CH51 Diabetes
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? 1) Urine ketones 2) 6-hour glucose tolerance test 3) Serum glycosylated hemoglobin (Hb A1c) 4) Fasting blood glucose test
Serum glycosylated hemoglobin (Hb A1c) 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
NPH is an example of which type of insulin? 1) Intermediate-acting 2) Long-acting 3) Rapid-acting 4) Short-acting
Intermediate-acting NPH is an intermediate-acting insulin.
A client with a history of type 1 diabetes is demonstrating fast, deep, labored breathing and has fruity odored breath. What could be the cause of the client's current serious condition? 1) ketoacidosis 2) hyperosmolar hyperglycemic nonketotic syndrome 3) hepatic disorder 4) All options are correct.
ketoacidosis Kussmaul respirations (fast, deep, labored breathing) are common in ketoacidosis. Acetone, which is volatile, can be detected on the breath by its characteristic fruity odor. If treatment is not initiated, the outcome of ketoacidosis is circulatory collapse, renal shutdown, and death. Ketoacidosis is more common in people with diabetes who no longer produce insulin, such as those with type 1 diabetes. People with type 2 diabetes are more likely to develop hyperosmolar hyperglycemic nonketotic syndrome because with limited insulin, they can use enough glucose to prevent ketosis but not enough to maintain a normal blood glucose level.
A nurse educator has been invited to a local senior center to discuss health-maintaining strategies for older adults. The nurse discusses diabetes mellitus, its symptoms, and consequences. What is the prevalence of Type I diabetes? 1) 0% to 5% of all diagnosed cases 2) 10% to 15% of all diagnosed cases 3) 5% to 10% of all diagnosed cases 14) 5% to 20% of all diagnosed cases
5% to 10% of all diagnosed cases Type 1 diabetes accounts for approximately 5% to 10% of all diagnosed cases of diabetes (National Institute of Diabetes and Digestive and Kidney Diseases [NIDDK], 2008).
A nurse expects to note an elevated serum glucose level in a client with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which other laboratory finding should the nurse anticipate? 1) Below-normal serum potassium level 2) Serum alkalosis 3) Elevated serum acetone level 4) Serum ketone bodies
Below-normal serum potassium level A client with HHNS has an overall body deficit of potassium resulting from diuresis, which occurs secondary to the hyperosmolar, hyperglycemic state caused by the relative insulin deficiency. An elevated serum acetone level and serum ketone bodies are characteristic of diabetic ketoacidosis. Metabolic acidosis, not serum alkalosis, may occur in HHNS.
When the nurse is caring for a patient with type 1 diabetes, what clinical manifestation would be a priority to closely monitor? 1) Ketonuria 2) Hyponatremia 3) Hypoglycemia 4) Polyphagia
Hypoglycemia The therapeutic goal for diabetes management is to achieve normal blood glucose levels (euglycemia) without hypoglycemia while maintaining a high quality of life.
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? 1) Increased hunger 2) Numbness 3) Fatigue 4) Dizziness
Increased hunger 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.
Lispro (Humalog) is an example of which type of insulin? 1) Long-acting 2) Intermediate-acting 3) Short-acting 4) Rapid-acting
Rapid-acting Humalog is a rapid-acting insulin. NPH is an intermediate-acting insulin. A short-acting insulin is Humulin-R. An example of a long-acting insulin is Glargine (Lantus).
A nurse is providing education to a client who is newly diagnosed with diabetes mellitus. What are classic symptoms associated with diabetes? 1) Increased weight loss, dehydration, and fatigue 2) Increased weight gain, appetite, and thirst 3) Loss of appetite, increased urination, and dehydration 4) increased thirst, hunger, and urination
increased thirst, hunger, and urination The three classic symptoms of both types of diabetes mellitus are polyuria, polydipsia, and polyphagia. Weight loss, dehydration, and fatigue are additional symptoms.
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? 1) "Ketones help the physician determine how serious your diabetes is." 2) "Ketones will tell us if your body is using other tissues for energy." 3) "The spleen releases ketones when your body can't use glucose." 4) "Ketones can damage your kidneys and eyes."
"Ketones will tell us if your body is using other tissues for energy." 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 student with diabetes reports feeling nervous and hungry. The school nurse assesses the student and finds the child has tachycardia and is diaphoretic with a blood glucose level of 50 mg/dL (2.8 mmol/L). What should the school nurse administer? 1) A combination of protein and carbohydrates, such as a small cup of yogurt 2) Half a sandwich with a protein-based filling 3) Half of a cup of juice, followed by cheese and crackers 4) Two teaspoons of sugar dissolved in a cup of apple juice
Half of a cup of juice, followed by cheese and crackers Initial treatment for hypoglycemia is 15 g concentrated carbohydrate, such as two or three glucose tablets, 1 tube glucose gel, or 0.5 cup juice. Initial treatment should be followed with a snack including starch and protein, such as cheese and crackers, milk and crackers, or half of a sandwich. It is unnecessary to add sugar to juice, even it if is labeled as unsweetened juice, because the fruit sugar in juice contains enough simple carbohydrate to raise the blood glucose level and the additional sugar may result in a sharp rise in blood sugar that will last for several hours.
Which type of insulin acts most quickly? 1) Regular 2) Lispro 3) Glargine 4) NPH
Lispro 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 suspects that a patient with diabetes has developed proliferative retinopathy. The nurse confirms this by the presence of which of the following diagnostic signs? 1) Neovascularization into the vitreous humor 2) The leakage of capillary wall fragments into surrounding areas 3) Microaneurysm formation 4) Decreased capillary permeability
Neovascularization into the vitreous humor Proliferative retinopathy, an ocular complication of diabetes, occurs because of the abnormal growth of new blood vessels on the retina that bleed into the vitreous and block light. Blood vessels in the vitreous form scar tissue that can pull and detach the retina. Neovascularization into the vitreous humor is considered a diagnostic sign.
A client with diabetes mellitus must learn how to self-administer insulin. The physician has ordered 10 units of U-100 regular insulin and 35 units of U-100 isophane insulin suspension (NPH) to be taken before breakfast. When teaching the client how to select and rotate insulin injection sites, the nurse should provide which instruction? 1) "Administer insulin into areas of scar tissue or hypertrophy whenever possible." 2)"Inject insulin into healthy tissue with large blood vessels and nerves." 3) "Rotate injection sites within the same anatomic region, not among different regions." 4) "Administer insulin into sites above muscles that you plan to exercise heavily later that day."
"Rotate injection sites within the same anatomic region, not among different regions." The nurse should instruct the client to rotate injection sites within the same anatomic region. Rotating sites among different regions may cause excessive day-to-day variations in the blood glucose level; also, insulin absorption differs from one region to the next. Insulin should be injected only into healthy tissue lacking large blood vessels, nerves, or scar tissue or other deviations. Injecting insulin into areas of hypertrophy may delay absorption. The client shouldn't inject insulin into areas of lipodystrophy (such as hypertrophy or atrophy); to prevent lipodystrophy, the client should rotate injection sites systematically. Exercise speeds drug absorption, so the client shouldn't inject insulin into sites above muscles that will be exercised heavily.
The health care provider has explained to a client that the client has developed diabetic neuropathy in the right foot. Later that day, the client asks the nurse what causes diabetic neuropathy. What would be the nurse's best response? 1) "Research has shown that diabetic neuropathy is caused by fluctuations in blood sugar that have gone on for years." 2) "Research has shown that diabetic neuropathy is caused by a combination of elevated glucose and ketone levels." 3) "The cause is not known for sure but it is thought to involve elevated blood glucose levels over a period of years." 4) "The cause is not known for sure but it is thought to have something to do with ketoacidosis."
"The cause is not known for sure but it is thought to involve elevated blood glucose levels over a period of years." The etiology of neuropathy may involve elevated blood glucose levels over a period of years. High blood sugar (rather than fluctuations or variations in blood sugars) is thought to be responsible. Ketones and ketoacidosis are not direct causes of neuropathies.
A nurse is caring for a client with type 1 diabetes. The client's medication administration record includes the administration of regular insulin three times daily. Knowing that the client's lunch tray will arrive at 11:45 AM, when should the nurse administer the client's insulin? 1) 1145 AM 2) 1130 AM 3) 1045 AM 4) 1150 AM
1130 Short-acting insulin is called regular insulin. It is in a clear solution and is usually given 15 minutes before a meal or in combination with a longer-acting insulin. Earlier administration creates a risk for hypoglycemia; later administration creates a risk for hyperglycemia
A nurse is caring for a client with type 1 diabetes who exhibits confusion, light-headedness, and aberrant behavior. The client is conscious. The nurse should first administer: 1) 15 to 20 g of a fast-acting carbohydrate such as orange juice. 2) I.M. or subcutaneous glucagon. 3) 10 units of fast-acting insulin. 4) I.V. bolus of dextrose 50%.
15 to 20 g of a fast-acting carbohydrate such as orange juice. This client is experiencing hypoglycemia. Because the client is conscious, the nurse should first administer a fast-acting carbohydrate, such as orange juice, hard candy, or honey. If the client has lost consciousness, the nurse should administer I.M. or subcutaneous glucagon or an I.V. bolus of dextrose 50%. The nurse shouldn't administer insulin to a client who's hypoglycemic; this action will further compromise the client's condition.
A nurse is caring for a diabetic patient with a diagnosis of nephropathy. What would the nurse expect the urinalysis report to indicate? 1) Albumin 2) Red blood cells 3) Bacteria 4) White blood cells
Albumin Nephropathy, or kidney disease secondary to diabetic microvascular changes in the kidney, is a common complication of diabetes. Consistent elevation of blood glucose levels stresses the kidney's filtration mechanism, allowing blood proteins to leak into the urine and thus increasing the pressure in the blood vessels of the kidney. Albumin is one of the most important blood proteins that leak into the urine, and its leakage is among the earliest signs that can be detected. Clinical nephropathy eventually develops in more than 85% of people with microalbuminuria but in fewer than 5% of people without microalbuminuria. The urine should be checked annually for the presence of proteins, which would include microalbumin.
A nurse is working for the summer at a camp for adolescents with diabetes. When providing information on the prevention and management of hypoglycemia, what action should the nurse promote? 1) Perform exercise prior to eating whenever possible. 2) Always carry a form of fast-acting sugar. 3) Check blood sugar at least every 24 hours. 4) Eat a meal or snack every 8 hours.
Always carry a form of fast-acting sugar. The following teaching points should be included in information provided to the client on how to prevent hypoglycemia: Always carry a form of fast-acting sugar, increase food prior to exercise, eat a meal or snack every 4 to 5 hours, and check blood sugar regularly.
A nurse is preparing a client with type 1 diabetes for discharge. The client can care for himself; however, he's had a problem with unstable blood glucose levels in the past. Based on the client's history, he should be referred to which health care worker? 1) Psychiatrist 2) Social worker 3) Home health nurse 4) Dietitian
Dietitian The client should be referred to a dietitian, who will help him gain better control of his blood glucose levels. The client can care for himself, so a home health agency isn't necessary. The client shows no signs of needing a psychiatric referral, and referring the client to a psychiatrist isn't in the nurse's scope of practice. Social workers help clients with financial concerns; the scenario doesn't indicate that the client has a financial concern warranting a social worker at this time.
Which combination of adverse effects should a nurse monitor for when administering IV insulin to a client with diabetic ketoacidosis? 1) Hypokalemia and hypoglycemia 2) Hypocalcemia and hyperkalemia 3) Hyperkalemia and hyperglycemia 4) Hypernatremia and hypercalcemia
Hypokalemia and hypoglycemia Blood glucose needs to be monitored in clients receiving IV insulin because of the risk of hyperglycemia or hypoglycemia. Hypoglycemia might occur if too much insulin is administered. Hypokalemia, not hyperkalemia, might occur because I.V. insulin forces potassium into cells, thereby lowering the plasma level of potassium. Calcium and sodium levels aren't affected by IV insulin administration.
A nurse explains to a client that she will administer his first insulin dose in his abdomen. How does absorption at the abdominal site compare with absorption at other sites? 1) Insulin is absorbed rapidly regardless of the injection site. 2) Insulin is absorbed more rapidly at abdominal injection sites than at other sites. 3) Insulin is absorbed more slowly at abdominal injection sites than at other sites. 4) Insulin is absorbed unpredictably at all injection sites.
Insulin is absorbed more rapidly at abdominal injection sites than at other sites. Subcutaneous insulin is absorbed most rapidly at abdominal injection sites, more slowly at sites on the arms, and slowest at sites on the anterior thigh. Absorption after injection in the buttocks is less predictable.
A nurse expects to find which signs and symptoms in a client experiencing hypoglycemia? 1) Nervousness, diaphoresis, and confusion 2) Polydipsia, pallor, and irritability 3) Polyphagia and flushed, dry skin 4) Polyuria, headache, and fatigue
Nervousness, diaphoresis, and confusion 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.
A client has been living with type 2 diabetes for several years, and the nurse realizes that the client is likely to have minimal contact with the health care system. In order to ensure that the client maintains adequate blood sugar control over the long term, what should the nurse recommend? 1) Participation in a support group for persons with diabetes 2) Regular consultation of websites that address diabetes management 3) Weekly telephone "check-ins" with an endocrinologist 4) Participation in clinical trials relating to antihyperglycemics
Participation in a support group for persons with diabetes Participation in support groups is encouraged for clients who have had diabetes for many years as well as for those who are newly diagnosed. This is more interactive and instructive than simply consulting websites. Weekly telephone contact with an endocrinologist is not realistic in most cases. Participation in research trials may or may not be beneficial and appropriate, depending on clients' circumstances.
An older adult patient that has type 2 diabetes comes to the emergency department with second-degree burns to the bottom of both feet and states, "I didn't feel too hot but my feet must have been too close to the heater." What does the nurse understand is most likely the reason for the decrease in temperature sensation? 1) A faulty heater 2) Peripheral neuropathy 3) Autonomic neuropathy 4) Sudomotor neuropathy
Peripheral Neuropathy As the neuropathy progresses, the feet become numb. In addition, a decrease in proprioception (awareness of posture and movement of the body and of position and weight of objects in relation to the body) and a decreased sensation of light touch may lead to an unsteady gait. Decreased sensations of pain and temperature place patients with neuropathy at increased risk for injury and undetected foot infections.
Which clinical characteristic is associated with type 1 diabetes (previously referred to as insulin-dependent diabetes mellitus)? 1) Presence of islet cell antibodies 2) Obesity 3) Requirement for oral hypoglycemic agents 4) Rare ketosis
Presence of islet cell antibodies 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.
A patient has been newly diagnosed with type 2 diabetes, and the nurse is assisting with the development of a meal plan. What step should be taken into consideration prior to making the meal plan? 1) Reviewing the patient's diet history to identify eating habits and lifestyle and cultural eating patterns 2) Making sure that the patient is aware that quantity of foods will be limited 3) Ensuring that the patient understands that some favorite foods may not be allowed on the meal plan and substitutes will need to be found 4) Determining whether the patient is on insulin or taking oral antidiabetic medication
Reviewing the patient's diet history to identify eating habits and lifestyle and cultural eating patterns The first step in preparing a meal plan is a thorough review of the patient's diet history to identify eating habits and lifestyle and cultural eating patterns.
A client with type 2 diabetes normally achieves adequate glycemic control through diet and exercise. Upon being admitted to the hospital for a cholecystectomy, however, the client has required insulin injections on two occasions. The nurse would identify what factor most likely caused for this short-term change in treatment? 1) Stress has likely caused an increase in the client's blood sugar levels. 2) Alterations in bile metabolism and release have likely caused hyperglycemia. 3) The client's efforts did not control the diabetes using nonpharmacologic measures. 4) The client's volatile fluid balance surrounding surgery has likely caused unstable blood sugars.
Stress has likely caused an increase in the client's blood sugar levels. During periods of physiologic stress, such as surgery, blood glucose levels tend to increase because levels of stress hormones (epinephrine, norepinephrine, glucagon, cortisol, and growth hormone) increase. The client's need for insulin is unrelated to the action of bile. The client's normal routine of nonpharmacological strategies of diet and exercise have been changed due to the client's admission to the hospital. Therefore, the client cannot overestimate what they cannot control. Electrolyte/ fluid balances may have some bearing on glucose levels, but stress is the most impactful cause of the change happening to this client.
A nurse is assessing a client who has diabetes for the presence of peripheral neuropathy. The nurse should question the client about what sign or symptom that would suggest the possible development of peripheral neuropathy? 1) Acute pain, unrelieved by rest 2) The presence of a tingling sensation 3) Persistently cold feet 4) Pain that does not respond to analgesia
The presence of a tingling sensation Although approximately half of clients with diabetic neuropathy do not have symptoms, initial symptoms may include paresthesias (prickling, tingling, or heightened sensation) and burning sensations (especially at night). Cold and intense pain are atypical early signs of this complication.
Which statement is correct regarding glargine insulin? 1) Its peak action occurs in 2 to 3 hours. 2) It cannot be mixed with any other type of insulin. 3) It is absorbed rapidly. 4) It is given twice daily.
It cannot be mixed with any other type of insulin. Because this insulin is in a suspension with a pH of 4, it cannot be mixed with other insulins because this would cause precipitation. There is no peak in action. It is approved to give once daily.
Which of the following clients with type 1 diabetes is most likely to experience adequate glucose control? 1) A client who adheres closely to a meal plan and meal schedule 2) A client who eliminates carbohydrates from the daily intake 3) A client who skips breakfast when the glucose reading is greater than 220 mg/dL (12.3 mmol/L) 4) A client who never deviates from the prescribed dose of insulin
A client who adheres closely to a meal plan and meal schedule The therapeutic goal for diabetes management is to achieve normal blood glucose levels without hypoglycemia. Therefore, diabetes management involves constant assessment and modification of the treatment plan by health professionals and daily adjustments in therapy (possibly including insulin) by clients. For clients who require insulin to help control blood glucose levels, maintaining consistency in the amount of calories and carbohydrates ingested at meals is essential. In addition, consistency in the approximate time intervals between meals, and the snacks, helps maintain overall glucose control. Skipping meals is never advisable for person with type 1 diabetes.
A client has received a diagnosis of type 2 diabetes. The diabetes nurse has made contact with the client and will implement a program of health education. What is the nurse's priority action? 1) Ensure that the client understands the basic pathophysiology of diabetes. 2) Identify the client's body mass index. 3) Assess the client's readiness to learn. 4) Teach the client "survival skills" for diabetes.
Assess the client's readiness to learn. Before initiating diabetes education, the nurse assesses the client's (and family's) readiness to learn. This must precede other physiologic assessments (such as BMI) and providing health education.
A client with type 1 diabetes has told the nurse that the client's most recent urine test for ketones was positive. What is the nurse's most plausible conclusion based on this assessment finding? 1) The client should withhold the next scheduled dose of insulin. 2) The client would benefit from a dose of metformin. 3) The client's insulin levels are inadequate. 4) The client should promptly eat some protein and carbohydrates.
The client's insulin levels are inadequate. Ketones in the urine signal that there is a deficiency of insulin and that control of type 1 diabetes is deteriorating. Withholding insulin or eating food would exacerbate the client's ketonuria. Metformin will not cause short-term resolution of hyperglycemia.
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? 1) "Don't worry about what your friends think; the carbohydrates you eat are being quickly digested, increasing your metabolism." 2) "Your body is using protein and fat for energy instead of glucose." 3) "You may be having undiagnosed infections, causing you to lose extra weight." 4) "I will refer you to a dietician who can help you with your weight."
"Your body is using protein and fat for energy instead of glucose." 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.
An agitated, confused client arrives in the emergency department. The client's history includes type 1 diabetes, hypertension, and angina pectoris. Assessment reveals pallor, diaphoresis, headache, and intense hunger. A stat blood glucose sample measures 42 mg/dl, and the client is treated for an acute hypoglycemic reaction. After recovery, the nurse teaches the client to treat hypoglycemia by ingesting: 1) 25 to 30 g of a simple carbohydrate. 2) 18 to 20 g of a simple carbohydrate. 3) 2 to 5 g of a simple carbohydrate. 4) 10 to 15 g of a simple carbohydrate.
10 to 15 g of a simple carbohydrate. To reverse hypoglycemia, the American Diabetes Association recommends ingesting 10 to 15 g of a simple carbohydrate, such as three to five pieces of hard candy, two to three packets of sugar (4 to 6 tsp), or 4 oz of fruit juice. Then the client should check his blood glucose after 15 minutes. If necessary, this treatment may be repeated in 15 minutes. Ingesting only 2 to 5 g of a simple carbohydrate may not raise the blood glucose level sufficiently. Ingesting more than 15 g may raise it above normal, causing hyperglycemia.
The nurse is administering lispro insulin. Based on the onset of action, how long before breakfast should the nurse administer the injection? 1) 10 to 15 minutes 2) 30 to 40 minutes 3) 1 to 2 hours 4) 3 hours
10 to 15 minutes The onset of action of rapid-acting lispro insulin is within 10 to 15 minutes. It is used to rapidly reduce the glucose level
The nurse is discussing macrovascular complications of diabetes with a client. The nurse would address what topic during this dialogue? 1) The need to monitor urine for the presence of albumin 2) The need for frequent eye examinations for clients with diabetes 3) The relationship between kidney function and blood glucose levels 4) The fact that clients with diabetes have an elevated risk of myocardial infarction
The fact that clients with diabetes have an elevated risk of myocardial infarction Myocardial infarction and stroke are considered macrovascular complications of diabetes, while the effects on vision and kidney function are considered to be microvascular.
A patient who is diagnosed with type 1 diabetes would be expected to: 1) Need exogenous insulin. 2) Have no damage to the islet cells of the pancreas. 3) Be restricted to an American Diabetic Association diet. 4) Receive daily doses of a hypoglycemic agent.
Need exogenous insulin Type 1 diabetes is characterized by the destruction of pancreatic beta cells that require exogenous insulin.
A client diagnosed with hyperosmolar hyperglycemic nonketotic syndrome (HHNS) is stabilized and prepared for discharge. When preparing the client for discharge and home management, which statement indicates that the client understands his condition and how to control it? 1) "If I begin to feel especially hungry and thirsty, I'll eat a snack high in carbohydrates." "I can avoid getting sick by not becoming dehydrated and by paying attention to my need to urinate, drink, or eat more than usual." "I will have to monitor my blood glucose level closely and notify the physician if it's constantly elevated." "If I experience trembling, weakness, and headache, I should drink a glass of soda that contains sugar."
"I can avoid getting sick by not becoming dehydrated and by paying attention to my need to urinate, drink, or eat more than usual." The client stating that he'll remain hydrated and pay attention to his eating, drinking, and voiding needs indicates understanding of HHNS. Inadequate fluid intake during hyperglycemic episodes commonly leads to HHNS. By recognizing the signs of hyperglycemia (polyuria, polydipsia, and polyphagia) and increasing fluid intake, the client may prevent HHNS. Drinking a glass of non-diet soda would be appropriate for hypoglycemia. A client whose diabetes is controlled with oral antidiabetic agents usually doesn't need to monitor blood glucose levels. A high-carbohydrate diet would exacerbate the client's condition, particularly if fluid intake is low.
A diabetic educator is discussing "sick day rules" with a newly diagnosed type 1 diabetic. The educator is aware that the client will require further teaching when the client states what? 1) "If I cannot eat a meal, I will eat a soft food such as soup, gelatin, or pudding six to eight times a day." 2) "I will call the doctor if I am not able to keep liquids in my body due to vomiting or diarrhea." 3) "I will call the doctor if my blood sugar is over 300 mg/dL (16.6 mmol/L) or if I have ketones in my urine." 4) "I will not take my insulin on the days when I am sick, but I will certainly check my blood sugar every 2 hours."
"I will not take my insulin on the days when I am sick, but I will certainly check my blood sugar every 2 hours." The nurse must explain the "sick day rules" again to the client who plans to stop taking insulin when sick. The nurse should emphasize that the client should take insulin agents as usual and test the blood sugar and urine ketones every 3 to 4 hours. In fact, insulin-requiring clients may need supplemental doses of regular insulin every 3 to 4 hours. The client should report elevated glucose levels (greater than 300 mg/dL or 16.6 mmol/L, or as otherwise instructed) or urine ketones to the health care provider. If the client is not able to eat normally, the client should be instructed to substitute with soft foods such a gelatin, soup, and pudding. If vomiting, diarrhea, or fever persists, the client should have an intake of liquids every 30 to 60 minutes to prevent dehydration.
A nurse is observing a newly diagnosed client with diabetes mellitus administer an insulin injection. Which site will the nurse advise the client to predominantly use? 1) abdomen 2) thighs 3) upper arms 4) buttocks
Abdomen Clients with diabetes are taught to use the abdomen for self-administration of insulin.
A client is admitted to the health care center with abdominal pain, nausea, and vomiting. The medical reports indicate a history of type 1 diabetes. The nurse suspects the client's symptoms to be those of diabetic ketoacidosis (DKA). Which action will help the nurse confirm the diagnosis? 1) Assess the client's ability to take a deep breath 2) Assess for excessive sweating 3) Assess the client's breath odor 4) Assess the client's ability to move all extremities
Assess the client's breath odor DKA is commonly preceded by a day or more of polyuria, polydipsia, nausea, vomiting, and fatigue, with eventual stupor and coma if not treated. The breath has a characteristic fruity odor due to the presence of ketoacids. Checking the client's breath will help the nurse confirm the diagnosis.
Which of the following is a characteristic of diabetic ketoacidosis (DKA)? Select all that apply. 1) Absent ketones 2) Normal arterial pH level 3) Rapid onset 4) Elevated blood urea nitrogen (BUN) and creatinine 5) More common in type 1 diabetes
Elevated blood urea nitrogen (BUN) and creatinine Rapid onset More common in type 1 diabetes DKA is characterized by an elevated BUN and creatinine, rapid onset, and it is more common in type 1 diabetes. Hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is characterized by the absence of urine and serum ketones and a normal arterial pH level.
A diabetes nurse educator is teaching a group of clients with type 1 diabetes about "sick day rules." What guideline applies to periods of illness in a diabetic client? 1) Report elevated glucose levels greater than 150 mg/dL (8.3 mmol/L). 2) Do not eliminate insulin when nauseated and vomiting. 3) Reduce food intake and insulin doses in times of illness. 4) Eat three substantial meals a day, if possible.
Do not eliminate insulin when nauseated and vomiting. The most important issue to teach clients with diabetes who become ill is not to eliminate insulin doses when nausea and vomiting occur. Rather, they should take their usual insulin or oral hypoglycemic agent dose, and then attempt to consume frequent, small portions of carbohydrates. In general, blood sugar levels will rise but should be reported if they are greater than 300 mg/dL (16.6 mmol/L).
Which information should be included in the teaching plan for a client receiving glargine, which is "peakless" basal insulin? 1) Do not mix with other insulins. 2) Administer the total daily dosage in 2 doses. 3) Draw up the drug first, then add regular insulin. 4) Glargine is rapidly absorbed and has a fast onset of action.
Do not mix with other insulins Because glargine is in a suspension with a pH of 4, it cannot be mixed with other insulins because this would cause precipitation. Glargine is a "peakless" basal insulin that is absorbed very slowly over a 24-hour period and can be given once a day. When administering glargine insulin it is very important to read the label carefully and to avoid mistaking Lantus insulin for Lente insulin and vice versa.
A nurse is providing health education to a teenage client newly diagnosed with type 1 diabetes mellitus, as well as the client's family. The nurse teaches the client and family nonpharmacologic measures that will decrease the body's need for insulin. What measure provides the greatest impact on glucose reduction? 1) Low stimulation 2) Low-fat diet 3) Exercise 4) Adequate sleep
Exercise Exercise lowers blood glucose, increases levels of HDLs, and decreases total cholesterol and triglyceride levels. Low-fat intake and low levels of stimulation do not reduce a client's need for insulin. Adequate sleep is beneficial in reducing stress, but does not have an effect that is pronounced as that of exercise.
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? 1) Glycosylated hemoglobin level 2) Glucose via a urine dipstick test 3) Glucose via an oral glucose tolerance test 4) Fasting blood glucose level
Glycosylated hemoglobin level 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.
A client with diabetes mellitus is receiving an oral antidiabetic agent. The nurse observes for which condition when caring for this client? 1) Hypoglycemia 2) Polyuria 3) Blurred vision 4) Polydipsia
Hypoglycemia The nurse should observe the client receiving an oral antidiabetic agent for 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 nurse is assessing a client who is receiving total parenteral nutrition (TPN). Which finding suggests that the client has developed hyperglycemia? 1) Cheyne-Stokes respirations 2) Increased urine output 3) Diaphoresis 4) Decreased appetite
Increased urine output Glucose supplies most of the calories in TPN; if the glucose infusion rate exceeds the client's rate of glucose metabolism, hyperglycemia arises. When the renal threshold for glucose reabsorption is exceeded, osmotic diuresis occurs, causing an increased urine output. A decreased appetite and diaphoresis suggest hypoglycemia, not hyperglycemia. Cheyne-Stokes respirations are characterized by a period of apnea lasting 10 to 60 seconds, followed by gradually increasing depth and frequency of respirations. Cheyne-Stokes respirations typically occur with cerebral depression or heart failure.
A nurse is caring for a client with type 1 diabetes who is being discharged home tomorrow. What is the best way to assess the client's ability to prepare and self-administer insulin? 1) Review the client's first hemoglobin A1C result after discharge. 2) Observe the client drawing up and administering the insulin. 3) Provide a health education session reviewing the main points of insulin delivery. 4) Ask the client to describe the process in detail.
Observe the client drawing up and administering the insulin Nurses should assess the client's ability to perform diabetes-related self-care as soon as possible during the hospitalization or office visit to determine whether the client requires further diabetes teaching. While consulting a home care nurse is beneficial, an initial assessment should be performed during the hospitalization or office visit. Nurses should directly observe the client performing the skills such as insulin preparation and infection, blood glucose monitoring, and foot care. Simply questioning the client about these skills without actually observing performance of the skill is not sufficient. Further education does not guarantee learning.
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? 1) Serum sodium level 2) Arterial blood gas (ABG) values 3) Serum potassium level 4) Serum osmolarity
Serum osmolarity 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 nurse is preparing to administer two types of insulin to a client with diabetes mellitus. What is the correct procedure for preparing this medication? 1) The intermediate-acting insulin is withdrawn before the short-acting insulin. 2) If administered immediately, there is no requirement for withdrawing one type of insulin before another. 3) Different types of insulin are not to be mixed in the same syringe. 4) The short-acting insulin is withdrawn before the intermediate-acting insulin.
The short-acting insulin is withdrawn before the intermediate-acting insulin. When combining two types of insulin in the same syringe, the short-acting regular insulin is withdrawn into the syringe first and the intermediate-acting insulin is added next. This practice is referred to as "clear to cloudy."
The greatest percentage of people have which type of diabetes? 1) Gestational 2) Type 1 3) Impaired glucose tolerance 4) Type 2
Type 2 Type 2 diabetes accounts for 90% to 95% of all diabetes. Type 1 accounts for 5% to 10% of all diabetes. Gestational diabetes has an onset during pregnancy. Impaired glucose tolerance is defined as an oral glucose tolerance test value between 140 mg/dL and 200 mg/dL.
A visiting nurse is setting up an insulin schedule for an older adult who has diabetes mellitus. What should the nurse consider when determining the dosing time? 1) cognitive problems 2) client's history 3) client's ability to self-administer insulin 4) client's eating and sleeping habits
client's eating and sleeping habits The eating and sleeping habits of older adults differ from those of young or middle-aged persons. The nurse should consider the client's eating and sleeping habits when planning meals and selecting the proper type and dosage of insulin or oral hypoglycemic agent.
