ATI Practice Assessment (Diabetes Mellitus)

A nurse is evaluating teaching with a client who is receiving continuous subcutaneous insulin via an external insulin pump. Which of the following statements by the client indicates a need for further teaching? "I will change the needle every 3 days." "I should store all unused insulin in the refrigerator." "If I skip lunch, I will skip my mealtime dose of insulin." "I will use insulin glargine in my insulin pump."

"I will use insulin glargine in my insulin pump." The client should use a short-acting insulin in the insulin pump. The insulin pump is designed to administer rapid-acting or short-acting insulin 24 hr a day. Insulin glargine is classified as a long-acting insulin and is administered at the same time each day to maintain stable blood glucose concentration for a 24-hr period.

A nurse is teaching a client who has a new prescription for NPH insulin. Which of the following instructions should the nurse include? - "Discard the medication if it is cloudy." - "Briskly shake the medication before filling the syringe." - "Take this medication15 minutes before meals." - "Eat a snack 8 hours after taking this medication."

"Eat a snack 8 hours after taking this medication." NPH insulin peaks in 6 to 14 hr after dosing. The client is at risk for hypoglycemia and might require a snack at this time. Clients should check blood glucose 8 to 10 hr after administration of NPH insulin, and if hypoglycemic, consume a small snack of 15 g of carbohydrates, followed by rechecking of the blood glucose in 15 min.

A nurse is teaching an older adult client who has diabetes mellitus about preventing the long-term complications of retinopathy and nephropathy. Which of the following instructions should the nurse include? - "Have an eye examination once per year." - "Examine your feet carefully every day." - "Wear compression stockings daily." - "Maintain stable blood glucose levels."

"Examine your feet carefully every day."

A nurse is providing teaching for a client who is newly diagnosed with type 2 diabetes mellitus and has a prescription for glipizide. Which of the following statements by the nurse best describes the action of glipizide? - "Glipizide absorbs the excess carbohydrates in your system." - "Glipizide stimulates your pancreas to release insulin." - "Glipizide replaces insulin that is not being produced by your pancreas." - "Glipizide prevents your liver from destroying your insulin."

"Glipizide stimulates your pancreas to release insulin." Glipizide is an oral antidiabetic medication in the pharmacological classification of sulfonylurea agents. These medications help to lower blood glucose levels in clients who have type 2 diabetes mellitus using several methods, including reducing glucose output by the liver, increasing peripheral sensitivity to insulin, and stimulating the release of insulin from the functioning beta cells of the pancreas.

A nurse is teaching about disease management for a client who has type 1 diabetes mellitus. Which statement made by the client indicates an understanding of the teaching? -"I am to take my blood sugar reading after meals." - "Insulin allows me to eat ice cream at bedtime." - "A weight reduction program will make me hypoglycemic." - "I give the insulin injections in my abdominal area."

"I give the insulin injections in my abdominal area." The client should give insulin injections in one anatomic area for consistent day-to-day absorption. The abdomen is the area for fastest absorption.

A nurse is providing teaching about self-administration of insulin to the parent of a school-age child who has a new of diabetes mellitus. Which of the following statements by the parent indicates a need for further teaching? - "I will be sure my child aspirates before injecting the insulin." - "The insulin can be injected anywhere there is adipose tissue." - "I will be sure my child rotates sites after 5 injections in one area." - "The insulin should be injected at a 90-degree angle."

"I will be sure my child aspirates before injecting the insulin." It is not necessary to aspirate before injecting the insulin.

A nurse is teaching a client who has diabetes mellitus about the manifestations of hypoglycemia. Which of the following statements by the client indicates an understanding of the teaching? "I will feel shaky." "I will be more thirsty than usual." "My skin will be warm and moist." "My appetite will be decreased."

"I will feel shaky." Manifestations of hypoglycemia include feeling shaky and nervous.

A nurse is teaching a client who has a new diagnosis of Type 1 diabetes mellitus about self-administration of insulin. Which of the following instructions should the nurse include? - "Pull back on the plunger after injecting the insulin." - "Massage the injection site after removing the needle." - "Store the current bottle of insulin at room temperature." - "Use each syringe up to six times."

"Store the current bottle of insulin at room temperature." The nurse should instruct the client to keep the bottle of insulin she is currently using at room temperature to minimize painful injections. The client should refrigerate unused bottles of insulin to protect the quality of the medication.

A nurse is teaching a client who is taking metformin XR for type II diabetes mellitus. Which of the following instructions should the nurse include in the teaching? - "Take the medication with a meal." - "You may crush or chew the medication." - "This medication may cause an increase in perspiration." - "This medication may turn your urine orange."

"Take the medication with a meal." The client should take metformin with a meal to avoid hypoglycemia and GI upset, and to provide the most absorption of the medication.

A client who has Type 2 diabetes mellitus asks the nurse, "Why did I develop diabetes?" Which of the following responses should the nurse make? - "Your body is destroying the cells that secrete insulin." - "Your body has insulin resistance and decreased insulin secretion." - "An infection in your pancreas destroyed the cells that make insulin." - "Your kidneys are not able to reabsorb water which leads to Type 2 diabetes mellitus."

"Your body has insulin resistance and decreased insulin secretion." A client genetically susceptible can develop Type 2 diabetes mellitus when obesity and physical inactivity lead to insulin resistance at cells as well as decreased secretion of insulin by pancreatic beta-cells.

A nurse in an emergency department is caring for a client who has diabetic ketoacidosis (DKA) and a blood glucose level of 925 mg/dL. The nurse should anticipate which of the following prescriptions from the provider? Glucocorticoid medications Dextrose 5% in 0.45% sodium chloride Oral hypoglycemic medications 0.9% sodium chloride IV bolus

0.9% sodium chloride IV bolus The nurse should expect a prescription for an IV bolus of 0.9% sodium chloride to be administered at 15 to 20 mL/kg/hr for the first hour to restore volume and maintain perfusion to the vital organs.

A nurse is caring for a client with diabetes mellitus who is prescribed regular insulin via a sliding scale. After administering the correct dose at 0715, the nurse should ensure the client receives breakfast at which of the following times? - 0720 - 0730 - 0745 - 0815

0745 Regular insulin should be given 20 to 30 minutes before eating because the onset of action is 30 minutes. There are circumstances when this lag time guide can be adjusted.

A nurse is caring for a client who has diabetic ketoacidosis. Which of the following manifestations should the nurse expect? - Malignant hypertension - Acetone odor to breath - Cheyne-Stokes breathing - Blood glucose level below 40 mg/dL

Acetone odor to breath Because of the lack of insulin, the body is unable to use glucose and instead breaks down fats resulting in excessive ketones. The large amount of ketones causes the body to become acidotic and causes a fruity, or acetone odor to the breath

A nurse is providing teaching to a client who has a diabetes mellitus about carbohydrate intake needs when exercising. Which of the following foods should the nurse include as containing a 15 g serving of carbohydrates? - 2 slices bread - 1 cup sugar-free yogurt - 1 cup milk - 1 cup regular ice cream

1 cup milk The nurse should instruct the client that 1 cup of milk contains 15 g of carbohydrates.

A nurse is caring for a client who has diabetes and a new prescription for 14 units of regular insulin and 28 units of NPH insulin subcutaneously at breakfast daily. What is the total number of units of insulin that the nurse should prepare in the insulin syringe? - 14 units - 28 units - 32 units - 42 units

42 units Each order of for units of insulin is combined in the same syringe. The nurse should withdraw the regular insulin into the syringe first.

A nurse working for a home health agency is teaching a client who has diabetes mellitus about disease management. Which of the following glycosylated hemoglobin (HbA1c) values should the nurse include in the teaching as an indicator that the client is appropriately controlling his glucose levels? - 6.3% - 7.8% - 8.5% - 10%

6.3% The client who has diabetes mellitus needs to manage activity and diet while monitoring blood glucose levels. High levels of blood glucose cause damage to the macro and microcirculation, affecting such things as eyesight and kidney function. The goal for a client who has diabetes mellitus is to keep the HbA1c values at 6.5% or less.

A nurse is caring for a 4-year-old child who has a new diagnosis of diabetes mellitus and is distressed after an insulin injection. Which of the following play activities should the nurse recognize is therapeutic in helping the child deal with the injection? - A needleless syringe and a doll - A video game - A story book about a child who has diabetes - A period of play in the playroom

A needleless syringe and a doll Playing with a needleless syringe and a doll is an appropriate therapeutic activity for the child, because they will allow the child to act out feelings of anger and helplessness.

A nurse observes mild hand tremors in a client who has diabetes mellitus. Which of the following actions should the nurse take after obtaining a glucose meter reading of 60 mg/dL? - Administer 15 g of carbohydrates. - Retest the blood glucose level. - Administer 1 mg of glucagon IM. - Administer IV dextrose.

Administer 15 g of carbohydrates The first step in preventing the client's blood glucose level from dropping further is to administer 15 to 20 g of carbohydrates. A client who is awake and can swallow can consume carbohydrates, such as glucose tablets or glucose gel, 120 mL (4 oz) of orange juice, 240 mL (8 oz) of skim milk, 6 saltine crackers, 3 graham crackers, or 6 to 10 hard candies.

A nurse is teaching a client who has diabetes mellitus and a new prescription for glimepiride. The nurse should teach the client to avoid which of the following drinks while taking this medication? - Grapefruit juice - Milk - Alcohol - Coffee

Alcohol The nurse should teach the client to avoid alcohol while taking this medication to prevent a disulfiram reaction, such as nausea, headache, and hypoglycemia.

A nurse is providing teaching to a client who has a new diagnosis of type 2 diabetes mellitus. The nurse should recognize that the client understands the teaching when he identifies which of the following as manifestations of hypoglycemia? (SATA) Polyuria Blurred vision Polydipsia Tachycardia Moist, clammy skin

Blurred vision Manifestations of hypoglycemia include blurred vision. Tachycardia Manifestations of hypoglycemia include tachycardia. Moist, clammy skin Manifestations of hypoglycemia include moist, clammy skin.

A nurse is assessing a client who has diabetes mellitus. Which of the following findings is a manifestation of hypoglycemia? - Bradycardia - Cool, clammy skin - Vomiting - Fruity odor on the client's breath

Cool, clammy skin Cool, clammy skin is a manifestation of hypoglycemia.

A nurse is teaching a client how to draw up regular insulin and NPH insulin into the same syringe. Which of the following instructions should the nurse include? Draw up the NPH insulin into the syringe first. Inject air into the regular insulin first. Shake the NPH insulin until it is well mixed. Discard regular insulin that appears cloudy.

Discard regular insulin that appears cloudy. The nurse should teach the client to discard any regular insulin that appears cloudy, as regular insulin should be clear. NPH insulin has a cloudy appearance.

A nurse is teaching a client who has type 1 diabetes mellitus about exercise. Which of the following instructions should the nurse include? Perform vigorous exercise when blood glucose is less than 100 mg/dL. Do not exercise if ketones are present in your urine. Avoid eating for 2 hr before exercise. Examine your feet weekly.

Do not exercise if ketones are present in your urine. The nurse should instruct the client not exercise if ketones are present in her urine because this is an indication of inadequate insulin and increases the risk for hyperglycemia.

A nurse is teaching a client who has diabetes mellitus and receives 25 units of NPH insulin every morning if her blood glucose level is above 200 mg/dL. Which of the following information should the nurse include? - Discard the NPH solution if it appears cloudy. - Shake the insulin vigorously before loading the syringe. - Expect the NPH insulin to peak in 6 to 14 hr. - Freeze unopened insulin vials.

Expect the NPH insulin to peak in 6 to 14 hr. NPH insulin is an intermediate-acting insulin. Its onset of action is 1 to 2 hr, peaking at 6 to 14 hr. Its duration of action is 16 to 24 hr. The client is at risk for hypoglycemia during the peak time.

A nurse is reviewing the laboratory results of a client who is at risk for developing diabetes mellitus. The nurse should recognize that which of the following results indicates the client meets the criteria for diagnosis of diabetes mellitus? - HbA1c 5.5% - 2 hr blood glucose 170 mg/dL - Fasting blood glucose 155 mg/dL - Casual blood glucose 180 mg/dL

Fasting blood glucose 155 mg/dL A fasting blood glucose above 126 mg/dL meets the criteria for a diagnosis of diabetes mellitus.

A nurse is caring for a client who has diabetes and plans to administer his regular insulin subcutaneously before he eats breakfast at 0800. After checking the client's morning glucose level, which of the following actions should the nurse take? - Give the insulin at 0700. - Give the insulin when the breakfast tray arrives. - Give the insulin 30 min after breakfast with the client's other routine medicines. - Give the insulin at 0730.

Give the insulin at 0730. Regular insulin has an onset of 30 to 60 minutes and should be given at a specific time before meals, usually within 30 min. The nurse should always check the blood glucose levels prior to administering short-acting insulin.

A nurse is caring for a client with type 1 diabetes mellitus who reports feeling shaky and having palpitations. When the nurse finds the client's blood glucose to be 48 mg/dL on the glucometer, he should give the client which of the following? Graham crackers 1 tsp sugar 4 oz diet soda 4 oz skim milk

Graham crackers After establishing that the client has hypoglycemia, the nurse should give the client about 15 g of a rapid-acting, concentrated carbohydrate, such as 4 oz of fruit juice, 8 oz of skim milk, 3 tsp of sugar or honey, 3 graham crackers, or commercially prepared glucose tablets. The nurse should recheck the client's blood glucose level in 15 minutes.

A nurse is assessing a client who has type 1 diabetes mellitus and finds the client lying in bed, sweating, and reporting feeling anxious. Which of the following complications should the nurse suspect? Hypoglycemia Nephropathy Hyperglycemia Ketoacidosis

Hypoglycemia Manifestations of hypoglycemia include sweating, tachycardia, tremors, palpitations, hunger, and anxiety.

A nurse is preparing to administer 10 units of regular insulin and 20 units of NPH insulin to a client who has diabetes mellitus. When mixing the two types of insulin, which of the following actions should the nurse take first? - Inject 10 units of air into the regular insulin vial. - Inject 20 units of air into the NPH insulin vial. - Withdraw 10 units of insulin from - the regular insulin vial. - Replace the needle for withdrawal with a safety needle.

Inject 20 units of air into the NPH insulin vial. The first action the nurse should take is to inject 20 units of air into the NPH insulin vial because this insulin is the intermediate-acting insulin, which will be drawn up last in order to avoid contaminating the regular insulin with NPH insulin.

A nurse is preparing to administer lispro insulin to a client who has type 1 diabetes mellitus. Which of the following actions should the nurse take? - Assess for hypoglycemia 4 hr after the insulin injection. - Inject the insulin 15 min before a meal. - Monitor for polyuria. - Administer with short-acting insulin.

Inject the insulin 15 min before a meal. The nurse should administer lispro insulin 15 min before a meal, because lispro insulin is rapid-acting insulin that has an onset within 15 to 30 min. The client may develop hypoglycemia quickly if they do not eat.

A nurse is preparing to administer 10 units of regular insulin and 20 units of NPH insulin to a client. What is the sequence of events the nurse should follow? (Move the steps of mixing insulin on the left into the box on the right, placing them in the selected order of performance. All steps must be used.)

Inspect vials for contaminants With the exception of NPH insulin, all insulin available today is supplied as a clear, colorless solution. Do not use insulin that is colored, cloudy, or has formed a precipitate. The first step is to observe the characteristics of the regular and NPH insulin to determine whether they are safe to use. - Roll NPH vial between palms of hands Rationale: Because NPH insulin is a suspension, the particles must be evenly dispersed by rolling the vial gently between the palms of the hands. This should be done gently because vigorous mixing may cause the solution to become frothy and cause inaccurate dosing. If granules or clumps are present after mixing, discard the solution. This should be done prior to withdrawing the solution into the syringe. - Inject air into NPH insulin vial Rationale: This creates a pressure in the vial for accuracy in measuring the amount prescribed. • Inject air into regular insulin vial: The amount of air injected into the vial of short-acting insulin is equal to the amount to be administered. • Withdraw short-acting insulin into syringe: When the prescription requires the administration of two types of insulin, it is preferable to mix the solutions into one syringe if they are compatible to prevent the client from receiving two injections. Of the longer-acting insulin available, only NPH insulin is mixed with short-acting insulin. When two insulins are to be mixed, withdraw the short-acting insulin first to avoid contaminating the stock vial with NPH insulin. • Add intermediate insulin to syringe: The mixture is stable for 28 days.

A nurse is providing teaching for a client who has diabetes and a new prescription for insulin glargine. Which of the following instructions should the nurse provide regarding this type of insulin? - Insulin glargine has a duration of 3 to 6 hr. - Insulin glargine has a duration of 6 to 10 hr. - Insulin glargine has a duration of 16 to 24 hr. Insulin glargine has a duration of 18 to 24 hr.

Insulin glargine has a duration of 18 to 24 hr. Insulin glargine is a long duration insulin that has a duration of 18 to 24 hr. It is only dosed once a day.

A nurse is teaching a client who has a new prescription for regular insulin and NPH insulin. Which of the following instructions should the nurse include in the teaching? - Keep the open vial of insulin at room temperature. - Inject the insulin into a large muscle. - Aspirate the medication prior to administration. - Administer the insulin in two separate injections.

Keep the open vial of insulin at room temperature. The client should keep the vial in use at room temperature to minimize tissue injury and to reduce the risk for lipodystrophy.

A nurse is caring for a client who has type 1 diabetes mellitus. The nurse misread the client's morning blood glucose level as 210 mg/dL instead of 120 mg/dL and administered the insulin dose appropriate for a reading over 200 mg/dL before the client's breakfast. Which of the following actions is the nurse's priority? Give the client 15 to 20 g of carbohydrate. Monitor the client for hypoglycemia. Complete an incident report. Notify the nurse manager.

Monitor the client for hypoglycemia. The first action the nurse should take using the nursing process is to assess or collect data from the client. The nurse should immediately check the client's blood glucose level, expecting it to be low because of the excessive dose of insulin. If it is within the expected reference range, the nurse should continue to monitor the client for signs of hypoglycemia.

A nurse is providing teaching to a female client who has type 2 diabetes and a new prescription for pioglitazone. Which of the following instructions should the nurse include in the teaching? (SATA) - Expect urine to be darkened. - Monitor weight daily. - Increase calcium intake. - Use oral contraceptives to avoid pregnancy. - Take tablets whole.

Monitor weight daily Pioglitazone may lead to fluid retention and worsen heart failure. Clients should monitor weight and report any rapid gains to the provider. Increase calcium intake Pioglitazone increases the risk of fractures in women. Clients should be advised to exercise and ensure adequate intake of vitamin D and calcium to protect bone health.

A nurse is reviewing the medication list for a client who has a new diagnosis of type 2 diabetes mellitus. The nurse should recognize which of the following medications can cause glucose intolerance? - Cimetidine - Dextromethorphan - Prednisone - Atorvastatin

Prednisone Corticosteroids such as prednisone can cause glucose intolerance and hyperglycemia. The client might require increased dosage of a hypoglycemic medication.

A nurse is caring for an adolescent client who has a long history of diabetes mellitus and is being admitted to the emergency department confused, flushed, and with an acetone odor on the breath. Diabetic ketoacidosis is suspected. The nurse should anticipate using which of the following types of insulin to treat this client? NPH insulin Insulin glargine Insulin detemir Regular insulin

Regular insulin Regular insulin is classified as a short-acting insulin. It can be given intravenously with an onset of action of less than 30 min. This is the insulin that is most appropriate in emergency situations of severe hyperglycemia or diabetic ketoacidosis.

A nurse is caring for a client who has uncontrolled type 1 diabetes mellitus. Which of the following findings should the nurse expect? Hypertension Hematuria Weight loss Bradycardia

Weight loss Weight loss is an expected finding for a client who has uncontrolled diabetes.