Nclex- Saunders questions Diabetes with rationales

A client is admitted to a hospital with a diagnosis of diabetic ketoacidosis (DKA). The initial blood glucose level was 950 mg/dL. A continuous intravenous infusion of short-acting insulin is initiated, along with intravenous rehydration with normal saline. The serum glucose level is now 240 mg/dL. The nurse would next prepare to administer which item? 1. Ampule of 50% dextrose 2. NPH insulin subcutaneously 3. Intravenous fluids containing dextrose 4. Phenytoin (Dilantin) for the prevention of seizures

3 During management of DKA, when the blood glucose level falls to 250 to 300 mg/dL, the infusion rate is reduced and a dextrose solution is added to maintain a blood glucose level of about 250 mg/dL, or until the client recovers from ketosis. Fifty percent dextrose is used to treat hypoglycemia. NPH insulin is not used to treat DKA. Phenytoin (Dilantin) is not a usual treatment measure for DKA.

A client with diabetes mellitus is being tested to determine long-term diabetic control. Which result should the nurse expect to see if the client's long-term control is within acceptable limits? 1. Glycosylated hemoglobin of 6% 2. Presence of ketones in the urine 3. Presence of albumin in the urine 4. Fasting blood glucose level of 150 mg/dL

1 Rationale: This measurement of glycosylated hemoglobin (Hb A1c) detects glucose binding on the red blood cell (RBC) membrane and is expressed as a percentage. It measures glucose for the life of the RBC, which is 120 days. A glycosylated hemoglobin of 6% is acceptable. The fasting blood glucose level should be at 110 mg/dL. The urine should be free of both ketones and urine.

A test to measure long-term control of diabetes mellitus has been prescribed for a client. In instructing the client about the test, the nurse explains that long-term control can be measured because chronic high blood glucose levels lead to irreversible glucose binding onto what? 1. Platelets 2. Muscle tissue 3. Adipose tissue 4. Red blood cells

4 Rationale: With chronic high circulating blood glucose levels, some glucose binds irreversibly onto red blood cells (RBCs) and remains there for the life of the cell. The average life span of an RBC is 120 days. The measurement of glycosylated hemoglobin (HbA1c), which detects glucose binding on the RBC membrane, is expressed as a percentage. Glucose does not bind onto platelets in diabetes mellitus. One of the problems in diabetes is that muscle and adipose cells may be unable to transport glucose across cell membranes.

The home health nurse visits a client with a diagnosis of type 1 diabetes mellitus. The client relates a history of vomiting and diarrhea and tells the nurse that no food has been consumed for the last 24 hours. Which additional statement by the client indicates a need for further teaching? 1. "I need to stop my insulin." 2. "I need to increase my fluid intake." 3. "I need to monitor my blood glucose every 3 to 4 hours." 4. "I need to call the health care provider (HCP) because of these symptoms."

1 Rationale: When a client with diabetes mellitus is unable to eat normally because of illness, the client still should take the prescribed insulin or oral medication. The client should consume additional fluids and should notify the HCP. The client should monitor the blood glucose level every 3 to 4 hours. The client should also monitor the urine for ketones.

A client arrives in the hospital emergency department complaining of severe thirst and polyuria. The client tells the nurse that she has a history of diabetes mellitus. A blood glucose level is drawn, and the result is 685 mg/dL. Which intervention should the nurse anticipate to be initially prescribed for the client? 1. Glucagon via the subcutaneous route 2. Glyburide (DiaBeta) via the oral route 3. Humulin N insulin via the subcutaneous route 4. Humulin R insulin via the intravenous (IV) route

4 Rationale: The client is most likely in diabetic ketoacidosis (DKA). Humulin R insulin via the IV route is the preferred treatment for DKA. Humulin R insulin is a short-acting insulin and can be given intravenously; it is titrated to the client's high blood glucose levels. Glucagon is used to treat hypoglycemia, and glyburide is an oral hypoglycemia agent used to treat diabetes mellitus type 2. Humulin N insulin is an intermediate-acting insulin and is not appropriate for the emergency treatment of DKA.

The nurse has provided instructions for measuring blood glucose levels to a client newly diagnosed with diabetes mellitus who will be taking insulin. The client demonstrates understanding of the instructions by identifying which method as the best method for monitoring blood glucose levels? 1. "I will check my blood glucose level every day at 5:00 pm." 2. "I will check my blood glucose level 1 hour after each meal." 3. "I will check my blood glucose level 2 hours after each meal." 4. "I will check my blood glucose level before each meal and at bedtime."

4 Rationale: The most effective and accurate measure for testing blood glucose is to test the level before each meal and at bedtime. If possible and feasible, testing should be done during the nighttime hours. Checking the level after the meal will provide an inaccurate assessment of diabetes control. Checking the level once daily will not provide enough data related to control the diabetes mellitus.

An external insulin pump is prescribed for a client with diabetes mellitus and the client asks the nurse about the functioning of the pump. The nurse bases the response on which information about the pump? 1. Is timed to release programmed doses of short-duration or NPH insulin into the bloodstream at specific intervals 2. Continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels 3. Is surgically attached to the pancreas and infuses regular insulin into the pancreas, which in turn releases the insulin into the bloodstream 4. Gives a small continuous dose of short-duration insulin subcutaneously, and the client can self-administer a bolus with an additional dose from the pump before each meal

4..Gives a small continuous dose of short-duration insulin subcutaneously, and the client can self-administer a bolus with an additional dose from the pump before each meal Rationale: An insulin pump provides a small continuous dose of short-duration (rapid or short-acting) insulin subcutaneously throughout the day and night, and the client can self-administer a bolus with an additional dose from the pump before each meal as needed. Short-duration insulin is used in an insulin pump. An external pump is not attached surgically to the pancreas.

The nurse is preparing a plan of care for a client with diabetes mellitus who has hyperglycemia. The nurse places highest priority on which client problem? 1. Lack of knowledge 2. Inadequate fluid volume 3. Compromised family coping 4. Inadequate consumption of nutrients

2 Rationale: An increased blood glucose level will cause the kidneys to excrete the glucose in the urine. This glucose is accompanied by fluids and electrolytes, causing an osmotic diuresis leading to dehydration. This fluid loss must be replaced when it becomes severe. Options 1, 3, and 4 are not related specifically to the subject of the question.

The nurse in a health care clinic is reviewing the record of a client with diabetes mellitus who was just seen by the health care provider (HCP). The nurse notes that the HCP has prescribed acarbose (Precose). Which preexisting disorder, if noted in the client's record, would indicate a contraindication to the use of this medication? 1. Hypothyroidism 2. Renal insufficiency 3. Arterial insufficiency 4. Coronary artery disease

2 Rationale: Acarbose is an antidiabetic medication that may be administered alone or in conjunction with another antidiabetic medication. It is contraindicated in clients with significant renal dysfunction. It also is contraindicated in clients with inflammatory bowel disease, colonic ulceration, or partial intestinal obstruction.

The emergency department nurse is reviewing the laboratory test results for a client suspected of having diabetic ketoacidosis (DKA). Which laboratory result should the nurse expect to note in this disorder? 1. Serum pH of 9.0 2. Absent ketones in the urine 3. Serum bicarbonate of 22 mEq/L 4. Blood glucose level of 500 mg/dL

4 Rationale: In the client with DKA, the nurse should expect to note blood glucose levels between 350 and 1500 mg/dL, ketonuria, serum pH less than 7.35, and serum bicarbonate less than 15 mEq/dL.

he nurse is monitoring a client newly diagnosed with diabetes mellitus for signs of complications. Which sign, if exhibited in the client, would indicate hyperglycemia? 1. Polyuria 2. Diaphoresis 3. Hypertension 4. Increased pulse rate

1 Rationale: Classic symptoms of hyperglycemia include polydipsia, polyuria, and polyphagia. Diaphoresis may occur in hypoglycemia. Options 2, 3, and 4 are not signs of hyperglycemia.

The nurse is caring for a client admitted to the hospital with uncontrolled type 1 diabetes mellitus. In the event that diabetic ketoacidosis (DKA) does occur, the nurse anticipates that which medication would most likely be prescribed? 1. Glucagon 2. Regular insulin 3. Glyburide (DiaBeta) 4. Neutral protamine Hagedorn (NPH) insulin

2 Rationale: Giving regular insulin by the intravenous route is the treatment of choice for DKA. A short-acting insulin is the only insulin that can be given intravenously because it can be titrated to the client's blood glucose levels. Glucagon is used to treat hypoglycemia because it increases blood glucose levels, and glyburide is an oral hypoglycemic agent used to treat type 2 diabetes mellitus; both agents are inappropriate. NPH insulin is an intermediate-acting insulin and therefore is not appropriate for treatment of DKA.

A client with diabetes mellitus is at risk for a serious metabolic disorder from the breakdown of fats for conversion to glucose. The nurse plans care for the client, knowing that pathological fat metabolism is occurring if the client has elevated levels of which substance? 1. Glucose 2. Ketones 3. Glucagon 4. Lactate dehydrogenase

2 Rationale: Ketones are a by-product of fat metabolism. When this process occurs to an extreme, the resulting condition is called ketoacidosis. Options 1, 3, and 4 are not associated with the breakdown of fats.

The nurse teaches a client with diabetes mellitus about differentiating between hypoglycemia and ketoacidosis. The client demonstrates an understanding of the teaching by stating that a form of glucose should be taken if which symptoms develop? Select all that apply. 1. Polyuria 2. Shakiness 3. Palpitations 4. Blurred vision 5. Lightheadedness 6. Fruity breath odor

2,3 & 5 Rationale: Shakiness, palpitations, and lightheadedness are signs of hypoglycemia and would indicate the need for food or glucose. Polyuria, blurred vision, and a fruity breath odor are signs of hyperglycemia.

The nurse performs a physical assessment on a client with type 2 diabetes mellitus. Findings include a fasting blood glucose level of 120 mg/dL, temperature of 101° F, pulse of 88 beats/minute, respirations of 22 breaths/minute, and blood pressure of 100/72 mm Hg. Which assessment would be of most concern to the nurse? 1. Pulse 2. Respiration 3. Temperature 4. Blood pressure

3 Rationale: An elevated temperature may indicate infection. Infection is a leading cause of hyperglycemic hyperosmolar state or diabetic ketoacidosis. The other findings noted in the question are within normal limits.

The nurse provides instructions to a client newly diagnosed with type 1 diabetes mellitus. The nurse recognizes accurate understanding of measures to prevent diabetic ketoacidosis when the client makes which statement? 1. "I will stop taking my insulin if I'm too sick to eat." 2. "I will decrease my insulin dose during times of illness." 3. "I will adjust my insulin dose according to the level of glucose in my urine." 4. "I will notify my health care provider (HCP) if my blood glucose level is higher than 250 mg/dL."

4 During illness, the client should monitor blood glucose levels and should notify the HCP if the level is higher than 250 mg/dL. Insulin should never be stopped. In fact, insulin may need to be increased during times of illness. Doses should not be adjusted without the HCP's advice and are usually adjusted on the basis of blood glucose levels, not urinary glucose readings.

A client arrives in the hospital emergency department in an unconscious state. As reported by the spouse, the client has diabetes mellitus and began to show symptoms of hypoglycemia. A blood glucose level is obtained for the client, and the result is 40 mg/dL. Which medication should the nurse anticipate to be prescribed for the client? 1. Glucagon 2. Humulin N insulin 3. Humulin R insulin 4. Glyburide (DiaBeta)

1 Rationale: A blood glucose lower that 50 mg/dL is considered to be critically low. Glucagon is used to treat hypoglycemia because it increases blood glucose levels. Humulin N insulin and Humulin R insulin would lower the client's blood glucose and would not be an appropriate treatment for hypoglycemia. Glyburide is an oral hypoglycemic agent used to treat type 2 diabetes mellitus and would not be given to a client with hypoglycemia. Additionally, an oral medication would not be administered to an unconscious client.

A nurse notes that a client with type 1 diabetes mellitus has lipodystrophy on both upper thighs. The nurse should ask the client if which measure is taken? 1. Rotating sites for injection 2. Administering the insulin at a 45-degree angle 3. Cleaning the skin with alcohol before each injection 4. Aspirating for blood before injection into the subcutaneous tissue

1 Rationale: Lipodystrophy (hypertrophy of subcutaneous tissue at the injection site) occurs in some clients with diabetes mellitus when injection sites are used for a prolonged period. Therefore, clients are instructed to adhere to a plan of rotating injection sites to avoid tissue changes. Angle of insulin administration, cleansing with alcohol, and aspiration do not produce this complication.

The nurse is monitoring a client who was diagnosed with type 1 diabetes mellitus and is being treated with NPH and regular insulin. Which client complaints would alert the nurse to the presence of a possible hypoglycemic reaction? Select all that apply. 1. Tremors 2. Anorexia 3. Irritability 4. Nervousness 5. Hot, dry skin 6. Muscle cramps

1,3 & 4 Decreased blood glucose levels produce autonomic nervous system symptoms, which are manifested classically as nervousness, irritability, and tremors. Option 5 is more likely to occur with hyperglycemia. Options 2 and 6 are unrelated to the signs of hypoglycemia. In hypoglycemia, usually the client feels hunger.

A client with type 1 diabetes mellitus calls the nurse to report recurrent episodes of hypoglycemia with exercising. Which statement by the client indicates an inadequate understanding of the peak action of NPH insulin and exercise? 1. "The best time for me to exercise is after I eat." 2. "The best time for me to exercise is after breakfast." 3. "The best time for me to exercise is mid- to late afternoon." 4. "The best time for me to exercise is after my morning snack."

3 Rationale: A hypoglycemic reaction may occur in response to increased exercise. Clients should avoid exercise during the peak time of insulin. NPH insulin peaks at 4 to 12 hours; therefore, afternoon exercise takes place during the peak of the medication. Options 1, 2, and 4 do not address peak action times.

A nurse is preparing a teaching plan for a client with diabetes mellitus regarding proper foot care. Which instruction should be included in the plan? 1. Soak the feet in hot water. 2. Avoid using a mild soap on the feet. 3. Always have a podiatrist cut the toenails. 4. Apply a moisturizing lotion to dry feet but not between the toes.

4 Rationale: The client is instructed to use a moisturizing lotion on the feet and avoid applying lotion between the toes. The client should be instructed not to soak the feet and should avoid hot water to prevent burns. The client should be instructed to wash the feet daily with a mild soap. The client may cut the toenails straight across and even with the toe itself and would consult a podiatrist if the toenails are thick or hard to cut or if vision is poor.

A client with diabetes mellitus who refuses to take insulin as prescribed exhibits markedly increased blood glucose levels after a meal. The nurse caring for the client anticipates that which initial body response to elevated glucose levels will worsen the situation for the client? 1. Glycogenolysis 2. Gluconeogenesis 3. Binding of glucose onto cell membranes 4. Transport of glucose across cell membranes

1 Rationale: As blood glucose levels rise when glucose is not being carried into the cells, the body interprets this to mean that more glucose is needed. The initial response by the body is to use up the stores of glycogen in the liver. The conversion of glycogen to glucose for use by the body is called glycogenolysis. If this mechanism fails, the body breaks down fats and proteins and converts them into glucose; this process is called gluconeogenesis. Glucose binds onto cell membranes and is transported across them into the cells when there is sufficient circulating insulin.

A hospitalized client is diagnosed with type 1 diabetes mellitus. The nurse plans care for the client, understanding that which factors are likely causes of the beta cell destruction that accompanies this disorder? Select all that apply. 1. Viruses 2. Genetic factors 3. Autoimmune factors 4. Human leukocyte antigen (HLA) 5. Primary failure of glucagon secretion

1, 2, 3, 4 Rationale: Viruses and autoimmune factors are thought to play a role in the development of type 1 diabetes mellitus. Other causes of type 1 diabetes mellitus include genetic factors, specifically the presence of the human leukocyte antigen (HLA). This factor is found in many clients with type 1 diabetes mellitus. The problem with type 1 diabetes mellitus is destruction of the beta cells. It is not caused by a primary failure of glucagon secretion.

A client with type 1 diabetes mellitus is admitted to the emergency department with suspected diabetic ketoacidosis (DKA). Which laboratory result would be expected with this diagnosis? 1. Urine is negative for ketones. 2. Serum potassium is 6.8 mEq/L. 3. Serum osmolality is 260 mOsm/L. 4. Arterial blood gas values are: pH 7.52, Pco2 44 mm Hg, HCO3 30 mEq/L.

2 Rationale: Movement of hydrogen ions from the extracellular to the intracellular fluid promotes the movement of potassium from intracellular to extracellular fluid. Thus the serum potassium level will rise. The value in option 2 is greater than the normal range of 3.5 to 5.0 mEq/L. Presence of ketones in urine would be expected, and the serum osmolality would be elevated to reflect dehydration (the serum osmolality in option 3 is decreased). The client with DKA experiences metabolic acidosis (not metabolic alkalosis as noted in option 4).

The nurse is providing instructions to a client newly diagnosed with diabetes mellitus. The nurse gives the client a list of the signs of hyperglycemia. Which specific sign of this complication should be included on the list? 1. Shakiness 2. Increased thirst 3. Profuse sweating 4. Decreased urine output

2 Rationale: The classic signs of hyperglycemia include polydipsia, polyuria, and polyphagia. Profuse sweating and shakiness would be noted in a hypoglycemic condition.

A client with diabetes mellitus has a blood glucose level of 50 mg/dL and reports feeling hungry and shaky. Which should the nurse provide the client? 1. 3 oz of 2% milk 2. 4 oz of apple juice 3. 2 oz of orange juice 4. A teaspoon of granulated sugar

2 Rationale: When a client is exhibiting symptoms of mild hypoglycemia the nurse should provide the client with 15 g of a simple carbohydrate to quickly increase the blood glucose level. One half cup of apple juice is equivalent to 15 g of carbohydrates. The items in options 1, 3, and 4 do not provide a sufficient amount of carbohydrate.

A client with a history of diabetes mellitus has a fingerstick blood glucose level of 460 mg/dL. The home care nurse anticipates that which additional finding would be present with further testing if the client is experiencing diabetic ketoacidosis (DKA)? 1. Hyponatremia 2. Rise in serum pH 3. Presence of ketone bodies 4. Elevated serum bicarbonate level

3 Rationale: DKA is marked by the presence of excessive ketone bodies. As a result of the acidosis, the pH and serum bicarbonate level would decrease. Hyponatremia is not related to DKA.

The nurse is monitoring a client with diabetes mellitus for signs of hypoglycemia. Which manifestations are associated with this complication? 1. Slow pulse; lethargy; warm, dry skin 2. Elevated pulse; lethargy; warm, dry skin 3. Elevated pulse; shakiness; cool, clammy skin 4. Slow pulse, confusion, increased urine output

3 Rationale: Signs and symptoms of mild hypoglycemia include tachycardia, shakiness, and cool, clammy skin. Options 1, 2, and 4 do not specify the manifestations of hypoglycemia.

The nurse is providing instructions regarding insulin administration for a client newly diagnosed with diabetes mellitus. The health care provider has prescribed a mixture of Humulin N and Humulin R insulin. The nurse should instruct the client that which is the first step in this procedure? 1. Draw up the correct dosage of Humulin N insulin into the syringe. 2. Draw up the correct dosage of Humulin R insulin into the syringe. 3. Inject air equal to the amount of Humulin N prescribed into the vial of Humulin N insulin. 4. Inject air equal to the amount of Humulin R prescribed into the vial of Humulin R insulin.

3 Rationale: The initial step in preparing an injection of insulin that is a mixture of Humulin N and regular is to inject air into the Humulin N bottle equal to the amount of insulin prescribed. The client would then be instructed to next inject an amount of air equal to the amount of prescribed insulin into the Humulin R bottle. The regular insulin would then be withdrawn, followed by the Humulin N insulin. Contamination of regular insulin with Humulin N insulin will convert part of the Humulin R insulin into a longer-acting form.

A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the emergency department. Which findings would the nurse expect to note as confirming this diagnosis? Select all that apply. 1. Increase in pH 2. Comatose state 3. Deep, rapid breathing 4. Decreased urine output 5. Elevated blood glucose level 6. Low plasma bicarbonate level

3, 5 & 6 Rationale: In DKA, the arterial pH is lower than 7.35, plasma bicarbonate is lower than 15 mEq/L, the blood glucose level is higher than 250 mg/dL, and ketones are present in the blood and urine. The client would be experiencing polyuria, and Kussmaul's respirations (deep and rapid breathing pattern) would be present. A comatose state may occur if DKA is not treated, but coma would not confirm the diagnosis.

A client is brought to the emergency department in an unresponsive state, and a diagnosis of hyperglycemic hyperosmolar state (HHS) is made. The nurse would immediately prepare to initiate which anticipated health care provider's prescription? 1. Endotracheal intubation 2. 100 units of NPH insulin 3. Intravenous infusion of normal saline 4. Intravenous infusion of sodium bicarbonate

3. Intravenous solution of normal saline. Rationale: The primary goal of treatment in hyperglycemic hyperosmolar state (HHS) is to rehydrate the client to restore fluid volume and to correct electrolyte deficiency. Intravenous fluid replacement is similar to that administered in diabetic ketoacidosis (DKA) and begins with IV infusion of normal saline. Regular insulin, not NPH insulin, would be administered. The use of sodium bicarbonate to correct acidosis is avoided because it can precipitate a further drop in serum potassium levels. Intubation and mechanical ventilation are not required to treat HHS.

The nurse is reviewing the health care provider (HCP) prescriptions for a client with a diagnosis of diabetes mellitus who has been hospitalized for treatment of an infected foot ulcer. The nurse expects to note which finding in the HCP prescriptions? 1. A decreased-calorie diet 2. An increased-calorie diet 3. A decreased amount of NPH daily insulin 4. An increased amount of NPH daily insulin

4 Rationale: Infection is a physiological stressor that can cause an increase in the level of epinephrine in the body. An increase in epinephrine causes an increase in blood glucose levels. When the client is under stress, such as when an infection is present, an increase in the dose of insulin will be required to facilitate the transport of excess glucose into the cells. The client will not necessarily need an adjustment in the daily diet.

A client is undergoing an oral glucose tolerance test. The nurse interprets that the client's results are compatible with diabetes mellitus if the glucose level is at which value after 120 minutes (2 hours)? 1. 80 mg/dL 2. 110 mg/dL 3. 130 mg/dL 4. 160 mg/dL

4 Rationale: The normal reference values for oral glucose tolerance tests are lower than 140 mg/dL at 120 minutes; lower than 200 mg/dL at 30, 60, and 90 minutes; and lower than 115 mg/dL in the fasting state. 160 mg/dL is higher than the normal reference range so therefore is the correct answer.