Chapter 51: Assessment and Management of Patients With Diabetes

The nurse is preparing to administer intermediate-acting insulin to a patient with diabetes. Which insulin will the nurse administer? NPH Iletin II Lispro (Humalog) Glargine (Lantus)

1

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

2

Which clinical manifestation of type 2 diabetes occurs if glucose levels are very high? Hyperactivity Blurred vision Oliguria Increased energy

2

A hospitalized, insulin-dependent patient with diabetes has been experiencing morning hyperglycemia. The patient will be awakened once or twice during the night to test blood glucose levels. The health care provider suspects that the cause is related to the Somogyi effect. Which of the following indicators support this diagnosis? Select all that apply. Normal bedtime blood glucose Rise in blood glucose about 3:00 AM Increase in blood glucose from 3:00 AM until breakfast Decrease in blood sugar to a hypoglycemic level between 2:00 to 3:00 AM Elevated blood glucose at bedtime

1,3,4

A nurse is providing dietary instructions to a client with hypoglycemia. To control hypoglycemic episodes, the nurse should recommend: 1. increasing saturated fat intake and fasting in the afternoon. 2. increasing intake of vitamins B and D and taking iron supplements. 3. eating a candy bar if light-headedness occurs. 4. consuming a low-carbohydrate, high-protein diet and avoiding fasting.

4

A client is receiving insulin lispro at 7:30 AM. The nurse ensures that the client has breakfast by which time? 1- 7:45 AM 2- 8:00 AM 3- 8:15 AM 4- 8:30 AM

1

Insulin is secreted by which of the following types of cells? Beta cells Melanocytes Neural cells Basal cells

1

What is the duration of regular insulin? 1- 4 to 6 hours 2- 3 to 5 hours 3- 12 to 16 hours 4- 24 hours

1

Which statement is correct regarding glargine insulin? Its peak action occurs in 2 to 3 hours. It cannot be mixed with any other type of insulin. It is absorbed rapidly. It is given twice daily.

2

Every morning, a client with type 1 diabetes receives 15 units of Humulin 70/30. What does this type of insulin contain? 1- 70 units of neutral protamine Hagedorn (NPH) insulin and 30 units of regular insulin 2- 70 units of regular insulin and 30 units of NPH insulin 3- 70% NPH insulin and 30% regular insulin 4- 70% regular insulin and 30% NPH insulin

3

The nurse practitioner worked with a registered dietitian to customize a 1,800-calorie diabetic diet for a 53-year-old man with special dietary needs. Which of the following percent distribution of calories should be provided? Carbohydrates 35%, fat 10%, and protein 5% Carbohydrates 40%, fat 15%, and protein 10% Carbohydrates 45%, fat 20%, and protein 15% Carbohydrates 50%, fat 25%, and protein 20%

4

Which assessment finding is most important in determining nursing care for a client with diabetes mellitus? 1- Respirations of 12 breaths/minute 2- Cloudy urine 3- Blood sugar 170 mg/dL 4- Fruity breath

4

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.

1

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 continues medication therapy despite adequate food intake. The client has not consumed sufficient calories. The client has been exercising more than usual. The client has eaten and has not taken or received insulin.

4

Which statement indicates that a client with diabetes mellitus understands proper foot care? "I'll schedule an appointment with my physician if my feet start to ache." "I'll rotate insulin injection sites from my left foot to my right foot." "I'll go barefoot around the house to avoid pressure areas on my feet." "I'll wear cotton socks with well-fitting shoes."

4

Which intervention is essential when performing dressing changes on a client with a diabetic foot ulcer? Applying a heating pad Debriding the wound three times per day Using sterile technique during the dressing change Cleaning the wound with a povidone-iodine solution

3

A nurse is teaching a diabetic support group about the causes of type 1 diabetes. The teaching is determined to be effective when the group is able to attribute which factor as a cause of type 1 diabetes? Presence of autoantibodies against islet cells Obesity Rare ketosis Altered glucose metabolism

1

Lispro (Humalog) is an example of which type of insulin? 1- Rapid-acting 2- Intermediate-acting 3- Short-acting 4- Long-acting

1

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? Fasting blood glucose level Glucose via a urine dipstick test Glycosylated hemoglobin level Glucose via an oral glucose tolerance test

3

The nurse expects that a type 1 diabetic patient may receive what percentage of his or her usual morning dose of insulin preoperatively? 10% to 20% 25% to 40% 50% to 60% 85% to 90%

3

A client with type 1 diabetes mellitus is receiving short-acting insulin to maintain control of blood glucose levels. In providing glucometer instructions, the nurse would instruct the client to use which site for most accurate findings? Finger Upper arm Thigh Forearm

1

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

1

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. The intermediate-acting insulin is withdrawn before the short-acting insulin. Different types of insulin are not to be mixed in the same syringe. If administered immediately, there is no requirement for withdrawing one type of insulin before another.

1

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 Creates an overall feeling of well-being and lowers risk of depression Decreases need for pancreas to produce more cells Decreases risk of developing insulin resistance and hyperglycemia

1

An obese Hispanic client, age 65, is diagnosed with type 2 diabetes. Which statement about diabetes mellitus is true? 1- Nearly two-thirds of clients with diabetes mellitus are older than age 60. 2- Diabetes mellitus is more common in Hispanics and Blacks than in Whites. 3- Type 2 diabetes mellitus is less common than type 1 diabetes mellitus. 4- Approximately one-half of the clients diagnosed with type 2 diabetes are obese.

2

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: 1- encourage the client to ask questions about personal sexuality. 2- provide time for privacy. 3- provide support for the spouse or significant other. 4- suggest referral to a sex counselor or other appropriate professional.

4

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 are formed when insufficient insulin leads to cellular starvation. As cells rupture, they release these acids into the blood." "When the body does not have enough insulin, hyperglycemia occurs. Excess glucose is broken down by the liver, causing acidic by-products to be released." "Excess glucose in the blood is metabolized by the liver and turned into ketones, which are an acid." "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."

4

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: 90 mg/dL before meals. 120 mg/dL, 1 hour postprandial. 80 mg/dL, 1 hour postprandial. 138 mg/dL, 2 hours postprandial.

4

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

4

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 Kussmaul's respirations, dry skin, hypotension, and bradycardia Polyuria, polydipsia, hypotension, and hypernatremia Polyuria, polydipsia, polyphagia, and weight loss

1

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. 10:30 AM. 12:30 PM. 2:30 PM.

1

A client with diabetes mellitus has a blood glucose level of 40 mg/dL. Which rapidly absorbed carbohydrate would be mosteffective? 1/2 cup fruit juice or regular soft drink 4 oz of skim milk 1/2 tbsp honey or syrup three to six LifeSavers candies

1

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 Dry skin, bradycardia, and somnolence Bradycardia, thirst, and anxiety Polyuria, polydipsia, and polyphagia

1

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 Increased weight loss, dehydration, and fatigue Loss of appetite, increased urination, and dehydration Increased weight gain, appetite, and thirst

1

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? 1- "Your child will need less blood work as his glucose levels stabilize." 2- "Your child is young and will soon forget this experience." 3- "I'll see if the physician can reduce the number of blood draws." 4- "Our laboratory technicians use tiny needles and they're really good with children."

1

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 Serum calcium level Serum sodium level Serum chloride level

1

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? 1- It carries glucose into body cells. 2- It aids in the process of gluconeogenesis. 3- It stimulates the pancreatic beta cells. 4- It decreases the intestinal absorption of glucose.

1

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. Insulin will be released to facilitate the transport of sugar. Glycogenesis will be decreased by the liver. The process of gluconeogenesis will be inhibited.

1

A nurse is assessing a client who is receiving total parenteral nutrition (TPN). Which finding suggests that the client has developed hyperglycemia? Cheyne-Stokes respirations Increased urine output Decreased appetite Diaphoresis

2

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- Home health nurse 2- Dietitian 3- Psychiatrist 4- Social worker

2

An older adult patient is in the hospital being treated for sepsis related to a urinary tract infection. The patient has started to have an altered sense of awareness, profound dehydration, and hypotension. What does the nurse suspect the patient is experiencing? Systemic inflammatory response syndrome Hyperglycemic hyperosmolar syndrome Multiple-organ dysfunction syndrome Diabetic ketoacidosis

2

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: 1- at least once per week. 2- at least three times per week. 3- at least five times per week. 4- every day.

2

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? 1- Duration of the insulin 2- Accuracy of the dosage 3- Area for insulin injection 4- Technique for injecting

2

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? "I will refer you to a dietician who can help you with your weight." "You may be having undiagnosed infections, causing you to lose extra weight." "Your body is using protein and fat for energy instead of glucose." "Don't worry about what your friends think; the carbohydrates you eat are being quickly digested, increasing your metabolism."

3

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

3

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 have no effect. They decrease the need for insulin. They increase the need for insulin. They cause wide fluctuations in the need for insulin.

3

A client with type 1 diabetes has a highly elevated glycosylated hemoglobin (Hb) test result. In discussing the result with the client, the nurse is most accurate in stating: "The test must be repeated following a 12-hour fast." "It looks like you aren't following the ordered diabetic diet." "It tells us about your sugar control for the last 3 months." "Your insulin regimen must be altered significantly."

3

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? Inserting a feeding tube and providing tube feedings Administering a 500-ml bolus of normal saline solution Administering 1 ampule of 50% dextrose solution, per physician's order Observing the client for 1 hour, then rechecking the fingerstick glucose level

3

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 more slowly at abdominal injection sites than at other sites. 2- Insulin is absorbed rapidly regardless of the injection site. 3- Insulin is absorbed more rapidly at abdominal injection sites than at other sites. 4- Insulin is absorbed unpredictably at all injection sites.

3

A nurse is preparing the daily care plan for a client with newly diagnosed diabetes mellitus. The priority nursing concern for this client should be: 1- monitoring blood glucose every 4 hours and as needed. 2- checking for the presence of ketones with each void. 3- providing client education at every opportunity. 4- administering insulin routinely and as needed via a sliding scale.

3

A nurse obtains a fingerstick glucose level of 45 mg/dl on a client newly diagnosed with diabetes mellitus. The client is alert and oriented, and the client's skin is warm and dry. How should the nurse intervene? Give the client 4 oz of milk and a graham cracker with peanut butter. Obtain a serum glucose level. Obtain a repeat fingerstick glucose level. Notify the physician.

3

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- Fasting blood glucose test 2- 6-hour glucose tolerance test 3- Serum glycosylated hemoglobin (Hb A1c) 4- Urine ketones

3

Which instruction should a nurse give to a client with diabetes mellitus when teaching about "sick day rules"? 1- "Don't take your insulin or oral antidiabetic agent if you don't eat." 2- "It's okay for your blood glucose to go above 300 mg/dl while you're sick." 3- "Test your blood glucose every 4 hours." 4- "Follow your regular meal plan, even if you're nauseous."

3

Which statement is true regarding gestational diabetes? It occurs in the majority of pregnancies. Onset usually occurs in the first trimester. A glucose challenge test should be performed between 24 to 28 weeks. There is a low risk for perinatal complications.

3

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 potassium level 2. Serum sodium level 3. Arterial blood gas (ABG) values 4. Serum osmolarity

4

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- Rare ketosis 4- Requirement for oral hypoglycemic agents

1

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

1

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." "Shake the vials before withdrawing the insulin." "Store unopened vials of insulin in the freezer at temperatures well below freezing." "Discard the intermediate-acting insulin if it appears cloudy."

1

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 May reduce postprandial glucose levels Increase potassium levels

1,2,3

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- "Inject insulin into healthy tissue with large blood vessels and nerves." 2- "Rotate injection sites within the same anatomic region, not among different regions." 3- "Administer insulin into areas of scar tissue or hypertrophy whenever possible." 4- "Administer insulin into sites above muscles that you plan to exercise heavily later that day."

2

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

3