Adult Theory -- Diabetes

D

A client with DM demonstrates acute anxiety when first admitted for the treatment of hyperglycemia. The most appropriate intervention to decrease the client's anxiety would be to: a. administer a sedative b. make sure the client knows all the correct medical terms to understand what is happening c. ignore the signs and symptoms of anxiety so that they will soon disappear d. convey empathy, trust, and respect toward the client

A Option A: In diabetic acidosis, the arterial pH is less than 7.35. plasma bicarbonate is less than 15mEq/L, and the blood glucose level is higher than 250mg/dl and ketones are present in the blood and urine. Options B and C: The client would be experiencing polyuria, and Kussmaul's respirations would be present. Option D: A comatose state may occur if DKA is not treated, but coma would not confirm the diagnosis

A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the ER. Which finding would a nurse expect to note as confirming this diagnosis? a. elevated blood glucose level and a low plasma bicarbonate b. decreased urine output c. increased respiration and an increase in pH d. comatose state

A -- Because the client has diabetes, it is essential that the blood glucose level is determined before meals to evaluate the success of control of diabetes and the possible need for insulin coverage.

A client with diabetes mellitus has an above-knee amputation because of severe peripheral vascular disease. Two days following surgery, when preparing the client for dinner, it is the nurse's primary responsibility to: a. check the client's serum glucose level b. assist the client out of bed to the chair c. place the client in a High-Fowler's position d. ensure that the client's residual limb is elevated

A -- An understanding of the diet is imperative for compliance. A balance of carbohydrates, proteins, and fats usually apportioned over three main meals and two between meals snacks need to be tailored to the client's specific needs, with due regard for activity, diet, and therapy.

A client with diabetes mellitus states, "I cannot eat big meals; I prefer to snack throughout the day." The nurse should carefully explain that: a. regulated food intake is basic to control b. salt and sugar restriction is the main concern c. small, frequent meals are better for digestion d. large meals can contribute to a weight problem

A -- Prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics, and potassium supplements.

A client with diabetes mellitus visits a health care clinic. The client's diabetes previously had been well controlled with glyburide (Diabeta), 5 mg PO daily, but recently, the fasting blood glucose has been running 180-200 mg/dl. Which medication, if added to the clients regimen, may have contributed to the hyperglycemia? a. prednisone b. atenolol c. phenelzine d. allopurinol

D, E

A nurse is teaching foot care to a client who has diabetes. 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 toes C. Test water temperature with the fingers before bathing D. Trim toenails straight across E. Wear close toed shoes

A Option A: A hypoglycemic reaction may occur in response to increased exercise. Clients should avoid exercise during the peak time of insulin. NPH insulin peaks at 6-14 hours; therefore afternoon exercise will occur during the peak of the medication. Options B, C, and D do not address peak action times.

A client with type 1 diabetes mellitus calls the nurse to report recurrent episodes of hypoglycemia with exercise. Which statement by the client indicated an inadequate understanding of the peak action of NPH insulin and exercise? a. "The best time for me to exercise is every afternoon." b. "The best time for me to exercise is right after I eat." c. "The best time for me to exercise is after breakfast." d. "The best time for me to exercise is after my morning snack."

B -- A hypoglycemic reaction activates a fight-or-flight response in the body which then triggers the release of epinephrine and norepinephrine resulting in diaphoresis.

A clinical feature that distinguishes a hypoglycemic reaction from a ketoacidosis reaction is: a. blurred vision b. diaphoresis c. nausea d. vomiting

B

A diagnosis of hyperglycemic hyperosmolar non-ketotic coma Is made for a client with type two diabetes he was brought to the emergency department in an unresponsive state. Which intervention will the nurse anticipate this patient will need first? A. Administration of 50% Dextrose bolus B. Insertion of a large bore IV catheter C. Initiation of oxygen by nasal cannula D. Administration of glargine insulin

C Option C: Intermediate-acting insulins include Humulin N and Novolin N. They have an onset of two to four hours, peak of 4 to 12 hours, and a duration of 14 to 18 hours. Option A: Regular or short-acting insulins include Humulin R and Novolin R. They have an onset of half an hour, a peak of two to three hours, and a duration of six to eight hours. Option D: Long-acting insulins include Levemir and Lantus. They have an onset of several hours, minimal or no peak, and a duration of 24 hours or more.

A male nurse is providing a bedtime snack for his patient. This is based on the knowledge that intermediate-acting insulins are effective for an approximate duration of: a. 6-8 hrs b. 10-14 hrs c. 14-18 hrs d. 24-28 hrs

B, C, D, E

A nurse is assessing a client who has diabetic ketoacidosis 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. Kussmaul respirations E. Metabolic acidosis

A Option A: Lack (absolute or relative) of insulin is the primary cause of DK1. Options B and C: Treatment consists of insulin administration (regular insulin), IV fluid administration (normal saline initially), and potassium replacement, followed by correcting acidosis. Option D: Applying an electrocardiogram monitor is not a priority action.

A nurse is caring for a client admitted to the ER with DKA. In the acute phase the priority nursing action is to prepare to: a. administer regular insulin intravenously b. administer 5% dextrose intravenously c. correct the acidosis d. apply an electrocardiogram monitor

C - recheck the blood glucose in 15 minutes after a rapidly absorbed carbohydrate is ingested. Give the client a carbohydrate and protein food if the next meal is more than one hour away after the blood glucose returns to a normal range. The greatest risk to the client is injury from hypoglycemia; therefore, the priority action to take is to administer 15 to 20 g of a rapidly absorbed carbohydrate such as grape juice.

A nurse is caring for a client who has blood glucose 52 mg/dL. The client is lethargic but arousable. Which of the following actions should the nurse perform first? A. Recheck glucose in 15 mins B. Provide a carbohydrate and protein food C. Provide 15 g of simple carbs D. Report findings to provider

A Option A: Increased blood glucose will cause the kidneys to excrete the glucose on the urine. This glucose is accompanied by fluids and electrolytes, causing osmotic diuresis leading to dehydration. This fluid loss must be replaced when it becomes severe. Options B, C, and D are not related specifically to the issue of the question.

A nurse is preparing a plan of care for a client with diabetes mellitus who has hyperglycemia. The priority nursing diagnosis would be: a. high risk for deficient fluid volume b. deficient knowledge: disease process and treatment c. imbalanced nutrition: less than body requirements d. disabled family coping: compromised

C - administer each insulin as a separate injection. These insulin's are not compatible and should not be drawn up in the same syringe.

A nurse is preparing to administer morning doses of insulin glargine and regular insulin to a client who has a blood glucose 278 mg/dL. Which of the following actions should the nurse take? A. Draw up the regular insulin and then the glargine insulin in the same syringe B. Draw up the glargine insulin then the regular insulin in the same syringe. C. Draw up and administer regular and glargine insulin in separate syringes. D. Administer the regular insulin, wait one hour, and then administer the glargine insulin.

A, B, C, E

A nurse is presenting information to a group of clients about nutrition habits that prevent type two diabetes. Which of the following should the nurse include in the information? Select all that apply. A. Eat at regular intervals B. Decrease intake of saturated foods C. Increase daily fiber intake D. Limit saturated fat intake to 15% of daily caloric intake E. Include omega-3 fatty acids in the diet

B - A client who has HHS would have a blood osmolarity greater than 320.

A nurse is reviewing lab results of a client who has hyperglycemic hyperosmolar state. Which of the following findings should the nurse expect? A. Blood pH 7.2 B. Blood osmolarity 350 C. Blood potassium 3.8 D. Blood creatinine 0.8

A, B, C, D

A nurse is reviewing the health history of a client who has diabetes type two. Which of the following are risk factors for hyperglycemic hyperosmolar state? Select all that apply. A. Evidence of a recent myocardial infarction B. BUN 35 mg/dL C. Takes a calcium channel blocker D. Age 77 years E. Daily insulin injections

C - expect to rapidly administer an IV infusion of 0.9% sodium chloride, an isotonic fluid, as prescribed to maintain blood perfusion to vital organs. The initial infusion for a client who has an elevated sodium would be 0.45% sodium chloride.

A nurse is reviewing the medical record for a client who is to begin therapy for DKA. Which of the following prescriptions should the nurse expect? A. Administer an IV infusion of regular insulin at 0.3 units per kilogram per hour B. Administer a slow IV infusion of 3% sodium chloride C. Rapidly administer an IV infusion of 0.9% sodium chloride D. Add glucose to the IV infusion when blood glucose is 350 mg/dL

D An elevated temperature may indicate infection. Infection is a leading cause of hyperglycemic hyperosmolar nonketotic syndrome or diabetic ketoacidosis.

A nurse performs a physical assessment on a client with type 2 diabetes mellitus. Findings include fasting blood glucose of 120mg/dl, temperature of 101ºF, pulse of 88 bpm, respirations of 22 bpm, and a BP of 140/84 mmHg. Which finding would be of most concern to the nurse? a. pulse b. BP c. respirations d. temp

B -- Eating a bedtime snack can prevent blood glucose levels from dropping very low during the night and lessen the Somogyi effect where glucose levels drop significantly between 2:00 a.m. and 3:00 a.m.

A nurse went to a patient's room to do routine vital signs monitoring and found out that the patient's bedtime snack was not eaten. This should alert the nurse to check and assess for: a. elevated serum bicarbonate and decreased blood pH b. signs of hypoglycemia earlier than expected c. symptoms of hyperglycemia during the peak time of NPH insulin d. sugar in the urine

B Administer insulin aspart when breakfast arrives to avoid a hypoglycemic episode. This insulin is a rapid acting insulin and should be administered 5 to 10 minutes before breakfast

A nurses preparing to administer a morning dose of insulin aspart to a client who has type one diabetes. Which of the following action should the nurse take? A. Check blood glucose immediately after breakfast B. Administer insulin when breakfast arrives C. Hold breakfast for one hour after insulin administration D. Clarify the prescription because insulin should not be administered at this time

B - impaired fasting glucose and impaired glucose tolerance represent an intermediate stage between normal glucose homeostasis and diabetes. This stage is called pre-diabetes, and patients are increase risk for the development of type two diabetes.

A patient screened for diabetes at a clinic has a fasting plasma glucose level of 120 mg/dL. Which statement by the nurse is best? A. You will develop type two diabetes within five years. B. You are at increased risk for developing diabetes. C. The test is normal, and diabetes is not a problem. D. The lab test result is positive for type two diabetes.

C - if a person with type one diabetes is ill, he or she should test blood glucose levels at least at 2 to 4 hour intervals to determine the effects of this stressor on the blood glucose level.

A patient with type one diabetes cause the clinic with complaints of nausea, vomiting, and diarrhea. It is most important that the nurse advised the patient to: A. Withhold the regular dose of insulin B. Drink cool fluids with high glucose content C. Check the blood glucose level every 2 to 4 hours D. Use a less strenuous form of exercise than usual until the illness resolves

D

A student who has type one diabetes will take a daily swimming class at 1 PM. What should the student be advised to do? A. Delay eating the noon meal until after the class B. Increase the morning dose of NPH insulin on days of the swimming class C. Delay the morning insulin injection until after the class D. Check glucose levels before, during and after swimming

B -- The peak time of insulin is the time it is working the hardest to lower the blood glucose. NPH insulin is an intermediate-acting insulin that has an onset of 1 to 3 hours after injection, peaks 4 to 12 hours later, and is effective for about 12 to 16 hours.

Albert, a 35-year-old insulin-dependent diabetic, is admitted to the hospital with a diagnosis of pneumonia. He has been febrile since admission. His daily insulin requirement is 24 units of NPH. Every morning Albert is given NPH insulin at 0730. Meals are served at 0830, 1230, and 1830. The nurse expects that the NPH insulin will reach its maximum effect (peak) between the hours of: a. 1130 and 1330 b. 1330 and 1930 c. 1530 and 2130 d. 1730 and 2330

C - profuse perspiration is a symptom of hypoglycemia, a complication of diabetes that requires urgent treatment. A glucose level of 185 will need coverage with sliding scale insulin, but this is not urgent. Numbness and tingling, as well as bunions, are related to the chronic nature of diabetes and are not urgent problems

An LPN/LVN's assessment of two diabetic clients reveals all of these findings. What would you instruct the LPN/LVN to report immediately? A. Fingerstick glucose reading of 185 B. Numbness and tingling in both feet C. Profuse perspiration D. Bunion on the left great toe

A An insulin pump provides a small continuous dose of regular insulin subcutaneously throughout the day and night, and the client can self-administer a bolus with additional dosage from the pump before each meal as needed. Regular insulin is used in an insulin pump. An external pump is not attached surgically to the pancreas.

An external insulin pump is prescribed for a client with DM. The client asks the nurse about the functioning of the pump. The nurse bases the response on the information that the pump: a. gives a small continuous dose of regular insulin subcutaneously, and the client can self-administer a bolus with an additional dosage from the pump before each meal b. it is timed to release programmed doses of regular or NPH insulin into the bloodstream at specific intervals c. it is surgically attached to the pancreas and infuses regular insulin into the pancreas, which in turn releases the insulin into the bloodstream d. it continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels

A -- Glucose catabolism is the main pathway for cellular energy production.

Glucose is an important molecule in a cell because this molecule is primarily used for: a. extraction of energy b. synthesis of protein c. building of genetic material d. formation of cell membranes

B For a diagnosis of DM, HbA1C is 6.5% or greater. Option B: Glycosylated hemoglobin levels between 5.7%-6.4% is considered as pre-diabetes. Option A: Glycosylated hemoglobin levels over 6.5 % are considered diagnostic of diabetes. Options C and D: Glycosylated hemoglobin levels less than 5.6 % are normal.

Glycosylated hemoglobin (HbA1C) test measures the average blood glucose control of an individual over the previous three months. Which of the following values is considered a diagnosis of pre-diabetes? a. 6.5-7% b. 5.7-6.4% c. 5-5.6% d. greater than 5.6%

A, B, C, E

Inter nurses providing discharge teaching to a client who had diabetic ketoacidosis. Which of the following information should the nurse include about preventing DKA? Select all that apply. A. Drink 2 L fluids daily B. Monitor blood glucose every four hours when ill C. Administer insulin as prescribed when ill D. Notify the provider when blood glucose is 200 E. Report ketones in the urine after 24 hours of illness

D A. Although the incidence of DM is higher among Hispanics than Caucasians, Native Americans have the highest risk. B. The incidence of DM is low among Asian Americans. C. The young client who is obese does have an increased risk and should be explored for DM, but the Native American client is at greatest risk. The incidence of DM is higher among Native Americans than Caucasians, and the Native American client is older. D. The nurse should further explore whether the Native American male client has developed DM. Research has shown that the highest incidence of DM is among Native Americans.

The nurse is interviewing four clients. Which client is at the greatest risk for developing type 2 DM? A. 56-year-old Hispanic female B. 40-year-old Asian American female C. 25-year-old obese Caucasian male D. 38-year-old Native American male

B -- Insulin lipodystrophy produces fatty masses at the injection sites, causing unpredictable absorption of insulin injected into these sites.

Rotating injection sites when administering insulin prevents which of the following complications?A. Insulin edema B. Insulin lipodystrophy C. Insulin resistance D. Systemic allergic reactions

C Rotation of sites for insulin injection should be done every week or two. Frequently using the same spot over time can cause fat cells to break down or build up (lipodystrophy) causing lumps under the skin and may interfere with insulin absorption.

Rotation sites for insulin injection should be separated from one another by 2.5 cm (1 inch) and should be used only every: a. third day b. every other day c. 1-2 weeks d. 2-4 weeks

A Option A: Hypoglycemia does not occur in type 2 diabetes unless the patient is on insulin therapy or taking other diabetes medication. Option B: Type 2 diabetes can affect blood circulation which makes it easier for the skin to bruise. Option C: The presence of ketones in the urine happens due to a lack of available insulin. Option D: Losing a lot of fluids caused by frequent urination can lead to dehydration hence patients can develop dry mouth.

The nurse is admitting a patient diagnosed with type 2 diabetes mellitus. The nurse should expect the following symptoms during an assessment, except: a. hypoglycemia b. frequent bruising c. ketonuria d. dry mouth

A - electrolytes are depleted in dka

The nurse is caring for a patient with type one diabetes malitis who is admitted for diabetic ketoacidosis. The nurse would expect which lab test result? A. Hypokalemia B. Fluid overload C. Hypoglycemia D. Hyperphosphatemia

B Option B: Lispro is a rapid-acting insulin that works within 15 minutes after injection, a peak of 30-90 minutes, and a duration of 2-4 hours. Option A: Human regular (Humulin R) is a regular or short-acting insulin that usually reaches the bloodstream in 30 minutes, a peak of 2-3 hours, and a duration of 3 to 6 hours. Option C: Glargine (Toujeo) is ultra-long-acting insulin that reaches the bloodstream within 6 hours, has no peak, and duration 36 hours or longer. Option D: Insulin NPH (Humulin N) is an intermediate-acting insulin that reaches the bloodstream about 2 to 4 hours after injection, a peak of 4-12 hours, and duration of 12-18 hours.

The nurse is teaching a client regarding the administration of insulin as part of the discharge plan. Which of the following insulin has the most rapid onset of action? a. insulin regular b. lispro c. glargine d. insuliin NPH

D A. Administering insulin when hypoglycemia is already present could cause unconsciousness and death. B. Calling the lab to obtain a STAT serum glucose level will delay the client's treatment for hypoglycemia. C. Having the client choose foods for a meal will delay the client's treatment for hypoglycemia. D. Normal blood glucose level is 70-110 mg/dL. Hypoglycemia is treated with 15 to 20 g of a simple (fast-acting) carbohydrate, such as 4 to 6 oz of fruit juice or 8 oz of low-fat milk.

The nurse obtains a fingerstick blood glucose reading of 48 mg/dL for the client with type 1 DM. The client is to receive 6 units of regular and 10 units of NPH insulin now. Which is the nurse's best immediate intervention? a. administer the insulin that is due now b. call the lab for a STAT serum glucose level c. have the client choose foods for a meal now d. provide juice with 15 grams of carbs

C

Two hours after taking a morning dose of regular insulin, a client presents to the emergency department with diaphoresis tremors palpitations and tachycardia. Which nursing action is most appropriate for this client? A. Check pulse oximetry and administer oxygen at 2 L per nasal cannula B. Administer a baby aspirin, one sublingual nitroglycerin tablet, and obtain an EKG C. Check blood glucose level and provide carbohydrates if less than 70 D. Check vital signs and administer atenolol 25 mg orally if heart rate is greater

C -- As a result of osmotic pressures created by increased serum glucose, the cells become dehydrated; the client must receive fluid and then insulin.

When a client is first admitted with hyperglycemic hyperosmolar nonketotic syndrome (HHNS), the nurse's priority is to provide: a. oxygen b. carbohydrates c. fluid replacement d. dietary instruction

B

Which of the following chronic complications is associated with diabetes?A. Dizziness, dyspnea on exertion, and coronary artery disease B. Retinopathy, neuropathy, and coronary artery disease C. Leg ulcers, cerebral ischemic events, and pulmonary infarcts D. Fatigue, nausea, vomiting, muscle weakness, and cardiac arrhythmias

C -- When a client who has taken an oral antidiabetic agent vomits, the nurse would monitor glucose and assess him frequently for signs of hypoglycemia.

Which of the following nursing interventions should be taken for a client who complains of nausea and vomits one hour after taking his glyburide (DiaBeta)? a. give glyburide again b. give subcutaneous insulin and monitor blood glucose c. monitor blood glucose closely, and look for signs of hypoglycemia d. monitor blood glucose, and assess for signs of hyperglycemia