Chapter 46: Assessment and Management of Patients with Diabetes
A client with type 1 diabetes is admitted to an acute care facility with diabetic ketoacidosis. To correct this acute diabetic emergency, which measure should the health care team take first?
Initiate fluid replacement therapy.
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?
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 client receives a daily injection of glargine insulin at 7:00 a.m. When should the nurse monitor this client for a hypoglycemic reaction?
This insulin has no peak action and does not cause a hypoglycemic reaction.
Which information should be included in the teaching plan for a client receiving glargine, which is "peakless" basal insulin?
Do not mix with other insulins.
Which instruction about insulin administration should a nurse give to a client?
"Always follow the same order when drawing the different insulins into the syringe."
During a routine medical evaluation, a client is found to have a random blood glucose level of 210 mg/dL. Which client statement(s) made by the client are concerning to the nurse? Select all that apply.
"At times my vision is blurry." "I have to void nearly every hour." "I cannot seem to quench my thirst." "I have lost 10 pounds without even trying.
A newly admitted client with a diagnosis of type 1 diabetes asks the nurse what caused their diabetes. When the nurse is explaining to the client the etiology of type 1 diabetes, what process should the nurse describe?
"Destruction of special cells in the pancreas causes a decrease in insulin production. Glucose levels rise because insulin normally breaks it down."
Which statement indicates that a client with diabetes mellitus understands proper foot care?
"I'll wear cotton socks with well-fitting shoes."
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:
"I'm going to give your son some insulin. Then I'll be happy to talk with you."
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?
"Ketones will tell us if your body is using other tissues for energy."
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?
"Rotate injection sites within the same anatomic region, not among different regions."
Which instruction should a nurse give to a client with diabetes mellitus when teaching about "sick day rules"?
"Test your blood glucose every 4 hours."
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?
"Your body is using protein and fat for energy instead of glucose."
A physician orders blood glucose levels every 4 hours for a 4-year-old child with brittle type 1 diabetes. The parents are worried that drawing so much blood will traumatize their child. How can the nurse best reassure the parents?
"Your child will need less blood work as his glucose levels stabilize."
The nurse is administering lispro insulin. Based on the onset of action, how long before breakfast should the nurse administer the injection?
10 to 15 minutes
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:
15 to 20 g of a fast-acting carbohydrate such as orange juice.
A nurse knows to assess a patient with type 1 diabetes for postprandial hyperglycemia. The nurse knows that glycosuria is present when the serum glucose level exceeds:
180 mg/dL
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:
8:30 AM.
A client newly diagnosed with type 1 diabetes has an unusual increase in blood glucose from bedtime to morning. The physician suspects the client is experiencing insulin waning. Based on this diagnosis, the nurse expects which change to the client's medication regimen?
Administering a dose of intermediate-acting insulin before the evening meal
A child is brought into the emergency department with vomiting, drowsiness, and blowing respirations. The child's parent reports that the symptoms have been progressing throughout the day. The nurse suspects diabetic ketoacidosis (DKA). Which action should the nurse take first in the management of DKA?
Begin fluid replacements.
Which clinical characteristic is associated with type 2 diabetes (previously referred to as non-insulin-dependent diabetes mellitus)?
Blood glucose can be controlled through diet and exercise
A client is admitted with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which laboratory finding should the nurse expect in this client?
Blood glucose level 1,100 mg/dl
A client is diagnosed with diabetes mellitus. Which assessment finding best supports a nursing diagnosis of Ineffective coping related to diabetes mellitus?
Crying whenever diabetes is mentioned
Which of the following is a characteristic of diabetic ketoacidosis (DKA)? Select all that apply.
Elevated blood urea nitrogen (BUN) and creatinine Rapid onset More common in type 1 diabetes
The nurse is taking the history of a client with diabetes who is experiencing autonomic neuropathy. Which would the nurse expect the client to report?
Erectile dysfunction
Which is the best nursing explanation for the symptom of polyuria in a client with diabetes mellitus?
High sugar pulls fluid into the bloodstream, which results in more urine production.
A nurse is providing education to a client who is newly diagnosed with diabetes mellitus. What are classic symptoms associated with diabetes?
Increased thirst, hunger, and urination
For a client with hyperglycemia, which assessment finding best supports a nursing diagnosis of Deficient fluid volume?
Increased urine osmolarity
A nurse is assessing a client who is receiving total parenteral nutrition (TPN). Which finding suggests that the client has developed hyperglycemia?
Increased urine output
The client who is managing diabetes through diet and insulin control asks the nurse why exercise is important. Which is the best response by the nurse to support adding exercise to the daily routine?
Increases ability for glucose to get into the cell and lowers blood sugar
The nurse is preparing a presentation for a group of adults at a local community center about diabetes. Which of the following would the nurse include as associated with type 2 diabetes?
Insulin production insufficient
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?
It carries glucose into body cells.
Which type of insulin acts most quickly?
Lispro
The nurse is preparing to administer intermediate-acting insulin to a patient with diabetes. Which insulin will the nurse administer?
NPH
A nurse expects to find which signs and symptoms in a client experiencing hypoglycemia?
Nervousness, diaphoresis, and confusion
Which clinical characteristic is associated with type 1 diabetes (previously referred to as insulin-dependent diabetes mellitus)?
Presence of islet cell antibodies
Lispro (Humalog) is an example of which type of insulin?
Rapid-acting
A client is admitted to the unit with diabetic ketoacidosis (DKA). Which insulin would the nurse expect to administer intravenously?
Regular
What is the only insulin that can be given intravenously?
Regular
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?
Reviewing the patient's diet history to identify eating habits and lifestyle and cultural eating patterns
The client with diabetes asks the nurse why shoes and socks are removed at each office visit. The nurse gives which assessment finding as the explanation for the inspection of feet?
Sensory neuropathy
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?
Serum glycosylated hemoglobin (Hb A1c)
Insulin is a hormone secreted by the Islets of Langerhans and is essential for the metabolism of carbohydrates, fats, and protein. The nurse understands the physiologic importance of gluconeogenesis, which refers to the:
Synthesis of glucose from noncarbohydrate sources.
Which of the following factors would a nurse identify as a most likely cause of diabetic ketoacidosis (DKA) in a client with diabetes?
The client has eaten and has not taken or received insulin.
The greatest percentage of people have which type of diabetes?
Type 2
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?
Underlying problem of insulin resistance
A client with a 30-year history of type 2 diabetes is having an annual physical and blood work. Which test result would the physician be most concerned with when monitoring the client's treatment compliance?
glycosylated hemoglobin
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:
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:
glycosylated hemoglobin level.
A client with type 1 diabetes asks the nurse about taking an oral antidiabetic agent. The nurse explains that these medications are effective only if the client:
has type 2 diabetes.
Which is a characteristic of type 2 diabetes?
insulin resistance
What is the duration of regular insulin?
4 to 6 hours
NPH is an example of which type of insulin?
Intermediate-acting
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?
"Diet, exercise, and weight loss can eliminate the need for medication."
A client is evaluated for type 1 diabetes. Which client comment correlates best with this disorder?
"I'm thirsty all the time. I just can't get enough to drink."
Which statement is correct regarding glargine insulin?
It cannot be mixed with any other type of insulin.
After teaching a client with type 1 diabetes who is scheduled to undergo an islet cell transplant, which client statement indicates successful teaching?
"I might need insulin later on but probably not as much or as often."
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?
"I skip lunch when I don't feel hungry."
A nurse is teaching a client recovering from diabetic ketoacidosis (DKA) about management of "sick days." The client asks the nurse why it is important to monitor the urine for ketones. Which statement is the nurse's best response?
"Ketones accumulate in the blood and urine when fat breaks down in the absence of insulin. Ketones signal an insulin deficiency that will cause the body to start breaking down stored fat for energy."
A patient who is 6 months' pregnant was evaluated for gestational diabetes mellitus. The doctor considered prescribing insulin based on the serum glucose result of:
138 mg/dL, 2 hours postprandial.
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:
10 to 15 g of a simple carbohydrate.
A nurse is preparing a continuous insulin infusion for a child with diabetic ketoacidosis and a blood glucose level of 800 mg/dl. Which solution is the most appropriate at the beginning of therapy?
100 units of regular insulin in normal saline solution
A nurse is teaching a client with diabetes mellitus about self-management of his condition. The nurse should instruct the client to administer 1 unit of insulin for every:
15 g of carbohydrates.
Glycosylated hemoglobin reflects blood glucose concentrations over which period of time?
3 months
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?
6.5%
Which statement is true regarding gestational diabetes?
A glucose challenge test should be performed between 24 and 28 weeks.
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?
Accuracy of the dosage
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?
Assess the client's breath odor
The nurse is reviewing the initial laboratory test results of a client diagnosed with DKA. Which of the following would the nurse expect to find?
Blood pH of 6.9
The nurse is educating the patient with diabetes about the importance of increasing dietary fiber. What should the nurse explain is the rationale for the increase? Select all that apply.
May improve blood glucose levels Decrease the need for exogenous insulin Help reduce cholesterol levels
A client's blood glucose level is 45 mg/dl. The nurse should be alert for which signs and symptoms?
Coma, anxiety, confusion, headache, and cool, moist skin
A client with a serum glucose level of 618 mg/dl is admitted to the facility. He's awake and oriented, has hot dry skin, and has the following vital signs: temperature of 100.6° F (38.1° C), heart rate of 116 beats/minute, and blood pressure of 108/70 mm Hg. Based on these assessment findings, which nursing diagnosis takes highest priority?
Deficient fluid volume related to osmotic diuresis
Which information should be included in the teaching plan for a client receiving glargine, a "peakless" basal insulin?
Do not mix with other insulins.
Which assessment finding is most important in determining nursing care for a client with diabetes mellitus?
Fruity breath
A nurse is teaching a client with type 1 diabetes how to treat adverse reactions to insulin. To reverse hypoglycemia, the client ideally should ingest an oral carbohydrate. However, this treatment isn't always possible or safe. Therefore, the nurse should advise the client to keep which alternate treatment on hand?
Glucagon
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?
Glycosylated hemoglobin level
A client with diabetes mellitus is receiving an oral antidiabetic agent. The nurse observes for which condition when caring for this client?
Hypoglycemia
When the nurse is caring for a patient with type 1 diabetes, what clinical manifestation would be a priority to closely monitor?
Hypoglycemia
Which combination of adverse effects should a nurse monitor for when administering IV insulin to a client with diabetic ketoacidosis?
Hypokalemia and hypoglycemia
The nurse is educating the client with diabetes on setting up a sick plan to manage blood glucose control during times of minor illness such as influenza. Which is the most important teaching item to include?
Increase frequency of glucose self-monitoring.
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?
Increased hunger
The nurse is preparing a presentation for a group of adults at a local community center about diabetes. Which characteristic would the nurse inform the group is associated with type 2 diabetes?
Insulin resistance or insufficient insulin production
Which is a by-product of fat breakdown in the absence of insulin and accumulates in the blood and urine?
Ketones
A patient is diagnosed with type 1 diabetes. What clinical characteristics does the nurse expect to see in this patient? Select all that apply.
Ketosis-prone Little or no endogenous insulin Younger than 30 years of age
A client with diabetes is receiving an oral anti diabetic agent that acts to help the tissues use available insulin more efficiently. Which of the following agents would the nurse expect to administer?
Metformin
A client with diabetes is receiving an oral antidiabetic agent that acts to help the tissues use available insulin more efficiently. Which of the following agents would the nurse expect to administer?
Metformin
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?
Regular
After being sick for 3 days, a client with a history of diabetes mellitus is admitted to the hospital with diabetic ketoacidosis (DKA). The nurse should evaluate which diagnostic test results to prevent dysrhythmias?
Serum potassium level
A client with status asthmaticus requires endotracheal intubation and mechanical ventilation. Twenty-four hours after intubation, the client is started on the insulin infusion protocol. The nurse must monitor the client's blood glucose levels hourly and watch for which early signs and symptoms associated with hypoglycemia?
Sweating, tremors, and tachycardia
A client is diagnosed with diabetes mellitus. The client reports visiting the gym regularly and is a vegetarian. Which of the following factors is important to consider when the nurse assesses the client?
The client's consumption of carbohydrates
The pancreas continues to release a small amount of basal insulin overnight, while a person is sleeping. The nurse knows that if the body needs more sugar:
The pancreatic hormone glucagon will stimulate the liver to release stored glucose.
A nurse educator been invited to local seniors center to discuss health-maintaining strategies for older adults. The nurse addresses the subject of diabetes mellitus, its symptoms, and consequences. What should the educator teach the participants about type 1 diabetes?
The participants are unlikely to develop a new onset of type 1 diabetes.
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?
The short-acting insulin is withdrawn before the intermediate-acting insulin.
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?
They increase the need for insulin.
The nurse understands that a client with diabetes mellitus is at greater risk for developing which of the following complications?
Urinary tract infections
A client with diabetes mellitus is receiving an oral antidiabetic agent. When caring for this client, the nurse should observe for signs of:
hypoglycemia
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?
ketoacidosis
A client has been recently diagnosed with type 2 diabetes, and reports continued weight loss despite increased hunger and food consumption. This condition is called:
polyphagia.
A nurse is assigned to care for a postoperative client with diabetes mellitus. During the assessment interview, the client reports that he's impotent and says he's concerned about the effect on his marriage. In planning this client's care, the most appropriate intervention would be to:
suggest referral to a sex counselor or other appropriate professional.