self-care?
Check urine ketoens when blood glucose reading are high.
The nurse has been reviewing options for insulin therapy with several clients. For which client does the nurse choose to recommend the pen-type injector insulin delivery system?
Client on an intensive regimen with frequent, small insulin dose
A client has newly diagnosed diabetes. To delay the onset of microvascular and macrovascular complications in this client, the nurse stresses that the clien take which action?
Control hyperglycemia
Which statement made by a diabetic client who has a urinary tract infection indicates that teaching was effective regarding antibiotic therapy?
Even if I feel completely well, I should take the medication until it is gone.:
A client with type 1 diabetes asks whether an occasional glass of wine is allowed in the diet. Which is the nurse's best response?
One glass of wine is okay wit a meal and is counted as two fat exchanges.
The nurse determines that which arterial blood gas values are consistent with ketoacidosis in the client with diabetes?
pH 7.28, HCO3 18 mEq/L, PCO2 28 mm Hg, PO2 98 mmHg
A client with diabetes asks why more than one injection of insulin is required each day. Which 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."
A client has a new insulin pump. Which is the nurse's priority instruction in teaching the client.
"Change the needle every 3 day."
A client newly diagnosed with type 2 diabetes tells the nurse that since increasing fiber intake, he is having loose stools, flatulence, and abdominal cramping. Which is the nurse's best response?
"Decrease your intake of fiber now and gradually add it back into your diet."
The nurse is teaching a client about self-monitoring of blood glucose levels. To prevent bloodborne infection, which statement by the nurse is best?
"Do not share your monitoring equipment."
A client with diabetes is prescribed insulin glargine once daily and regular insulin four times daily. One dose of regular insulin is scheduled at the same time as the glargine. How does the nurse instruct the client to administer the two doses of insulin?
"Draw up and inject the insulin glargine first, then draw up and inject the regular insulin."
The client with type 2 diabetes has recently been changed from the oral antidiabetic agents glyburide (Micronase) and metformin (Glucophage) to glyburidemetformin (Glucovance). The nurse includes which information in the teaching about this medication?
"Glucovance contains a combination of glyburide and metformin."
A client with diabetes has proliferative retinopathy, nephropathy, and peripheral neuropathy. Which statement by the client indicates a good understanding of the disease and exercise?
I should look into swimming or water aerobics to get my exercise.
The nurse correlates which laboratory value with inadequate functioning of a transplanted pancreas?
50% decrease in urine amylase level
The nurse is performing health screening in a local mall. Which people does the nurse counsel to be tested for diabetes? (Select all that apply)
A) African-American or American Indians D) Male with a body mass index greater than 25 kg/m2 E) Middle-aged woman with physical inactivity most days of the week F) Young woman who gave birth to a baby weighting more than 9lbs.
Which statement by a client with type 2 diabetes indicates a need for further teaching about diabetic management and follow-up care?
Because my diabetes is controlled with diet and exercise, I have to be seen only if I am sick.
A young adult client newly diagnosed with type I diabetes mellitus has been taught about self-care. Which statement by the client indicates a good understanding of needed eye examinations?
Diabetes can cause blindness, so I should see the ophthalmologist yearly.
The nurse is caring for a critically ill client who has diabetic ketoacidosis (DKA). The nurse finds the following assessment data: blood pressure, 90/62; pulse, 120 beats/min; respirations, 28 breaths/min; urine output, 20 mL/1 hour per catheter; serum potassium, 2.6 mEq/L. The health care provider orders a 40 mEq potassium bolus and an increase in the IV flow rate. Which action by the nurse is most appropriate?
Increase the IV rate; consult the provider about the potassium.
Which client is at greatest risk for undiagnosed diabetes mellitus?
Middle-aged American Indian woman
A client with untreated diabetes melitus has polyuria, is lethargic, and has a blood glucose of 560 mg/dL. The nurse correlates the polyuria with which finding
Serum osmolarity, 375 mOsm/kg
A client has been taught about lifestyle changes to help manage newly diagnosed diabetes mellitus type 2. Which statement by the client indicates good understanding?
I may not need to take medications if my weigh is maintained.
A client who has used insulin for diabetes control for 20 years has a spongy swelling at the site used most frequently for insulin injection. Which is the nurse's best action?
Instruct the client to use a different site for injection.
The nurse is teaching a client with type 2 diabetes about acute complications. Which teaching point by the nurse is most accurate?
Insulin produced in type 2 diabetes prevents fat catabolism but not hyperglycemia.
