PN test 3
the nurse is reinforcing instructions with a client with diabetes mellitus who is recovering from DKA regarding measures to prevent a reoccurrence. which instruction is important for the nurse to emphasize? a. eat 6 small meals a day b. test the urine ketone level c. monitor blood glucose levels frequently d. receive appropriate followup healthcare
3 home glucose monitoring should be emphasized 4-5 times a day
a 50 year old woman was recently diagnosed with type 2 diabetes mellitus and desires to start a healthy lifestyle to control her disease. what is the initial recommendation that the nurse should make? a. engage in brisk walk b. lose 10 to 15 pounds c. maintain adequate glucose control d. develop an exercise schedule
c Once the patient has learned how to manage and monitor her glucose level, she can begin to balance her diet with exercise and gradually lose some weight.
during a prenatal visit, the nurse is explaining dietary management to a client with diabetes mellitus. the nurse determines that the teaching has been effective when the client makes which statement? a. "a can eat more sweets now because i need more calories" b. "i need more fat in my diet so that the baby can gain enough weight" c. "i need to eat a high protein, low carb diet now to control my blood glucose" d. "i need to increase the fiber in my diet to control my blood glucose and prevent constipation"
4 an increase in calories is needed, but an increase of sugar can cause hyperglycemia
when the nurse is reinforcing instructions to a client who has been newly diagnosed with type 1 DM. which statement by the client would indicate that teaching has been effective? a. "i will stop taking my insulin if i am too sick to eat" b. "i will decrease my insulin dose during times of illness" c. "i will adjust my insulin dose according to the level of glucose in my urine" d. "i will notify my HCP if my blood glucose level is consistently greater than 250 mg/dL"
4 during illness you should monitor the blood glucose level. and notify the HCP if the level is over 250 mg/dL. insulin should never be stopped. it may need to be increased during times of illness
the nursing assistant tells you that a patient with diabetes has a blood glucose level of 60 mg/dL. what symptoms would the nurse be most likely to observe with the glucose level? a. confusion, tremulousness, pallor, sweating, and weakness b. dry, flushed skin, and mild irritability c. deep, rapid breathing, and abdominal pain d. incoherent moaning, combativeness, and seizure activity
a Confusion, tremulousness, pallor, sweating, and weakness are the most likely symptoms. Incoherent moaning, combativeness, and seizure activity might occur if the nurse fails to intervene quickly. Dry, flushed skin is symptomatic of hyperglycemia. Irritability could be present to high or low glucose levels. Deep rapid breathing and abdominal pain are signs of hyperglycemia.
the nurse notes that a client with type 1 DM has lipodystrophy on both upper thighs. which further information should the nurse obtain from the client during data collection? a. plan for injection rotation b. consistency of aspiration c. preparation of the injection site d. angle at which medication is administered
a lipodystrophy (hypertrophy of subcutaneous tissue at the injection site) occurs when an injection site is used too much
It is most important for the nurse to include which risk factors in a teaching plan associated with the development of type 2 diabetes mellitus? Select all that apply. a. Hypertension b. History of pancreatic trauma c. Weight gain of 30 pounds during pregnancy d. Body mass index greater than 25 kg/m e. Triglyceride levels between 150 and 200 mg/dL f. Delivery of a 4.99-kg baby
a, d, f Risk factors for type 2 diabetes include habitual inactivity, hypertension, delivery of a baby weighing over 9 pounds, a history of vascular disease, a body mass index greater than 25 kg/m, and triglyceride levels over 200 mg/dL.
a patient with diabetes asks if a slice of cake can be added to the meal for dessert. the best response by the nurse would be: a. "diabetic patients should not eat cake" b. "yes, but you must omit other carbohydrates of equal value from the meal" c. "you will have to check with your HCP" d. "yes, but don't do this too often"
b Sweets can be consumed by a person with diabetes, but moderation is the key, since carbohydrate value of foods must be understood and consistent in the diet in order to avoid hyperglycemia. It is advised that sweets be limited because they are usually limited in protein and other nutrients.
a nurse is providing education on how to check blood glucose levels to a client who has a new diagnosis of type 1 DM. the nurse should include which of the following instructions about transferring blood onto the reagent portion of the test strip? a. smear the blood onto the strip b. squeeze the blood onto the strip c. touch the puncture to stimulate the bleeding d. hold the strip next to the blood on the fingertip
d holding the pad of the strip next to the blood allows it to flow onto the strip til the amount is adequate
a nurse is planning care to create dietary guidelines for a client who has type 2 DM. which of the following information should the nurse include in the dietary plan? (select all that apply) a. weight management b. lipid profile c. cultural needs d. sleep patterns e. personal preferences
a, b, c, e weight management, lipid profile, cultural needs, and preferences should be included in the teaching session
a nurse is reviewing a clients medication history. the client has an admission blood glucose level of 260 mg/dL and no documented history of diabetes mellitus. which of the following types of medication should alert the nurse to the possibility that the client has developed an adverse effect of pharmacological therapy? (select all that apply) a. diuretics b. corticosteroids c. oral anticoagulants d. opioid analgesics e. antipsychotics
a, b, e diuretics and corticosteroids can cause hyperglycemia. antipsychotics can cause new onset DM
a nurse is collecting data from a client who has DKA and ketones in the urine. the nurse should expect which of the following findings? (select all that apply) a. weight gain b. fruity odor of breath c. abdominal pain d. kussumal respirations e. metabolic acidosis
b, c, d, e fruity odor to breath, abdominal pain, kussumal respirations, and metabolic acidosis are all manifestations of DKA or ketones in the urine
A patient with type 1 diabetes mellitus (DM) plays tennis and asks if she will be able to continue with that sport. The nurse should base his response on which information? a. It would be better to take up walking or some quiet sport. b. She can play tennis, but she will need an extra dose of insulin. c. She can play tennis, but she will need to eat more before she plays. d. She cannot play tennis because heavy exercise is not permitted with this type of diabetes.
c Exercise is recommended for the patient with diabetes. Exercise will require changes in both diet and insulin use. Eating before exercise will aid in the prevention of hypoglycemia.
Which clinical manifestation of decreased renal function in the diabetic clinic should the nurse anticipate as a potential problem? a. Elevated specific gravity b. Ketone bodies in the urine c. Glucose in the urine d. Sustained increase in blood pressure from 130/82 mm Hg to 150/110 mm Hg
d Hypertension is both a cause and a result of renal dysfunction in the diabetic client. Although ketones and glucose in the urine are findings in diabetes mellitus, they are not specific for renal function. Specific gravity is elevated with dehydration.
Which clinical manifestation indicates to the nurse a patient's hyperosmolar nonketotic syndrome (HNKS) therapy needs to be adjusted? a. Ketone bodies in the urine have been absent for 3 hours. b. Blood osmolarity has decreased from 350 to 330 mOsm. c. Serum potassium level has increased from 2.8 to 3.2 mEq/L. d. The Glasgow Coma Scale is unchanged from 3 hours ago.
d Slow but steady improvement in central nervous system functioning should be seen with effective therapy for HNKS. An unchanged level of consciousness may indicate inadequate rates of fluid replacement. Ketone bodies, blood osmolarity, and serum potassium levels are consistent with improvement.
Which priority intervention will the nurse initiate for the patient having Kussmaul's respirations due to diabetic ketoacidosis? a. Administration of oxygen by nasal cannula at 15 L/min b. Intravenous infusion of 10% glucose c. Implementation of seizure precautions d. Administration of intravenous insulin
d The Kussmaul's respirations pattern is the body's attempt to reduce the acids produced by utilization of fat for fuel. Administration of insulin will reduce this respiration pattern by assisting glucose transport back into cells to be used for fuel instead of fat. Nasal cannula oxygen is given at 1 to 6 L per minute; intravenous glucose administration will not have the desired effect of treatment; and although seizure precautions may be implemented, they will not have any effect on glucose transport into cells.
a nurse if reinforcing teaching with a school aged child who has diabetes mellitus about insulin administration. which of the following instructions should the nurse include? a. "you should inject the needle at a 30 degree angle" b. "you should combine glargine and regular insulin into the same syringe" c. "you should aspirate for blood before you inject the insulin" d. "you should give 4 to 5 injections in one site before switching sites"
d the client should administer 4 to 5 injections about 2.5 cm apart before switching to another site
the nurse answers the call light for a patient with diabetes. the patient states she feels shaky and weak. the nurse notes pallor and moist skin. list in priority order the actions of the nurse. a. give patient 6 oz of orange juice b. document interventions c. check finger stick glucose d. assess level of consciousness
d, c, a, b The level of consciousness determines the glucose intervention. If the patient is not able to swallow, injectable forms of glucose will be utilized. If the patient is unconscious, treatment should be initiated immediately, not taking time for checking the blood glucose level. For the conscious patient, fingerstick glucose should be done and treatment given and actions documented. Fifteen minutes after treatment, the glucose should be rechecked.
a client with type 1 DM calls the nurse to report recurrent episodes of hypoglycemia. which statement by the client indicates a correct understanding of humulin N insulin and exercise? a. "i should not exercise after lunch" b. "i should not exercise after breakfast" c. "i should not exercise in the late evening" d. "i should not exercise in the late afternoon"
4 clients should avoid exercise during the peak time of insulin. Humulin N insulin peaks at 12-14 hours. therefore late afternoon exercise would occur during the peak time of insulin
Based on the nurse's assessment of a diabetic patient, which finding indicates the need for avoidance of exercise at this time? a. Ketone bodies in the urine b. Blood glucose level of 155 mg/dL c. Pulse rate of 66 beats per minute d. Weight gain of 1 pound over the previous week's weight
a Exercise would lead to further elevations in blood glucose levels due to inadequate insulin to promote intracellular glucose transport and uptake. Assessing for ketones in the urine may indicate insulin deficiency.
A patient with diabetes is admitted to the emergency department with complaints of lack of feeling, yet debilitating pain in his legs and feet, constipation, and sexual impotence. These symptoms most closely correlate with which disorder? a. Diabetic neuropathy b. Diabetic retinopathy c. Diabetic ketoacidosis d. Diabetic nephropathy
a When a patient has diabetic neuropathy, the peripheral nerves are affected, causing lack of feeling, yet debilitating pain in the legs and feet, constipation, and sexual impotence. Diabetic retinopathy is visual impairment, including possible blindness, from diabetes. Diabetic ketoacidosis symptoms may be polyuria, fatigue, anorexia, abdominal pain, and a fruity smell to the breath. Diabetic nephropathy occurs from changes in the renal blood circulation.
a school aged child with type 1 DM has soccer practice three afternoons a week. the nurse reinforces instructions regarding how to prevent hypoglycemia during practice. what should the nurse tell the child? a. drink half a cup of orange juice before soccer practice b. eat twice the amount that is normally eaten at lunch time c. take half the amount of prescribed insulin on practice days d. take the prescribed insulin at noontime rather than in the morning
a an extra snack of 10g to 15g of carbs eaten before activities and every 30-45 minutes of activity will prevent hypoglycemia
the nurse is monitoring a client who has been newly diagnosed with diabetes mellitus for signs of complications. which statement made by the client would indicate for hyperglycemia and thus warrant HCP notification? a. "i am urinating a lot" b. "my pulse is really slow" c. "i am sweating for no reason" d. "my BP is really high"
a polyuria, polydipsia, and polyphagia are all signs of hyperglycemia. slow pulse, sweating, and increased BP are not signs of hyperglycemia
a nurse is reviewing the health record of a client who has hyperglycemic-hyperosmolar state (HHS). which of the following factors can cause HHS? (select all that apply) a. evidence of recent myocardial infarction b. BUN 35 mg/dL c. takes a calcium channel blocker d. age 77 years e. fluid volume excess
a, b, c, d a myocardial infarction, BUN level of 35 mg/dL,a calcium channel blocker, and older age puts you at risk for HHS
a nurse is assisting with a presentation about nutrition habits that prevent type 2 DM for a group of clients. which of the following should the nurse include? (select all that apply) a. eat less meat and processed foods b. decrease intake of saturated fats c. increase daily fiber intake d. limit unsaturated fat intake to 15%of daily caloric intake e. include omega-3 fatty acids in the diet
a, b, c, e decrease eating processed foods, lower LDL fats increasing dietary fiber, eat omega-3 fatty acids to lower the risk for heart disease
a patient newly diagnosed with diabetes and is given diet instructions. what should the nurse do to effectively motivate the patient to comply with dietary recommendations? (select all that apply) a. emphasizes good food choices b. apply diet prescriptions to patient preferred foods c. instill guilt to self regulate when "cheating" occurs d. focus on the benefits of diet compliance e. involve meal preparers in diet teaching
a, b, d, e These options are good strategies. Fear and guilt create a situation where the patient will be reluctant to tell the truth to others. There will be times when the patient will not follow the diet (e.g., it may be very difficult during the holidays); however, the patient should be able to admit the deviation from the plan and then get back on schedule.
a nurse is determining a clients ability to self monitor blood glucose with a monitor. which of the following abilities should the nurse confirm that the client has before proceeding with caution? (select all that apply) a. finger dexterity b. visual acuity c. color vision d. basic literacy e. demonstration ability
a, b, e the patient must be able to cleanse and puncture the site as well as be able to see, and use the glucometer safely and effectively
a nurse is reinforcing dietary teaching to a client who has type 2 DM. which of the following instructions should the nurse include in the teaching? (select all that apply) a. carbohydrates should compromise 55% of daily caloric intake b. use hydrogenated oils for cooking c. you can add table sugar to cereal d. you can drink one alcoholic beverage with a meal e. use the same portion sizes to exchange carbohydrates
a, c, d, e carbs should be 45-60% of the daily caloric intake, sugar can be eaten if insulin is administered, alcoholic beverages can be drank with meals, and the client can exchange carbohydrates as long as portion sizes remain the same
a nurse is providing information to a client who has a new diagnosis of type 1 DM. which of the following information should the nurse include? (select all that apply) a. a viral infection can trigger the onset of type 1 DM b. alpha cells in the pancreas are damages in type 1 DM c. type 1 DM usually occurs before age 30 d. type 1 DM is treated with oral antiglycemic medications e. regular exercise can reduce insulin requirements in type 1 DM
a, c, e viral infections or genetic links can trigger an autoimmune response that triggers type 1 DM, type 1 DM usually occurs before age 30, and regular exercise can reduce insulin
which teaching technique(s) would be most useful for older adult patients with diabetes? (select all that apply) a. set a time for the teaching session that is agreeable with the patient b. invite the patient to join a teaching session for newly diagnosed patients with diabetes c. allow time for the patient to jot down important points d. use bold type printed materials with a white type on a dark blue or black background e. keep the sessions at a limit of 1 to 2 hours and give frequent breaks f. teach all necessary information in one session g. repeat key concepts frequently; if the patient does not understand, try rephrasing the concept
a, c, g Setting a specific time, allowing additional time to write down information, and repeating key concepts are good strategies. Group learning may work for some older patients, but generally it is more advisable to have less distraction and more time for individualized attention. Use dark type on white backgrounds for optimal visual clarity. Attempting to cover all material in long sessions is not ideal, even if you give the patient frequent breaks.
a nurse is reviewing a sick day management with a parent of a child who has type 1 DM. which of the following instructions should the nurse include in the teaching? (select all that apply) a. monitor blood glucose levels every 3 hours b. discontinue taking insulin until until feeling better c. drink 8 oz of fruit juice every hour d. test urine for ketones e. call the provider if blood glucose is greater than 240 ml/dL
a, d, e a client experiencing illness can have waning blood glucose levels. urine should be tested for ketones to help assist early detections of ketoacidosis. the HCP should be notified for a level above 240 mg/dL
during a routine checkup, the HCP tells a patient with diabetes that the test results reveal albuminuria. which long term complication is specific to this test result? a. metabolic syndrome b. neuropathy c. retinopathy d. peripheral vascular disease
b Albuminuria indicates that protein is passing into the urine because the filtering mechanism of the kidney has sustained damage from filtering blood with elevated glucose. The other complications are likely to be simultaneously occurring over time because of the damage to blood vessels and other organs.
a nurse determines the finger stick blood glucose reading for a patient with diabetes is 750 mg/dL. what is the nurses priority action? a. immediately notify the RN and the HCP b. assess the vital signs of the patient c. check the record to verify whether the patient has type 1 or 2 diabetes d. administer prescribed sliding scale insulin
b The patient should be assessed immediately for responsiveness and additional signs and symptoms. Notifying the RN and the physician after the patient has been assessed are appropriate actions. Checking the record to verify type 1 or type 2 diabetes is not incorrect, but hopefully the nurse would know this information from shift report. Administering the insulin should not happen until further assessment is completed.
the home health nurse is visiting an older adult patient who has successfully managed her type 2 diabetes for years. during the visit, the nurse notes that the patient has severe arthritis, poor vision, and several dry, red areas on the lower extremities. what is the priority patient problem? a. potential for noncompliance due to social circumstances b. potential for ineffective self-health management due to aging c. potential for infection due to poor peripheral perfusion d. potential for disturbed sensory perception due to degenerative changes
b This patient has had type 2 diabetes for years, but now changes related to aging place the patient at risk for ineffective self-health management. Risk for noncompliance is an inappropriate diagnosis. Patient does not have a history of noncompliance but now needs interventions related to aging to maximize self-care. Patient does have risk for infection and problems with sensory input; however, again, the nurse should use interventions that address the problems of aging, so that the patient can continue self-care.
a nurse is preparing to administer a morning dose of insulin aspart to a client who has type 1 DM. which of the following actions should the nurse take? a. check blood glucose immediately after breakfast b. administer insulin when breakfast arrives c. hold breakfast for 1 hour after insulin administration d. clarify the prescription because insulin should not be administered at this time
b administering insulin aspart when breakfast arrives can prevent a hypoglycemic episode. insulin aspart is rapid acting and should be administered 5-10 minutes before breakfast
the major component necessary for metabolism of carbohydrates is (are): a. pancreatic enzymes b. insulin secreted by the pancreas c. bile secreted by the liver d. mucous secreted from the duodenum
b Insulin is needed for the metabolism of carbohydrate.
A patient who is undergoing surgery will have an intravenous solution to which insulin will be added. Which type of insulin must be used? a. Lente b. Regular c. Ultralente d. Neutral protamine Hagedorn (NPH)
b Regular insulin is the only type that may be administered intravenously. NPH, Lantus, and Ultralente may be administered only subcutaneously.
A patient newly diagnosed with diabetes is learning to administer his injections of NPH and regular insulin. Which statement indicates that the patient understands the nurse's teaching regarding proper insulin administration? a. "I will draw up the NPH before the regular insulin." b. "I will draw up the regular insulin before the NPH." c. "I will give myself the NPH and the regular insulin in two different injections." d. "It doesn't matter which insulin I draw up first, as long as the amount is correct."
b The dose of regular insulin is drawn up into the syringe before the NPH to prevent accidentally contaminating the rapid-acting insulin (regular) with time-released insulin (NPH). Regular and NPH can be given mixed in one injection, as long as the regular insulin is drawn up before the NPH.
The nurse recommends the pen-injector insulin delivery system for the client with which clinical presentation? a. Confusion and reliance on another person for insulin injections b. Requirements for intensive therapy with small, frequent insulin doses c. Visual impairment affecting the ability to draw up insulin accurately d. Frequent episodes of hypoglycemia
b The pen injector allows greater accuracy with small doses of less than 5 units. It is not recommended for those with cognitive or visual impairments or those who suffer frequent hypoglycemic episodes.
a nurse is assessing a client who has hypoglycemia.which of the following findings should the nurse expect? a. fruity breath b. diaphoresis c. ketones in urine d. polyuria
b a client who has hypoglycemia can have diaphoresis and cool, clammy skin
a client who has been newly diagnosed with diabetes mellitus has been stabilized with daily insulin injections. which teaching information should the nurse reinforce upon discharge? a. keep insulin vials refrigerated at all times b. rotate the injection sites systemically c. increase the amount of insulin before unusual exercise d. monitor the urine acetone level to determine the insulin dosage
b changing sites can prevent dramatic changes in daily insulin absorption
the nurse reinforces teaching with a client with diabetes mellitus regarding differentiating between hypoglycemia and ketoacidosis. the client demonstrates an understanding of the teaching by stating that glucose will be taken if which symptom develops? a. polyuria b. shakiness c. blurred vision d. fruity breath odor
b shakiness is a sign of hypoglycemia. polyuria, blurred vision, and fruity breath are signs of hyperglycemia
a nurse is caring for a client who has diabetes mellitus and is shaky and weak. which of the following actions should the nurse take? a. provide subcutaneous insulin for the client b. offer the client 120 ml (4 oz) of fruit juice c. give the client IV potassium d. administer IV sodium bicarbonate
b the client has manifestations of hypoglycemia, so offer juice to help bring it up
a nurse is reinforcing teaching with an adolescent who has diabetes mellitus about manifestations of hypoglycemia. which of the following findings should the nurse include? (select all that apply) a. increased urination b. hunger c. manifestations of dehydration d. irritability e. sweating and pallor f. kussumal respirations
b, d, e hunger, irritability, and sweating and pallor are all manifestations of hypoglycemia
a 30 year old woman is admitted for a UTI with sepsis. a urinalysis reveals presence of ketones, glucose, and nitrates. which question would the nurse ask to further assess possible diabetes mellitus? a. "have you noticed an extra roundness to your face?" b. "have you had more gas or abdominal bloating?" c. "have you been thirstier than usual? do you find you urinate more now?" d. "have you experienced any pain or discomfort with urination?"
c Polydipsia, polyuria, and polyphagia (thirst, urinary frequency, and hunger, respectively) are signs of diabetes. A round moon face is characteristic of Cushing disease. Abdominal bloating is more associated with thyroid problems. Asking about pain with urination is appropriate to assess for urinary tract infection (UTI). There is an increased risk for UTI with diabetes, but asking about occurrence or frequency of UTIs is a better question to assess for possible diabetes.
A patient recently diagnosed as having hypoglycemia says, "Hypoglycemia! I can't live with that. My neighbor, Joseph, had that and he acted crazy!" Which response by the nurse is most appropriate? a. "You seem to be overreacting to the problem." b. "You're right; it would be difficult to live with hypoglycemia." c. "Hypoglycemia has been successfully treated by diet modifications." d. "Taking care of yourself years ago would have prevented the problem."
c Hypoglycemia refers to a low serum blood glucose level. It is best managed with dietary management. Telling the patient that the condition is hard to manage would be counterproductive and inaccurate. Making the patient's concerns appear trivial or discussing past self-care would not further the relationship between the nurse and patient.
The nurse should institute which precaution for the hypoglycemic patient receiving intramuscular glucagon due to an inability to swallow the oral form? a. Elevate the head of the bed. b. Have a padded tongue blade at the bedside. c. Position the client face down or in a side-lying position. d. Apply pressure and massage the injection site for 5 minutes.
c Intramuscular injection of glucagon often causes vomiting, increasing the patient's risk for aspiration. Elevating the head of the bed, instituting the use of a padded tongue blade, or applying pressure at or massaging injection site is not a safe nursing practice.
When planning care for a diabetic patient with microalbuminuria, it is important to include which goal to reduce the progression to renal failure? a. Decrease the total percentage of calories from carbohydrates. b. Decrease the total percentage of calories from fruits. c. Decrease the total percentage of calories from proteins. d. Decrease the total percentage of daily caloric intake.
c Restriction of dietary protein to 0.8 g/kg body weight per day is recommended for clients with microalbuminuria to reduce the progression to renal failure. All other choices can increase blood glucose and total body weight but are not specific for progression to renal failure.
A patient with diabetes asks her nurse about foot care when she is discharged home. What is the nurse's best response? a. "Cut your toenails in a V shape to prevent ingrown toenails." b. "Soak your feet in hot water each night before going to bed." c. "Inspect each foot daily for cuts, cracks, blisters, or abrasions." d. "There are no special instructions for your feet when you have diabetes."
c The nurse should instruct the patient to inspect each foot daily for cuts, cracks, blisters, abrasions, or discoloration of the toes and to report any abnormality to the health care provider. The patient should use a mirror if unable to bend to see the bottom of the foot. The patient should be certain to check between the toes and should wash the feet in warm (not hot) water, using mild soap. The patient should not soak the feet because this can cause cracking of the skin. The nails should be cut straight across, not in the shape of a V, to prevent ingrown toenails.
a nurse is reinforcing teaching about self care with a child who has type 1 DM. the nurse should identify which of the following statements by the child indicates understanding? a. "i should skip breakfast when i am not hungry" b. "i should increase my insulin with exercise" c. "i should drink a glass of milk when i am feeling irritable" d. "i should draw up the NPH insulin into the syringe before the regular insulin"
c an early manifestation of hypoglycemia is irritability. drinking a glass of milk indicates understanding of this teaching
the nurse provides dietary instructions to a client with diabetes mellitus regarding the prescribed diabetic diet. which statement made by the client indicates the need for further teaching? a. "ill eat a balanced meal plan" b. "i need to drink diet soft drinks" c. "i need to buy special diabetic foods" d. "i will snack on fruit instead of cake"
c diabetics should eat diabetic foods, but rather eat a balanced meal
a mother of a 6 year old child with type 1 DM calls the clinic nurse and tells the nurse that the child has been sick. the mother reports that she checked the child's urine and it showed positive ketones. what should the nurse instruct the mother to do? a. hold the next dose of insulin b. come to the clinic immediately c. encourage the child to drink liquids d. administer an additional dose of regular insulin
c the child should drink liquids so that they get rid of the ketones
the nurse is assisting with preparing a teaching plan for the client with diabetes mellitus regarding proper foot care. which instruction should be included in the plan of care? a. soak the feet in hot water b. avoid using soap on the feet c. apply a moisturizing lotion to dry feet, but not between the toes d. always have a podiatrist cut your toenails, never cut them yourself
c the client should use a moisturizing lotion of the feet just not between the toes
a nurse attempts to collect a capillary blood specimen via fingerstick for a blood glucose monitoring from a client who has diabetes mellitus. the nurse is unable to obtain an adequate drop of blood for the reagent strip. which of the following actions should the nurse take first? a. puncture another finger to obtain a capillary specimen b. test the urine with a urine reagent strip c. wrap the hand in a warm moist cloth d. perform a venipuncture to obtain a venous sample
c when providing client care, the nurse should use the least restrictive intervention
The nurse is providing discharge teaching to a patient recently diagnosed with type 2 DM. The nurse should include information on which long-term consequences of poor glycemic control? Select all that apply. a. Depression b. Hypertension c. Recurrent infections d. Delayed wound healing e. Peripheral vascular disease
c, d, e Long-term consequences of poor glycemic control can result in recurrent infections, delayed wound healing, and peripheral vascular disease. Depression and hypertension are not direct consequences of poor glycemic control.
The nurse is teaching a class on diabetes to a group of adults in the community. The nurse should be sure to include information on which classic symptoms of diabetes? Select all that apply. a. Hypertension b. Vision changes c. Excessive thirst d. Frequent urination e. Increased appetite f. Recurrent urinary tract infections (UTIs)
c, d, e Polyuria, polydipsia, and polyphagia are the classic symptoms of diabetes. Vision changes may occur after years of poor glycemic control. Hypertension is not a symptom of diabetes. The patient may experience recurrent UTIs due to diabetes, but this is not one of the three classic symptoms.
a nurse is caring for a patient who has type 1 DM. the nurse should identify which of the following findings are manifestations of DKA? (select all that apply) a. blood glucose of 58 mg/dL b. weight gain c. dehydration d. mental confusion e. fruity breath
c, d, e clients who have DKA experience osmotic diuresis, mental confusion because of electrolyte shift, and fruity breath because of the body's attempt to eliminate ketones
a nurse is teaching self monitoring of blood glucose (SMBG) to a client who has diabetes mellitus. which of the following instructions should the nurse include? (select all that apply) a. perform SMBG once daily at bedtime b. wipe the hand with an alcohol swab c. hold the hand in a dependent position prior to the puncture d. place the puncturing device perpendicular to the site e. prick the outer edge of the fingertip for the blood sample
c, d, e hold hand in dependent position to get blood flowing, client should hold the lancet perpendicular to ensure that it is getting the right depth, and the client should use the outer edge for blood sampling
a nurse is reinforcing teaching about foot care with a client who has DM. which of the following information should the nurse include in the teaching? (select all that apply) a. remove calluses using over the counter remedies b. apply lotion between the toes c. perform nail care after bathing d. trim toenails straight across e. wear closed toe shoes
c, d, e toenails are easier to trim after a shower, cutting the nails straight across can help reduce the risk for injuring the skin, and wear closed toe shoes to prevent injury to the feet
a patient who works as a personal trainer is diagnosed with insulin dependent diabetes. what should the nurse teach regarding to self administration of regular insulin? a. if you have a strenuous workout, skip your insulin for the day b. inject insulin before moderate exercise c. exercise during the insulin peak of action d. use the abdomen as an injection site
d The abdomen is a good site for insulin injection as absorption is steady, rapid, and not affected by exercise. Do not encourage the patient to skip insulin doses. Diabetics must learn to balance their nutrition, exercise, and insulin doses. Instruct the patient to eat a light snack before exercising. Depending on the type of insulin and the onset of action, injecting the insulin before exercise may cause a hypoglycemic reaction. Exercising during the peak of insulin will increase the chances of hypoglycemia.
The nurse teaches which action to the diabetic client who self-injects insulin to prevent local irritation at the injection site? a. Be sure to aspirate prior to injecting insulin. b. Massage the site after injecting insulin. c. Use a 1-inch needle for the injection. d. Allow the insulin to warm to room temperature before injecting it.
d Cold insulin from the refrigerator is the most common cause of irritation. Aspiration of insulin is not recommended; massaging the site can cause irritation; and a 1-inch needle is the improper size for insulin injections.
In discussing DM with a patient, it is important to base the discussion on which information regarding the disease? a. It can often be cured by insulin therapy. b. It has no cure and is considered "hopeless." c. It has no specific treatment other than use of insulin. d. It can often be controlled by diet and regular exercise.
d DM can be controlled with diet, exercise, and medications. The condition is not hopeless; many people lead productive lives after having the diagnosis. Treatments are multifaceted. Each patient's plan of care is individualized based on the type of diabetes and specific health history. Diabetes is a chronic condition and is not curable but managed.
When teaching a patient with type 1 diabetes about home care, the LPN/LVN would be sure to include which signs of diabetic ketoacidosis? a. Dark, scanty urine, and diarrhea b. Cool, clammy skin, and nervousness c. Hunger, headache, and tremulousness d. Thirst, dry mucous membranes, and dry skin
d Diabetic ketoacidosis is a condition associated with excessively high blood glucose levels. It may be caused by illness, stress, or significant lack of insulin. Early manifestations include thirst, dry mucous membranes, and dry skin. Cool, clammy skin; headache; and hunger are noted with hypoglycemia. Diarrhea and low urine output are not linked to ketoacidosis.
A diabetic patient has proliferative retinopathy, nephropathy, and peripheral neuropathy. What should the nurse teach this patient about exercise? a. "Jogging for 20 minutes 5 to 7 days a week would most efficiently help you to lose weight." b. "One hour of vigorous exercise daily is needed to prevent progression of disease." c. "Avoid all forms of exercise because of your diabetic complications." d. "Swimming or water aerobics 30 minutes each day would be the safest exercise routine for you."
d Exercise is not contraindicated for this client, but modifications are necessary to prevent further injury. Swimming or water aerobics provides support for the joints and muscles while increasing the uptake of glucose and promoting cardiovascular health. Jogging, vigorous exercise, or no exercise would increase the pathologies of this patient.
A diabetic patient is receiving intravenous insulin. Which laboratory results should the nurse anticipate as a potential problem? a. Serum chloride level of 90 mmol/L b. Serum calcium level of 8 mg/dL c. Serum sodium level of 132 mmol/L d. Serum potassium level of 2.5 mmol/L
d Insulin activates the sodium-potassium adenosine triphosphatase (ATPase) pump, which increases the movement of potassium from the extracellular fluid into the intracellular fluid, resulting in hypokalemia. The chloride, calcium, and sodium levels are in normal parameters.
the nurse teaches a patient with diabetes to limit saturated fat and sodium intake because: a. all diabetic patients are at risk for obesity b. these foods contribute to higher glucose levels c. these nutrients are nonessential d. diabetic patients are at risk for cardiovascular disease
d Patients with diabetes are at a greater risk of developing cardiovascular disease, so it is recommended that they follow American Heart Association guidelines. However, some experts recommend reduction of cholesterol to an even greater extent for people with diabetes (200 mg/day).
