CH.51 - Diabetes PrepU ?'s

A client with diabetes mellitus is receiving an oral antidiabetic agent. Which of the following aspects should the nurse observe when caring for this client? a) Signs of hypoglycemia b) Polyuria c) Polydipsia d) Blurred vision

a) Signs of hypoglycemia

During a follow-up visit 3 months following a new diagnosis of type 2 diabetes, a patient reports exercising and following a reduced-calorie diet. Assessment reveals that the patient has only lost 1 pound and did not bring the glucose-monitoring record. Which of the following tests will the nurse plan to obtain? a) Oral glucose tolerance test b) Fasting blood glucose level c) Glycosylated hemoglobin level d) Urine dipstick for glucose

c) Glycosylated hemoglobin level --- Glycosylated hemoglobin is a blood test that reflects average blood glucose levels over a period of approximately 2 to 3 months. When blood glucose levels are 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 glycated hemoglobin level becomes.

After taking glipizide (Glucotrol) for 9 months, a client experiences secondary failure. What should the nurse expect the physician to do? a) Restrict carbohydrate intake to less than 30% of the total caloric intake. b) Switch the client to a different oral antidiabetic agent. c) Initiate insulin therapy. d) Order an additional oral antidiabetic agent.

b) Switch the client to a different oral antidiabetic agent --- The nurse should anticipate that the physician will order a different oral antidiabetic agent. Many clients (25% to 60%) who take glipizide respond to a different oral antidiabetic agent. Therefore, it wouldn't be appropriate to initiate insulin therapy at this time. However, if a new oral antidiabetic agent is unsuccessful in keeping glucose levels at an acceptable level, insulin may be used in addition to the antidiabetic agent. Restricting carbohydrate intake isn't necessary.

A client with type 1 diabetes presents with a decreased level of consciousness and a fingerstick glucose level of 39 mg/dl. His family reports that he has been skipping meals in an effort to lose weight. Which nursing intervention is most appropriate? a) Inserting a feeding tube and providing tube feedings b) Observing the client for 1 hour, then rechecking the fingerstick glucose level c) Administering 1 ampule of 50% dextrose solution, per physician's order d) Administering a 500-ml bolus of normal saline solution

c) Administering 1 ampule of 50% dextrose solution, per physician's order

A 6 months' pregnant patient was evaluated for gestational diabetes mellitus. The doctor considered prescribing insulin based on the serum glucose result of: a) 90 mg/dL before meals. b) 120 mg/dL, 1 hour postprandial. c) 80 mg/dL, 1 hour postprandial. d) 138 mg/dL, 2 hours postprandial.

d) 138 mg/dL, 2 hours postprandial.

When administering insulin to a client with type 1 diabetes, which of the following would be most important for the nurse to keep in mind? a) Area for insulin injection b) Duration of the insulin c) Technique for injecting d) Accuracy of the dosage

d) Accuracy of the dosage

A client is taking glyburide (DiaBeta), 1.25 mg P.O. daily, to treat type 2 diabetes. Which statement indicates the need for further client teaching about managing this disease? a) "I skip lunch when I don't feel hungry." b) "I avoid exposure to the sun as much as possible." c) "I always wear my medical identification bracelet." d) "I always carry hard candy to eat in case my blood sugar level drops."

a) "I skip lunch when I don't feel hungry."

A controlled type 2 diabetic client states, "The doctor said if my blood sugars remain stable, I may not need to take any medication." Which response by the nurse is most appropriate? a) "Diet, exercise, and weight loss can eliminate the need for medication." b) "You will be placed on a strict low-sugar diet for better control." c) "You misunderstood the doctor. Let's ask for clarification." d) "Some doctors do not treat blood sugar elevation until symptoms appear."

a) "Diet, exercise, and weight loss can eliminate the need for medication."

A nurse is preparing to administer insulin to a child who's just been diagnosed with type 1 diabetes. When the child's mother stops the nurse in the hall, she's crying and anxious to talk about her son's condition. The nurse's best response is: a) "I'm going to give your son some insulin. Then I'll be happy to talk with you." b) "Everything will be just fine. I'll be back in a minute and then we can talk." c) "If you'll wait in your son's room, the physician will talk with you as soon as he's free." d) "I can't talk now. I have to give your son his insulin as soon as possible."

a) "I'm going to give your son some insulin. Then I'll be happy to talk with you."

A nurse is caring for a client with diabetes mellitus. The client has a blood glucose level of 40 mg/dL. Which of the following rapidly absorbed carbohydrate would be most effective? a) 1/2 cup fruit juice or regular soft drink b) 1/2 tbsp honey or syrup c) Three to six LifeSavers candies d) 4 oz of skim milk

a) 1/2 cup fruit juice or regular soft drink --- 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.

The nurse is describing the action of insulin in the body to a client newly diagnosed with type 1 diabetes. Which of the following would the nurse explain as being the primary action? a) It enhances transport of glucose across the cell wall. b) It decreases the intestinal absorption of glucose. c) It aids in the process of gluconeogenesis. d) It stimulates the pancreatic beta cells.

a) It enhances transport of glucose across the cell wall.

A 53-year-old client is brought to the ED, via squad, where you practice nursing. He is demonstrating fast, deep, labored breathing and has a fruity odor to his breath. He has a history of type 1 diabetes. What could be the cause of his current serious condition? a) Ketoacidosis b) Hyperosmolar hyperglycemic nonketotic syndrome c) All options are correct d) Hepatic disorder

a) Ketoacidosis

The nurse is explaining glycosylated hemoglobin testing to a diabetic client. Which of the following provides the best reason for this order? a) Reflects the amount of glucose stored in hemoglobin over past several months. b) Provides best information on the body's ability to maintain normal blood functioning c) Is less costly than performing daily blood sugar test d) Best indicator for the nutritional state of the client

a) Reflects the amount of glucose stored in hemoglobin over past several months.

A client with diabetes mellitus has a prescription for 5 units of U-100 regular insulin and 25 units of U-100 isophane insulin suspension (NPH) to be taken before breakfast. At about 4:30 p.m., the client experiences headache, sweating, tremor, pallor, and nervousness. What is the most probable cause of these signs and symptoms? a) Serum glucose level of 52 mg/dl b) Serum calcium level of 8.9 mg/dl c) Serum calcium level of 10.2 mg/dl d) Serum glucose level of 450 mg/dl

a) Serum glucose level of 52 mg/dl

The nurse is administering lispro (Humalog) insulin. Based on the onset of action, how soon should the nurse administer the injection prior to breakfast? a) 30 to 40 minutes b) 10 to 15 minutes c) 3 hours d) 1 to 2 hours

b) 10 to 15 minutes

A client with diabetes comes to the clinic for a follow-up visit. The nurse reviews the client's glycosylated hemoglobin test results. Which result would indicate to the nurse that the client's blood glucose level has been well controlled? a) 8.5% b) 6.5% c) 8.0% d) 7.5%

b) 6.5% ---- Normally the level of glycosylated hemoglobin is less than 7%. Thus a level of 6.5% would indicate that the client's blood glucose level is well-controlled. According to the American Diabetes Association, a glycosylated hemoglobin of 7% is equivalent to an average blood glucose level of 150 mg/dL. Thus, a level of 7.5% would indicate less control. Amount of 8% or greater indicate that control of the client's blood glucose level has been inadequate during the previous 2 to 3 months.

A nurse is caring for a diabetic patient with a diagnosis of nephropathy. What would the nurse expect the urinalysis report to indicate? a) White blood cells b) Albumin c) Red blood cells d) Bacteria

b) Albumin --- Albumin is one of the most important blood proteins that leak into the urine. Although small amounts may leak undetected for years, its leakage into the urine 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 (Chart 51-10). The urine should be checked annually for the presence of microalbumin

Which of the following are byproducts of fat breakdown, which accumulate in the blood and urine? a) Creatinine b) Ketones c) Cholesterol d) Hemoglobin

b) Ketones

A nurse is teaching a patient recovering from diabetic ketoacidosis (DKA) about management of "sick days." The patient asks the nurse why it is important to monitor the urine for ketones. Which of the following statements 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) Ketones accumulate in the blood and urine when fat breaks down. Ketones signal a deficiency of insulin that will cause the body to start to break down stored fat for energy. c) Excess glucose in the blood is metabolized by the liver and turned into ketones, which are an acid. d) When the body does not have enough insulin hyperglycemia occurs. Excess glucose is broken down by the liver, causing acidic byproducts to be released.

b) Ketones accumulate in the blood and urine when fat breaks down. Ketones signal a deficiency of insulin that will cause the body to start to break down stored fat for energy --- Ketones (or ketone bodies) are byproducts of fat breakdown, and they accumulate in the blood and urine. Ketones in the urine signal a deficiency of insulin and control of type 1 diabetes is deteriorating. When almost no effective insulin is available, the body starts to break down stored fat for energy.

An older adult patient that has diabetes type 2 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? a) Autonomic neuropathy b) Peripheral neuropathy c) A faulty heater d) Sudomotor neuropathy

b) Peripheral neuropathy

The nurse is administering an insulin drip to a patient in ketoacidosis. What insulin does the nurse know is the only one that can be used intravenously? a) Lispro b) Regular c) Lantus d) NPH

b) Regular

A nurse is explaining the action of insulin to a client with diabetes mellitus. During client teaching, the nurse reviews the process of insulin secretion in the body. The nurse is correct when she states that insulin is secreted from the: a) alpha cells of the pancreas. b) beta cells of the pancreas. c) adenohypophysis. d) parafollicular cells of the thyroid.

b) beta cells of the pancreas.

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? a) "I will have to monitor my blood glucose level closely and notify the physician if it's constantly elevated." b) "If I experience trembling, weakness, and headache, I should drink a glass of soda that contains sugar." c) "I can avoid getting sick by not becoming dehydrated and by paying attention to my need to urinate, drink, or eat more than usual." d) "If I begin to feel especially hungry and thirsty, I'll eat a snack high in carbohydrates.

c) "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 nondiet 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.

Every morning, a client with type 1 diabetes receives 15 units of Humulin 70/30. What does this type of insulin contain? a) 70 units of regular insulin and 30 units of NPH insulin b) 70% regular insulin and 30% NPH insulin c) 70% NPH insulin and 30% regular insulin d) 70 units of neutral protamine Hagedorn (NPH) insulin and 30 units of regular insulin

c) 70% NPH insulin and 30% regular insulin

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) 2:30 PM. b) 12:30 PM. c) 8:30 AM. d) 10:30 AM.

c) 8:30 AM

A client with type 1 diabetes presents with a decreased level of consciousness and a fingerstick glucose level of 39 mg/dl. His family reports that he has been skipping meals in an effort to lose weight. Which nursing intervention is most appropriate? a) Observing the client for 1 hour, then rechecking the fingerstick glucose level b) Administering a 500-ml bolus of normal saline solution c) Administering 1 ampule of 50% dextrose solution, per physician's order d) Inserting a feeding tube and providing tube feedings

c) Administering 1 ampule of 50% dextrose solution, per physician's order

Matt Thompson, a 37-year-old farmer, has been diagnosed with pre diabetes. Following his visit with his primary care provider, you begin your client education session to discuss treatment strategies. What can be the consequences of untreated pre diabetes? a) Cardiac disease b) CVA c) All options are correct. d) Type 2 diabetes

c) All options are correct. --- The NIDDK has developed criteria that identify people with prediabetes, which can lead to type 2 diabetes, heart disease, and stroke.

A diabetic 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? a) Eat a meal or snack every 8 hours. b) Check blood sugar at least every 24 hours. c) Always carry a form of fast-acting sugar. d) Perform exercise prior to eating whenever possible.

c) Always carry a form of fast-acting sugar.

A patient 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 patient's symptoms to be that of diabetic ketoacidosis (DKA). Which of the following actions will help the nurse confirm the diagnosis? a) Assessing the patient's ability to take a deep breath b) Assessing for excessive sweating c) Assessing the patient's breath odor d) Assessing the patient's ability to move all extremities

c) Assessing the patient'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 patient's breath will help the nurse confirm the diagnosis.

The nurse is discussing the new medication that a client will be taking for treatment of rheumatoid arthritis. Which disease-modifying antirheumatic drug (DMARD) will the nurse educate the client about? a) Infliximab (Remicade) b) Methylprednisolone (Medrol) c) Methotrexate (Rheumatrex) d) Etanercept (Enbrel)

c) Methotrexate (Rheumatrex) --- Methotrexate is a DMARD that reduces the amount of joint damage and slows the damage to other tissues as well. Etanercept and Infliximab are TNF-alpha inhibitors that reduce pain and inflammation. Methylprednisolone is a steroid to reduce pain and inflammation and slow joint destruction.

The diabetic client asks the nurse why shoes and socks are removed at each office visit. Which assessment finding is most significant in determining the protocol for inspection of feet? a) Nephropathy b) Retinopathy c) Sensory neuropathy d) Autonomic neuropathy

c) Sensory neuropathy --- Neuropathy results from poor glucose control and decreased circulation to nerve tissues. Neuropathy involving sensory nerves located in the periphery can lead to lack of sensitivity, which increases the potential for soft tissue injury without client awareness. The feet are inspected on each visit to insure no injury or pressure has occurred. Autonomic neuropathy, retinopathy, and nephropathy affect nerves to organs other than feet.

A male client, aged 42 years, is diagnosed with diabetes mellitus. He visits the gym regularly and is a vegetarian. Which of the following factors is important when assessing the client? a) The client's mental and emotional status b) The client's exercise routine c) The client's consumption of carbohydrates d) History of radiographic contrast studies that used iodine

c) The client's consumption of carbohydrates

A client with newly diagnosed type 2 diabetes is admitted to the metabolic unit. The primary goal for this admission is education. Which goal should the nurse incorporate into her teaching plan? a) Maintenance of blood glucose levels between 180 and 200 mg/dl b) An eye examination every 2 years until age 50 c) Weight reduction through diet and exercise d) Smoking reduction but not complete cessation

c) Weight reduction through diet and exercise

The nurse is teaching a patient about self-administration of insulin and mixing of regular and neutral protamine Hagedorn (NPH) insulin. Which of the following is important to include in the teaching plan? a) There is no longer a need to inject air into the bottle of insulin before insulin is withdrawn. b) When mixing insulin, the NPH insulin is drawn up into the syringe first. c) When mixing insulin, the regular insulin is drawn up into the syringe first. d) If two different types of insulin are ordered, they need to be given in separate injections.

c) When mixing insulin, the regular insulin is drawn up into the syringe first.

During a class on exercise for clients with diabetes mellitus, a client asks the nurse educator how often to exercise. To meet the goals of planned exercise, the nurse educator should advise the client to exercise: a) at least five times per week. b) at least once per week. c) at least three times per week. d) every day.

c) at least three times per week.

A client tells the nurse that she has been working hard for the past 3 months to control her type 2 diabetes with diet and exercise. To determine the effectiveness of the client's efforts, the nurse should check: a) urine glucose level. b) serum fructosamine level. c) glycosylated hemoglobin level. d) fasting blood glucose level.

c) glycosylated hemoglobin level.

After teaching a client with type 1 diabetes, who is scheduled to undergo an islet cell transplant, which client statement indicates successful teaching? a) "I will receive a whole organ with extra cells to produce insulin." b) "This transplant will provide me with a cure for my diabetes." c) "They'll need to create a connection from the pancreas to allow enzymes to drain." d) "I might need insulin later on but probably not as much or as often."

d) "I might need insulin later on but probably not as much or as often." --- Transplanted islet cells tend to lose their ability to function over time, and approximately 70% of recipients resume insulin administration in 2 years. However, the amount of insulin and the frequency of its administration are reduced because of improved control of blood glucose levels. Thus, this type of transplant doesn't cure diabetes. It requires the use of two human pancreases to obtain sufficient numbers of islet cells for transplantation. A whole organ transplant requires a means for exocrine enzyme drainage and venous absorption of insulin.

A nurse has been caring for a client newly diagnosed with diabetes mellitus. The client is overwhelmed by what he's facing and not sure he can handle giving himself insulin. This client has been discharged and the charge nurse is insisting the nurse hurry because she needs the space for clients being admitted. How should the nurse handle the situation? a) Tell the charge nurse she doesn't believe this client will be safe and refuse to rush. b) Ask the physician for a referral for a diabetes nurse-educator to see the client before discharge. c) Suggest the client find a supportive friend or family member to assist in his care. d) Ask the physician to delay the discharge because the client requires further teaching.

d) Ask the physician to delay the discharge because the client requires further teaching. --- The nurse's primary concern should be the safety of the client after discharge. She should provide succinct information to the physician concerning the client's needs, express her concern about ensuring the client's safety, and ask the physician to delay the client's discharge. The nurse shouldn't suggest that the client rely on a friend or family member because she doesn't know if a friend or family member will be available to help. Refusing to rush and telling the charge nurse she isn't sure the client will be safe demonstrate appropriate intentions, but these actions don't alleviate the pressure to discharge the client. Asking a physician to refer the client to a diabetic nurse-educator addresses the client's needs, but isn't the best response because there's no guarantee a diabetic nurse-educator will be available on such short notice.

A client is admitted with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which laboratory finding should the nurse expect in this client? a) Arterial pH 7.25 b) Blood urea nitrogen (BUN) 15 mg/dl c) Plasma bicarbonate 12 mEq/L d) Blood glucose level 1,100 mg/dl

d) Blood glucose level 1,100 mg/dl --- HHNS occurs most frequently in older clients. It can occur in clients with either type 1 or type 2 diabetes mellitus but occurs most commonly in those with type 2. The blood glucose level rises to above 600 mg/dl in response to illness or infection. As the blood glucose level rises, the body attempts to rid itself of the excess glucose by producing urine. Initially, the client produces large quantities of urine. If fluid intake isn't increased at this time, the client becomes dehydrated, causing BUN levels to rise. Arterial pH and plasma bicarbonate levels typically remain within normal limits

Which of the following should be included in the teaching plan for a patient receiving glargine (Lantus),"peakless" basal insulin? a) It is rapidly absorbed, has a fast onset of action. b) Draw up the drug first, then add regular insulin. c) Administer the total daily dosage in two doses. d) Do not mix with other insulins.

d) Do not mix with other insulin --- Because glargine is in a suspension with a pH of 4, it cannot be mixed with other insulins because this would cause precipitation. When administering glargine (Lantus) insulin it is very important to read the label carefully and to avoid mistaking Lantus insulin for Lente insulin and vice versa.

Which of the following would be included in the teaching plan for a patient diagnosed with diabetes mellitus? a) The only diet change needed in the treatment of diabetes is to stop eating sugar. b) Sugar is found only in dessert foods. c) Once insulin injections are started in the treatment of type 2 diabetes, they can never be discontinued. d) Elevated blood glucose levels contribute to complications of diabetes, such as diminished vision.

d) Elevated blood glucose levels contribute to complications of diabetes, such as diminished vision.

A patient who is diagnosed with type 1 diabetes would be expected to: a) Be restricted to an American Diabetic Association diet. b) Receive daily doses of a hypoglycemic agent. c) Have no damage to the islet cells of the pancreas. d) Need exogenous insulin.

d) Need exogenous insulin. --- Type 1 diabetes is characterized by the destruction of pancreatic beta cells that require exogenous insulin.

As a nurse educator, you have been invited to your local senior center to discuss health-maintaining strategies for older adults. During your education session on nutrition, you approach the subject of diabetes mellitus, its symptoms, and consequences. One of the women in your lecture group asks if you know the death rate from diabetes mellitus. What is your response? a) Ninth cause of death in the United States b) Tenth cause of death in the United States c) Fifth cause of death in the United States d) Seventh cause of death in the United States

d) Seventh cause of death in the United States

A client with diabetes mellitus develops sinusitis and otitis media accompanied by a temperature of 100.8° F (38.2° C). What effect do these findings have on his need for insulin? a) They decrease the need for insulin. b) They cause wide fluctuations in the need for insulin. c) They have no effect. d) They increase the need for insulin.

d) They increase the need for insulin.

A client has type 1 diabetes. Her husband finds her unconscious at home and administers glucagon, 0.5 mg subcutaneously. She awakens in 5 minutes. Why should her husband offer her a complex carbohydrate snack as soon as possible? a) To stimulate her appetite b) To decrease the amount of glycogen in her system c) To decrease the possibility of nausea and vomiting d) To restore liver glycogen and prevent secondary hypoglycemia

d) To restore liver glycogen and prevent secondary hypoglycemia

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) Need for lifelong immunosuppressive therapy b) Need for exocrine enzymatic drainage c) Increased risk for urologic complications d) Underlying problem of insulin resistance

d) Underlying problem of insulin resistance --- 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 developing a teaching plan for a client with diabetes mellitus. A client with diabetes mellitus should: a) use commercial preparations to remove corns. b) walk barefoot at least once each day. c) cut the toenails by rounding edges. d) wash and inspect the feet daily.

d) wash and inspect the feet daily.