Unit 2 - Diabetes (Prep-U)
A newly admitted client with a diagnosis of type 1 diabetes asks the nurse what caused their diabetes. When the nurse is explaining to the client the etiology of type 1 diabetes, what process should the nurse describe? A. "The tissues in your body are resistant to the action of insulin, making the glucose levels in your blood increase." B. "Damage to your pancreas causes an increase in the amount of glucose that it releases, and there is not enough insulin to control it." C. "The amount of glucose that your body makes overwhelms your pancreas and decreases your production of insulin." D. "Destruction of special cells in the pancreas causes a decrease in insulin production. Glucose levels rise because insulin normally breaks it down."
D. "Destruction of special cells in the pancreas causes a decrease in insulin production. Glucose levels rise because insulin normally breaks it down." Rationale: Type 1 diabetes is characterized by the destruction of pancreatic beta cells, resulting in decreased insulin production, unchecked glucose production by the liver, and fasting hyperglycemia. Also, glucose derived from food cannot be stored in the liver and remains circulating in the blood, which leads to postprandial hyperglycemia. Type 2 diabetes involves insulin resistance and impaired insulin secretion. The body does not "make" glucose.
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: A. Impaired adjustment. B. Defensive coping. C. Deficient knowledge (treatment regimen). D. Health-seeking behaviors (diabetes control).
C. Deficient knowledge (treatment regimen). Rationale: 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.
During a follow-up visit 3 months after a new diagnosis of type 2 diabetes, a client reports exercising and following a reduced-calorie diet. Assessment reveals that the client has only lost 1 pound and did not bring the glucose-monitoring record. Which value should the nurse measure? A. Fasting blood glucose level B. Glucose via a urine dipstick test C. Glycosylated hemoglobin level D. Glucose via an oral glucose tolerance test
C. Glycosylated hemoglobin level Rationale: Glycosylated hemoglobin is a blood test that reflects the average blood glucose concentration over a period of approximately 2 to 3 months. When blood glucose is elevated, glucose molecules attach to hemoglobin in red blood cells. The longer the amount of glucose in the blood remains above normal, the more glucose binds to hemoglobin and the higher the glycosylated hemoglobin level becomes.
The nurse is interpreting the negative feedback system that controls endocrine function. What secretion will the nurse correlate as decreasing while blood glucose levels decrease? A. glucagon B. adrenocorticotropic hormone C. insulin D. glycogen
C. insulin Rationale: Feedback is seen in endocrine systems that regulate concentrations of blood components such as glucose. Glucose from the ingested lactose or sucrose is absorbed in the intestine and the level of glucose in blood rises. Elevation of blood glucose concentration stimulates endocrine cells in the pancreas to release insulin. Insulin has the major effect of facilitating entry of glucose into many cells of the body; as a result, blood glucose levels fall. When the level of blood glucose falls sufficiently, the stimulus for insulin release disappears and insulin is no longer secreted. Glycogen is stored in the liver and muscles. It is released to provide energy when the blood glucose levels fall. Glucagon is also produced by the pancreas. Its job is to force the liver to release stored insulin when the body has a need for more insulin. The adrenocorticotropic hormone is produced by the anterior pituitary. Its function is to regulate cortisol. This is needed so the adrenal glands can function properly. It also helps the body respond to stress.
A child who has type 1 diabetes mellitus is brought to the emergency department and diagnosed with diabetic ketoacidosis. What treatment would the nurse expect to administer? A. Regular insulin B. Lispro C. NPH D. Detemir
A. Regular insulin Rationale: Insulin for diabetic ketoacidosis is given intravenously. Only regular insulin can be administered by this route.
A client with diabetes mellitus is receiving an oral antidiabetic agent. When caring for this client, the nurse should observe for signs of: A. hypoglycemia B. polyuria C. blurred vision D. polydipsia
A. hypoglycemia Rationale: The nurse should observe the client 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.
A client newly diagnosed with diabetes mellitus asks why he needs ketone testing when the disease affects his blood glucose levels. How should the nurse respond? A. "The spleen releases ketones when your body can't use glucose." B. "Ketones will tell us if your body is using other tissues for energy." C. "Ketones can damage your kidneys and eyes." D. "Ketones help the physician determine how serious your diabetes is."
B. "Ketones will tell us if your body is using other tissues for energy." Rationale: The nurse should tell the client that ketones are a byproduct of fat metabolism and that ketone testing can determine whether the body is breaking down fat to use for energy. The spleen doesn't release ketones when the body can't use glucose. Although ketones can damage the eyes and kidneys and help the physician evaluate the severity of a client's diabetes, these responses by the nurse are incomplete.
A child and her parents are being seen in the office after discharge from the hospital with a new diagnosis of type 2 diabetes. Which statement by the nurse is true? A. "You are lucky that you did not have to learn how to give yourself a shot." B. "Kids can usually be managed with an oral agent, meal planning, and exercise." C. "This will rectify itself if you follow all of the doctor's directions." D. "A weight-loss program should be implemented and maintained."
B. "Kids can usually be managed with an oral agent, meal planning, and exercise." Rationale: Treating type 2 diabetes in children may require insulin at the outset if the child is acidotic and acutely ill. More commonly, the child can be managed initially with oral agents, meal planning, and increased activity. Telling the child that she is lucky she did not have to learn how to give a shot might scare her, so it will inhibit her from seeking future health care. The condition will not rectify itself if all orders are followed. A weight-loss program might need to be implemented but that is not always the case.
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: A. 10 g of carbohydrates. B. 15 g of carbohydrates. C. 20 g of carbohydrates. D. 25 g of carbohydrates.
B. 15 g of carbohydrates. Rationale: The nurse should instruct the client to administer 1 unit of insulin for every 15 g of carbohydrates.
Which statement is true regarding gestational diabetes? A. It occurs in most pregnancies. B. Onset usually occurs in the first trimester. C. A glucose challenge test should be performed between 24 and 28 weeks. D. There is a low risk for perinatal complications.
C. A glucose challenge test should be performed between 24 and 28 weeks. Rationale: A glucose challenge test should be performed between 24 and 28 weeks in women at average risk. It occurs in less than 10% of all pregnancies. Onset usually occurs in the second or third trimester. There is an above-normal risk for perinatal complications.
Which type of insulin acts most quickly? A. Regular B. NPH C. Lispro D. Glargine
C. Lispro Rationale: The onset of action of rapid-acting lispro 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 insulin is 3 to 4 hours. The onset of action of very long-acting glargine is ~6 hours.
The nurse is explaining glycosylated hemoglobin testing to a diabetic client. Which of the following provides the best reason for this order? A. Provides best information on the body's ability to maintain normal blood functioning B. Best indicator for the nutritional state of the client C. Is less costly than performing daily blood sugar test D. Reflects the amount of glucose stored in hemoglobin over past several months.
D. Reflects the amount of glucose stored in hemoglobin over past several months. Rationale: Hemoglobin A1c tests reflect the amount of glucose that is stored in the hemoglobin molecule during its life span of 120 days. This test provides a more accurate picture of overall glucose control in a client. Glycosylated hemoglobin test does not indicate normal blood functioning or nutritional state of the client. Self-monitoring with a glucometer is still encouraged in clients who are taking insulin or have unstable blood glucose levels.
Which instruction about insulin administration should a nurse give to a client? A. "Always follow the same order when drawing the different insulins into the syringe." B. "Shake the vials before withdrawing the insulin." C. "Store unopened vials of insulin in the freezer at temperatures well below freezing." D. "Discard the intermediate-acting insulin if it appears cloudy."
A. "Always follow the same order when drawing the different insulins into the syringe." Rationale: 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.
A client has been recently diagnosed with type 2 diabetes, and reports continued weight loss despite increased hunger and food consumption. This condition is called: A. polyphagia. B. polydipsia. C. polyuria. D. anorexia.
A. polyphagia. Rationale: While the needed glucose is being wasted, the body's requirement for fuel continues. The person with diabetes feels hungry and eats more (polyphagia). Despite eating more, he or she loses weight as the body uses fat and protein to substitute for glucose.
The nurse is talking with a parent of an adolescent who is newly diagnosed with type 2 diabetes and asks, "How could this happen? No one in our family has diabetes." What response would be appropriate? A. "This is caused by the pancreas not making enough insulin." B. "This disorder usually occurs when inadequate calories are ingested on a regular basis." C. "Because this disorder is genetic, someone in the family will eventually develop the illness." D. "This is caused by insulin resistance from previous pancreatic injury or generalized infection."
D. "This is caused by insulin resistance from previous pancreatic injury or generalized infection." Rationale: Type 2 diabetes is now seen in overweight adolescents as well as those who eat a diet high in fats and carbohydrates and do not exercise regularly. Pancreatic malfunction is not a cause of type 2 diabetes. This disorder is not linked to inadequate ingestion of daily calories. This disorder may have a genetic link, but environmental factors such as obesity, diet, and exercise can influence its development. Type 2 diabetes is a result of insulin resistance in the metabolism of glucose to maintain normal blood glucose levels, but it is not associated with infection or a previous pancreatic injury.
A client is diagnosed with diabetes mellitus. Which assessment finding best supports a nursing diagnosis of Ineffective coping related to diabetes mellitus? A. Recent weight gain of 20 lb (9.1 kg) B. Failure to monitor blood glucose levels C. Skipping insulin doses during illness D. Crying whenever diabetes is mentioned
D. Crying whenever diabetes is mentioned Rationale: 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.
The nurse is preparing to administer the child's ordered lispro (Humalog) insulin at 0800. When will the child's blood glucose level begin to decline? A. 0815 B. 0845 C. 0900 D. 0930
A. 0815 Rationale: The onset of rapid-acting insulins like lispro (Humalog) is within 15 minutes. The onset of short-acting insulin is 30 to 60 minutes. The onset of intermediate-acting insulin is 1-3 hours, and long-acting insulin's onset is 1-2 hours.
What is the duration of regular insulin? A. 4 to 6 hours B. 3 to 5 hours C. 12 to 16 hours D. 24 hours
A. 4 to 6 hours Rationale: 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.
The nurse is teaching a group of caregivers of children diagnosed with diabetes. The nurse is explaining insulin shock and the caregivers make the following statements. Which statement indicates the best understanding of a reason an insulin reaction might occur? A. "If my child eats as much as their older brother eats they could have an insulin reaction." B. "My child measures their own medication but sometimes doesn't administer the correct amount." C. "My child monitors their glucose levels to keep them from going too high." D. "On the weekends we encourage our child to participate in lots of sports activities and stay busy so they don't have an insulin reaction."
B. "My child measures their own medication but sometimes doesn't administer the correct amount." Rationale: Insulin reaction (insulin shock, hypoglycemia) is caused by insulin overload, resulting in too-rapid metabolism of the body's glucose. This may be attributable to a change in the body's requirement, carelessness in diet (such as failure to eat proper amounts of food), an error in insulin measurement, or excessive exercise.
A child is brought into the emergency department with vomiting, drowsiness, and blowing respirations. The child's parent reports that the symptoms have been progressing throughout the day. The nurse suspects diabetic ketoacidosis (DKA). Which action should the nurse take first in the management of DKA? A. Give prescribed antiemetics. B. Begin fluid replacements. C. Administer prescribed dose of insulin. D. Administer bicarbonate to correct acidosis.
B. Begin fluid replacements. Rationale: Management of DKA is aimed at correcting dehydration, electrolyte loss, and acidosis before correcting the hyperglycemia with insulin.
A 60-year-old client comes to the ED reporting weakness, vision problems, increased thirst, increased urination, and frequent infections that do not seem to heal easily. The physician suspects that the client has diabetes. Which classic symptom should the nurse watch for to confirm the diagnosis of diabetes? A. Numbness B. Increased hunger C. Fatigue D. Dizziness
B. Increased hunger Rationale: The classic symptoms of diabetes are the three Ps: polyuria (increased urination), polydipsia (increased thirst), and polyphagia (increased hunger). Some of the other symptoms include tingling, numbness, and loss of sensation in the extremities and fatigue.
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? A. Onset most common during adolescence B. Insulin production insufficient C. Less common than type 1 diabetes D. Little to no relation to pre-diabetes
B. Insulin production insufficient Rationale: 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.
Health teaching for a patient with diabetes who is prescribed Humulin N, an intermediate NPH insulin, would include which of the following advice? A. "Your insulin will begin to act in 15 minutes." B. "You should expect your insulin to reach its peak effectiveness by 9:00 AM if you take it at 8:00 AM." C. "You should take your insulin after breakfast and after dinner." D. "Your insulin will last 8 hours, and you will need to take it three times a day."
C. "You should take your insulin after breakfast and after dinner." Rationale: NPH (Humulin N) insulin is an intermediate-acting insulin that has an onset of 2 to 4 hours, a peak effectiveness of 4 to 12 hours, and a duration of 16 to 20 hours.
Health teaching for a patient with diabetes who is prescribed Humulin N, an intermediate NPH insulin, would include which of the following advice? A. "Your insulin will begin to act in 15 minutes." B. "You should expect your insulin to reach its peak effectiveness by 12 noon if you take it at 8:00 AM." C. "You should take your insulin after you eat breakfast and dinner." D. "Your insulin will last 8 hours, and you will need to take it three times a day."
C. "You should take your insulin after you eat breakfast and dinner." Rationale: NPH (Humulin N) insulin is an intermediate-acting insulin that has an onset of 2 to 4 hours, a peak effectiveness of 6 to 8 hours, and a duration of 12 to 16 hours. See Table 30-3 in the text.
A patient who is diagnosed with type 1 diabetes would be expected to: A. Be restricted to an American Diabetic Association diet. B. Have no damage to the islet cells of the pancreas. C. Need exogenous insulin. D. Receive daily doses of a hypoglycemic agent.
C. Need exogenous insulin. Rationale: Type 1 diabetes is characterized by the destruction of pancreatic beta cells that require exogenous insulin.
Which assessment finding is most important in determining nursing care for a client with diabetes mellitus? A. Respirations of 12 breaths/minute B. Cloudy urine C. Blood sugar 170 mg/dL D. Fruity breath
D. Fruity breath Rationale: The rising ketones and acetone in the blood can lead to acidosis and be detected as a fruity odor on the breath. Ketoacidosis needs to be treated to prevent further complications such as Kussmaul respirations (fast, labored breathing) and renal shutdown. A blood sugar of 170 mg/dL is not ideal but will not result in glycosuria and/or trigger the classic symptoms of diabetes mellitus. Cloudy urine may indicate a UTI.
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. Which laboratory test is the most important for confirming this disorder? A. Serum potassium level B. Serum sodium level C. Arterial blood gas (ABG) values D. Serum osmolarity
D. Serum osmolarity Rationale: 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 10-year-old child is newly diagnosed with type 1 diabetes. The child's hemoglobin A1C level is being monitored. The nurse determines that additional intervention is needed with the child based on which result? A. 8.5% B. 6.5% C. 7.5 % D. 7.0%
A. 8.5% Rationale: The goal for hemoglobin A1C in children between the ages of 6 and 12 years is less than 8%. Therefore, a result of 8.5% would indicate that additional intervention is needed to achieve the recommended goal.
The nurse is caring for a 5-year-old child recently diagnosed with type 1 diabetes. When discussing the care and management of the disorder with the child's parents, which statement(s) indicates understanding? Select all that apply. A. "Regular exercise will help in the regulation of my child's blood sugar levels." B. "If my child's blood glucose remains stable for a few months, my child can move from injections to pills." C. "When my child is ill and unable to eat, we will need to hold the insulin until the child is able to tolerate fluids." D. "The insulin dosages will be directly associated to my child's carbohydrate ingestion." E. "We need to rotate insulin injection sites to prevent complications."
A. "Regular exercise will help in the regulation of my child's blood sugar levels." D. "The insulin dosages will be directly associated to my child's carbohydrate ingestion." E. "We need to rotate insulin injection sites to prevent complications." Rationale: When a child has type 1 diabetes, there is an absence of insulin to manage the metabolism of serum glucose. Regular exercise is helpful in the maintenance of stable serum glucose levels. Carbohydrate ingestion is linked to the amount of insulin that will be needed in the body. Carbohydrates break down and the body needs insulin to metabolize the resulting glucose. The rotation of insulin injection sites is important. Failing to rotate injection sites can cause a complication, lipohypertrophy. Type 1 diabetes means that the body does not have insulin, so injected insulin is needed to manage it. Oral medications are only an option for those having type 2 diabetes. When the child is ill, it is still important that the child with diabetes take the prescribed medications.
A client with diabetes mellitus has a blood glucose level of 40 mg/dL. Which rapidly absorbed carbohydrate would be most effective? A. 1/2 cup fruit juice or regular soft drink B. 4 oz of skim milk C. 1/2 tbsp honey or syrup D. three to five LifeSavers candies
A. 1/2 cup fruit juice or regular soft drink Rationale: In a client with hypoglycemia, the nurse uses the rule of 15: give 15 g of rapidly absorbed carbohydrate, wait 15 minutes, recheck the blood sugar, and administer another 15 g of glucose if the blood sugar is not above 70 mg/dL. One-half cup fruit juice or regular soft drink is equivalent to the recommended 15 g of rapidly absorbed carbohydrate. Eight ounces of skim milk is equivalent to the recommended 15 g of rapidly absorbed carbohydrate. One tablespoon of honey or syrup is equivalent to the recommended 15 g of rapidly absorbed carbohydrate. Six to eight LifeSavers candies is equivalent to the recommended 15 g of rapidly absorbed carbohydrate.
A nurse is preparing a continuous insulin infusion for a child with diabetic ketoacidosis and a blood glucose level of 800 mg/dl. Which solution is the most appropriate at the beginning of therapy? A. 100 units of regular insulin in normal saline solution B. 100 units of neutral protamine Hagedorn (NPH) insulin in normal saline solution C. 100 units of regular insulin in dextrose 5% in water D. 100 units of NPH insulin in dextrose 5% in water
A. 100 units of regular insulin in normal saline solution Rationale: Continuous insulin infusions use only short-acting regular insulin. Insulin is added to normal saline solution and administered until the client's blood glucose level falls. Further along in the therapy, a dextrose solution is administered to prevent hypoglycemia.
A health care provider prescribes short-acting insulin for a patient, instructing the patient to take the insulin 20 to 30 minutes before a meal. The nurse explains to the patient that Humulin-R taken at 6:30 AM will reach peak effectiveness by: A. 8:30 AM. B. 10:30 AM. C. 12:30 PM. D. 2:30 PM.
A. 8:30 AM. Rationale: Short-acting insulin reaches its peak effectiveness 2 to 3 hours after administration. See Table 30-3 in the text.
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? A. Control blood glucose levels. B. Drink plenty of fluids. C. Take the antidiabetic drugs regularly. D. Eat a high-fiber diet.
A. Control blood glucose levels. Rationale: 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 of the following would be considered a "free" item from the exchange list? A. Diet soda B. Green salad C. Medium apple D. 1 tsp olive oil
A. Diet soda Rationale: Free items include unsweetened iced tea, diet soda, and ice water with lemon. A green salad is exchanged for 1 vegetable. A medium apple is 1 fruit; 1 tsp of olive oil is 1 fat.
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? A. Metformin B. Glyburide C. Repaglinide D. Glipizide
A. Metformin Rationale: 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.
The nurse is preparing to administer intermediate-acting insulin to a patient with diabetes. Which insulin will the nurse administer? A. NPH B. Iletin II C. Lispro (Humalog) D. Glargine (Lantus)
A. NPH Rationale: Intermediate-acting insulins are called NPH insulin (neutral protamine Hagedorn) or Lente insulin. Lispro (Humalog) is rapid acting, Iletin II is short acting, and glargine (Lantus) is very long acting.
A nurse is teaching a diabetic support group about the causes of type 1 diabetes. The teaching is determined to be effective when the group is able to attribute which factor as a cause of type 1 diabetes? A. Presence of autoantibodies against islet cells B. Obesity C. Rare ketosis D. Altered glucose metabolism
A. Presence of autoantibodies against islet cells Rationale: There is evidence of an autoimmune response in type 1 diabetes. This is an abnormal response in which antibodies are directed against normal tissues of the body, responding to these tissues as if they were foreign. Autoantibodies against islet cells and against endogenous (internal) insulin have been detected in people at the time of diagnosis and even several years before the development of clinical signs of type 1 diabetes.
Which clinical characteristic is associated with type 1 diabetes (previously referred to as insulin-dependent diabetes mellitus)? A. Presence of islet cell antibodies B. Obesity C. Rare ketosis D. Requirement for oral hypoglycemic agents
A. Presence of islet cell antibodies Rationale: Individuals with type 1 diabetes often have islet cell antibodies and are usually thin or demonstrate recent weight loss at the time of diagnosis. These individuals are prone to experiencing ketosis when insulin is absent and require exogenous insulin to preserve life.
After being sick for 3 days, a client with a history of diabetes mellitus is admitted to the hospital with diabetic ketoacidosis (DKA). The nurse should evaluate which diagnostic test results to prevent dysrhythmias? A. Serum potassium level B. Serum calcium level C. Serum sodium level D. Serum chloride level
A. Serum potassium level Rationale: The nurse should monitor the client's potassium level because during periods of acidosis, potassium leaves the cell, causing hyperkalemia. As blood glucose levels normalize with treatment, potassium reenters the cell, causing hypokalemia if levels aren't monitored closely. Hypokalemia places the client at risk for cardiac arrhythmias such as ventricular tachycardia. DKA has a lesser affect on serum calcium, sodium, and chloride levels. Changes in these levels don't typically cause cardiac arrhythmias.
After teaching a group of students about endocrine disorders, the instructor determines that the teaching was successful when the students identify insulin deficiency, increased levels of counterregulatory hormones, and dehydration as the primary cause of which condition? A. diabetic ketoacidosis B. ketone bodies C. ketonuria D. glucosuria
A. diabetic ketoacidosis Rationale: Insulin deficiency, in association with increased levels of counterregulatory hormones (glucagon, growth hormone, cortisol, catecholamines) and dehydration, is the primary cause of diabetic ketoacidosis, a life-threatening form of metabolic acidosis that is a frequent complication of diabetes. The liver converts triglycerides (lipolysis) to fatty acids, which in turn change to ketone bodies. The accumulation and excretion of ketone bodies by the kidneys is called ketonuria. Glucosuria is glucose that is spilled into the urine.
A child with type 1 diabetes is brought to the emergency department. The nurse suspects diabetic ketoacidosis (DKA) based on which assessment findings? Select all that apply. A. fruity odor on the breath B. decreased level of consciousness C. poor skin turgor D. increased urine output E. quick capillary refill
A. fruity odor on the breath B. decreased level of consciousness C. poor skin turgor Rationale: If insulin deficiency persists and ketone bodies continue to be excreted, the child begins to experience stomach pains, vomiting, and continued weight loss. Dehydration quickly develops as DKA progresses. The degree of dehydration is assessed while the child is weighed and examined. Assessment includes examining the mucous membranes for moistness, the eyeballs for degree of depression, the skin for turgor, and the anterior fontanel (fontanelle), if present, for depression. The child may also show signs of impending shock: tachypnea, decreased output, decreased level of consciousness, slowed capillary refill, and tachycardia. A late sign of shock in children is hypotension. DKA is most commonly present in new-onset T1DM or during crises in children with known type 1 diabetes, but it may also be found in newly diagnosed type 2 diabetes in the adolescent age group. Kussmaul respirations and changes in mental status may ensue. The breath develops a fruity odor in all children with DKA. If the child becomes somnolent and advances into a coma, these are ominous signs of cerebral edema.
A 16-year-old client newly diagnosed with type 1 diabetes has a very low body weight despite eating regular meals. The client is upset because friends frequently state, "You look anorexic." Which statement by the nurse would be the best response to help this client understand the cause of weight loss due to this condition? A. "I will refer you to a dietician who can help you with your weight." B. "You may be having undiagnosed infections, causing you to lose extra weight." C. "Your body is using protein and fat for energy instead of glucose." D. "Don't worry about what your friends think; the carbohydrates you eat are being quickly digested, increasing your metabolism."
C. "Your body is using protein and fat for energy instead of glucose." Rationale: Persons with type 1 diabetes, particularly those in poor control of the condition, tend to be thin because when the body cannot effectively utilize glucose for energy (no insulin supply), it begins to break down protein and fat as an alternate energy source. Patients may be underweight at the onset of type 1 diabetes because of rapid weight loss from severe hyperglycemia. The goal initially may be to provide a higher-calorie diet to regain lost weight and blood glucose control.
The nurse is taking the history of a client with diabetes who is experiencing autonomic neuropathy. Which would the nurse expect the client to report? A. Skeletal deformities B. Paresthesias C. Erectile dysfunction D. Soft tissue ulceration
C. Erectile dysfunction Rationale: 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.
Which findings should the nurse expect to assess when completing the health history of a child admitted for possible type 2 diabetes? Select all that apply. A. Abrupt onset of symptoms B. Marked weight loss C. Polyuria D. Polydipsia E. Polyphagia
C. Polyuria D. Polydipsia E. Polyphagia Rationale: Type 2 diabetes mellitus is characterized by a gradual onset and is most often associated with obesity and not marked weight loss. Type 1 diabetes is most often abrupt and associated with marked weight loss. Polyuria, polydipsia, and polyphagia are frequent assessment findings in both types of diabetes mellitus.
Laboratory studies indicate a client's blood glucose level is 185 mg/dl. Two hours have passed since the client ate breakfast. Which test would yield the most conclusive diagnostic information about the client's glucose use? A. Fasting blood glucose test B. 6-hour glucose tolerance test C. Serum glycosylated hemoglobin (Hb A1c) D. Urine ketones
C. Serum glycosylated hemoglobin (Hb A1c) Rationale: Hb A1c is the most reliable indicator of glucose use because it reflects blood glucose levels for the prior 3 months. Although a fasting blood glucose test and a 6-hour glucose tolerance test yield information about a client's use of glucose, the results are influenced by such factors as whether the client recently ate breakfast. Presence of ketones in the urine also provides information about glucose use but is limited in its diagnostic significance.
Insulin is a hormone secreted by the Islets of Langerhans and is essential for the metabolism of carbohydrates, fats, and protein. The nurse understands the physiologic importance of gluconeogenesis, which refers to the: A. Transport of potassium. B. Release of glucose. C. Synthesis of glucose from noncarbohydrate sources. D. Storage of glucose as glycogen in the liver.
C. Synthesis of glucose from noncarbohydrate sources. Rationale: Gluconeogenesis refers to the making of glucose from noncarbohydrates. This occurs mainly in the liver. Its purpose is to maintain the glucose level in the blood to meet the body's demands.
A child presents to the primary care setting with enuresis, nocturia, increased hunger, weight loss, and increased thirst. What does the nurse suspect? A. Syndrome of inappropriate diuretic hormone B. Diabetes insipidus C. Type 1 diabetes mellitus D. Hypothyroidism
C. Type 1 diabetes mellitus Rationale: Signs and symptoms of type 1 diabetes mellitus include polyuria, polydipsia, polyphagia, enuresis, and weight loss.
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? A. Increased risk for urologic complications B. Need for exocrine enzymatic drainage C. Underlying problem of insulin resistance D. Need for lifelong immunosuppressive therapy
C. Underlying problem of insulin resistance Rationale: 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.
A nurse is teaching a client recovering from diabetic ketoacidosis (DKA) about management of "sick days." The client asks the nurse why it is important to monitor the urine for ketones. Which statement is the nurse's best response? A. "Ketones are formed when insufficient insulin leads to cellular starvation. As cells rupture, they release these acids into the blood." B. "When the body does not have enough insulin, hyperglycemia occurs. Excess glucose is broken down by the liver, causing acidic by-products to be released." C. "Excess glucose in the blood is metabolized by the liver and turned into ketones, which are an acid." D. "Ketones accumulate in the blood and urine when fat breaks down in the absence of insulin. Ketones signal an insulin deficiency that will cause the body to start breaking down stored fat for energy."
D. "Ketones accumulate in the blood and urine when fat breaks down in the absence of insulin. Ketones signal an insulin deficiency that will cause the body to start breaking down stored fat for energy." Rationale: Ketones (or ketone bodies) are by-products of fat breakdown in the absence of insulin, and they accumulate in the blood and urine. Ketones in the urine signal an insulin deficiency and that control of type 1 diabetes is deteriorating. When almost no effective insulin is available, the body starts to break down stored fat for energy.
The nurse has told the 14-year-old adolescent with diabetes that the doctor would like to have a hemoglobin A1C test performed. Which comment by the client indicates that she understands what this test is for? A. "That is the test that I take after I have fasted for at least 8 hours." B. "The normal level for my hemoglobin A1C is between 60 to 100 mg/dl." C. "I monitor my own blood glucose every day at home. I don't see why the doctor would want this done." D. "This will tell my doctor what my average blood glucose level has been over the last 2 to 3 months."
D. "This will tell my doctor what my average blood glucose level has been over the last 2 to 3 months." Rationale: Hemoglobin A1C (HgbA1C) provides the physician or nurse practitioner with information regarding the long-term control of glucose levels, as it provides an average of what the blood glucose levels are over a 2 to 3-month period. No fasting is required. Desired levels for children and adolescents 13 to 19 years are less than 7.5%.
A nurse expects to find which signs and symptoms in a client experiencing hypoglycemia? A. Polyuria, headache, and fatigue B. Polyphagia and flushed, dry skin C. Polydipsia, pallor, and irritability D. Nervousness, diaphoresis, and confusion
D. Nervousness, diaphoresis, and confusion Rationale: Signs and symptoms associated with hypoglycemia include nervousness, diaphoresis, weakness, light-headedness, confusion, paresthesia, irritability, headache, hunger, tachycardia, and changes in speech, hearing, or vision. If untreated, signs and symptoms may progress to unconsciousness, seizures, coma, and death. Polydipsia, polyuria, and polyphagia are symptoms associated with hyperglycemia.
