Concepts - Metabolism - Diabetes

A nurse is reinforcing teaching about self-care with a child who has type 1 diabetes mellitus. The nurse should identify which of the following statements by the child indicates understanding? 1 - "I should skip breakfast when I am not hungry." 2 - "I should increase my insulin with exercise 3 - "I should drink a glass of milk when I am feeling irritable." 4 - "I should draw up the NPH insulin into the syringe before the regular insulin."

3 - "I should drink a glass of milk when I am feeling irritable."

A nurse is providing teaching to a school-age child who has a new diagnosis of type 1 diabetes mellitus. Which of the following statements by the child indicates a need for additional teaching? 1 - "I will test my blood sugar before meals and at bedtime." 2 - "I should eat a snack before I play soccer." 3 - "I should not take my regular insulin when I am sick." 4 - "I will rotate injections sites within my abdominal area."

3 - "I should not take my regular insulin when I am sick." Rational 1 - A client who depends on insulin administration must manage glucose levels to prevent hypoglycemia and hyperglycemia. The client who has type 1 diabetes mellitus relies on self-administration of insulin every day because the beta cells of the client's pancreas produce little or no insulin. The goals of treatment are to maintain near-normal glucose levels of fewer than 126 mg/dL and glycosylated hemoglobin of 7% or lower. Hypoglycemia is a blood glucose level lower than 70 mg/dL. 2 - Exercise is encouraged and should not be restricted. Exercise lowers blood glucose levels. The child should eat a snack prior to the activity and, if the exercise is prolonged, the child may require a snack during the activity. Regular exercise aids in the utilization of food and often results in a reduction of insulin requirements. 3- During illness, the body requires more energy to fight the illness. A child who has type 1 diabetes mellitus experiences hyperglycemia during illness. Blood glucose levels are unpredictable during illness, especially when the client is unable to eat due to nausea, vomiting or diarrhea. Diligent glucose monitoring is essential in managing glycemic control. Insulin dosage is regulated by testing blood glucose and urine ketone levels. Diabetic ketoacidosis is frequently associated with dehydration from vomiting and diarrhea. During sick days, the child is encouraged to monitor glucose levels more frequently than on healthy days and adjust insulin doses as needed. 4 - The client should rotate injection sites to prevent injury to the skin and underlying tissue. Repeated insulin injected at the same site can harden the skin, weaken fatty subcutaneous tissue, and damage nerve endings. This would prevent absorption of the insulin and have an impact on the management of blood glucose levels. The focus of type 1 diabetes mellitus is insulin replacement, diet, and exercise. A rotation pattern enhances absorption.

A nurse receives a new prescription from the provider that reads "Give regular insulin 14 units and NPH insulin 28 units subcutaneously at breakfast." How many syringes should the nurse prepare?

1 Rational The nurse may mix regular insulin and NPH insulin in the same syringe because they are compatible; therefore, to minimize injury the nurse should administer the insulin with the least number of injections and use only one syringe.

A nurse is reinforcing teaching about self-administration of insulin with a parent of a school-age child who has a new diagnosis of diabetes mellitus. Which of the following statements by the parent indicates a need for further teaching? 1 - "I will be sure my child aspirates before injecting the insulin." 2 - "The insulin can be injected anywhere there is adipose tissue." 3 - "I will be sure my child rotates sites after five injections to one area." 4- "The insulin should be injected at a 90-degree angle."

1 - "I will be sure my child aspirates before injecting the insulin." Rational 1- It is not necessary to aspirate before injecting the insulin; therefore, this statement by the parent indicates a need for further teaching. 2 - Insulin can be administered subcutaneously anywhere there is adipose tissue. 3 - The child should rotate to a new insulin injection site after five injections in one area. 4 - Insulin should be administered subcutaneously at a 90° angle.

A nurse is reinforcing teaching with a client who has diabetes mellitus about the manifestations of hypoglycemia. Which of the following statements by the client indicates an understanding of the teaching? 1 - "I will feel shaky." 2 - "I will be more thirsty than usual." 3 - "My skin will be warm and moist." 4 - "My appetite will be decreased."

1 - "I will feel shaky." Rational 1 - This statement by the client indicates an understanding of the teaching as feeling shaky is a manifestation of hypoglycemia. 2 - Increased thirst is a manifestation of hyperglycemia. 3 - Warm, moist skin is a manifestation of hyperglycemia. A client who has hypoglycemia will experience cool, clammy skin. 4 - Hunger is a manifestation of hypoglycemia.

A nurse is reinforcing teaching for a client who is taking metformin XR for type II diabetes mellitus. Which of the following information should the nurse include in the teaching? 1 - "Take the medication with a meal" 2 - "You may crush or chew the medication." 3 - "This medication can cause an increase in perspiration." 4 - "This medication can turn your urine orange."

1 - "Take the medication with a meal" Rational 1- The client should take metformin with a meal to avoid hypoglycemia and gastrointestinal upset. 2 - The client should take the medication whole. 3 - Metformin does not cause an increase in perspiration. Sweating can indicate a hypoglycemic reaction. 4 - Metformin does not alter the color of urine.

A nurse is educating the parents of a child who has a new diagnosis of Prader-Willi Syndrome (PWS) and has been prescribed somatropin. Which of the following statements by a parent indicated understanding of the teaching? 1 - "We will use a different spot for injections each time we give the medication." 2 - "We'll give the shot in the thigh muscle rather than fatty tissue to decrease injection pain." 3 - "We'll watch our child for sings of low blood sugar while using somatropin." 4 - "We should stop the medication if our child loses weight."

1 - "We will use a different spot for injections each time we give the medication." Rational 1 - To avoid atrophy of the tissue, administration of somatropin includes rotating the injection site each time. The nurse should identify this statement as an understanding of somatropin administration. 2 - The parents should administer the somatropin injection subcutaneously rather than intramuscularly to decrease pain. This does not alter drug effectiveness. 3 - Growth hormone administration can cause diabetes mellitus and can increase the occurrence of hyperglycemia for clients who have diabetes. The parents should closely monitor the child for polyphagia, polydipsia, and polyuria while on growth hormone therapy 4 - A heathy loss of weight in clients who are taking somatropin is not a concern. Pediatric clients who have PWS and are taking growth hormone must be weighed often to assess for weight gain that could become problematic. Obesity is a contraindication for using somatropin for clients who have PWS.

A nurse administers pramlintide at 0800 to a client who has type 1 diabetes mellitus. At which of the following times should the nurse expect the drug to exert its peak action. 1 - 0820 2 - 0900 3 - 1030 4 - 1100

1 - 0820 Rational 1 - Pramlintide, an amylin mimetic, peaks 20 min after administration. The nurse should monitor the client for indications of hypoglycemia, such as diaphoresis and tremors. 2 - Pramlintide, an amylin mimetic, is unlikely to cause severe hypoglycemia 1 hr after administration. Aspart insulin is an injectable hypoglycemic drug that can exert its peak action at that time. 3 - Pramlintide, an amylin mimetic, is unlikely to cause severe hypoglycemia 2.5 hr after administration. Regular insulin is an injectable hypoglycemic drug that can exert its peak action at that time. 4 - Pramlintide, an amylin mimetic, is unlikely to cause severe hypoglycemia 3 hr after administration. Regular insulin is an injectable hypoglycemic drug that can exert its peak action at that time.

A nurse is caring for a client who has type 1 diabetes mellitus and observes mild hand tremors. Which of the following snacks should the nurse offer the client after obtaining a glucometer reading of 60 mg/dL? 1 - 4 oz of regular soda 2 - one to two oral glucose tablets 3 - three to four pieces of hard candy 4 - 6 oz of milk

1 - 4 oz of regular soda

A nurse is teaching a client who has a prescription for glipizide therapy to treat type 2 diabetes mellitus. Which of the following instructions should the nurse include? 1 - Avoid drinking alcohol 2 - Sit or stand for 30 min after take the drug 3 - Urinate every 4 hr 4 - Take the drug 2 hr after a meal

1 - Avoid drinking alcohol Rational 1 - The nurse should instruct the client to avoid drinking alcohol. Alcohol can interact with glipizide, a sulfonylurea, causing nausea, palpitations, and flushing. Alcohol also increases the drug's hypoglycemic effects. 2 - Glipizide, a sulfonylurea, is unlikely to cause esophagitis. However, it can cause gastrointestinal distress with heartburn. 3 - Glipizide, a sulfonylurea, is unlikely to cause urinary retention. However, it can cause diarrhea. Clients who develop this adverse reaction should maintain hydration by drinking plenty of electrolyte-rich fluids. 4 - Glipizide, a sulfonylurea, helps control hyperglycemia caused by type 2 diabetes mellitus. The client should take the drug 30 min before the first meal of the day.

The nursing assistant tells you that a patient with diabetes has a blood glucose level of 60 mg/dL. What symptoms would the nurse be most likely to observe with this glucose level? 1 - Confusion, tremulousness, pallor, sweating, and weakness 2 - Dry, flushed skin and mild irritability 3 - Deep, rapid breathing and abdominal pain 4 - Incoherent moaning, combativeness, and seizure activity.

1 - Confusion, tremulousness, pallor, sweating, and weakness Rational Confusion, tremulousness, pallor, sweating, and weakness are the most likely symptoms. Incoherent moaning, combativeness, and seizure activity might occur if the nurse fails to intervene quickly. Dry, flushed skin is symptomatic of hyperglycemia. Irritability could be present to high or low glucose levels. Deep rapid breathing and abdominal pain are signs of hyperglycemia.

A patient with diabetes is admitted to the emergency department with complaints of lack of feeling, yet debilitating pain in his legs and feet, constipation, and sexual impotence. These symptoms most closely correlate with which disorder? 1 - Diabetic neuropathy 2 - Diabetic retinopathy 3 - Diabetic ketoacidosis 4 - Diabetic nephropathy

1 - Diabetic neuropathy Rational When a patient has diabetic neuropathy, the peripheral nerves are affected, causing lack of feeling, yet debilitating pain in the legs and feet, constipation, and sexual impotence. Diabetic retinopathy is visual impairment, including possible blindness, from diabetes. Diabetic ketoacidosis symptoms may be polyuria, fatigue, anorexia, abdominal pain, and a fruity smell to the breath. Diabetic nephropathy occurs from changes in the renal blood circulation.

A nurse is reviewing a client's medication history. The client has an admission blood glucose of 260 mg/dL and no documented history of diabetes mellitus. Which of the following types of medications should alert the nurse to the possibility that the client has developed an adverse effect of pharmacological therapy? (Select all) 1 - Diuretics 2 - Corticosteroids 3 - Oral anticoagulants 4 - Opioid analgesics 5 - Antipsychotics

1 - Diuretics 2 - Corticosteroids 5 - Antipsychotics Rational 3 - Anticoagulants can cause excessive bleeding during blood sampling for glucose testing 4 - Opioid analgesics cause many adverse effects, including respiratory depression, but they are unlikely to raise blood glucose levels.

A nurse is teaching a client about acarbose therapy to treat type 2 diabetes mellitus. Which of the following instructions should the nurse include? 1 - Eat more iron-rich foods 2 - Avoid drinking grapefruit juice 3 - Increase fiber intake 4 - Avoid drinking green tea

1 - Eat more iron-rich foods Rational 1 - Acarbose, an alpha-glucosidase inhibitor, can cause iron-deficiency anemia. The nurse should instruct the client to increase their intake of iron-rich foods, such as red meat, spinach, and grains. The nurse should also monitor the client's CBC. 2 - Grapefruit juice is unlikely to alter the effects of acarbose, an alpha-glucosidase inhibitor. More than 1 L of grapefruit juice per day can increase the hypoglycemic effects of repaglinide, a meglitinide. 3 - Acarbose, an alpha-glucosidase inhibitor, is unlikely to cause constipation. It can cause diarrhea and flatulence. Metformin can worsen the gastrointestinal effects of the drug. 4 - Green tea is unlikely to alter the effects of acarbose, an alpha-glucosidase inhibitor. Green tea can increase the hypoglycemic effects of pioglitazone, another endocrine-system drug.

A nurse is reinforcing teaching about manifestations of hypoglycemia with an adolescent who has type 1 diabetes mellitus. Which of the following manifestations should the nurse include in the teaching? 1 - Headache 2 - Acetone breath 3 - Rapid respirations 4 - Diminished reflexes

1 - Headache Rational 1 - A headache is a manifestation of hypoglycemia. Other manifestations of hypoglycemia include nervousness, dizziness, tachycardia, and sweating. 2 - Acetone breath is a manifestation of hyperglycemia. A client who has hypoglycemia will have a normal breath odor. 3 - Rapid respirations, or Kussmaul breathing, is a manifestation of hyperglycemia. A client who has hypoglycemia will have shallow breathing 4 - Diminished reflexes is a sign of hyperglycemia. A client who has hypoglycemia will have tremors.

A nurse at a provider's office is assessing a client who has been taking hydrocortisone for adrenal insufficiency. The client reports fatigue and feeling overwhelmed by personal responsibilities. Which of the following findings should the nurse identify as an indication the provider might need to increase the client's dosage? 1 - Hypotension 2 - Hyperglycemia 3 - Weight gain 4 - Fat redistribution

1 - Hypotension Rational 1 - Hypotension and fatigue are findings of adrenal insufficiency. During times of stress, the client might need a dosage increase to prevent adrenal insufficiency. The nurse should report the findings to the provider. 2 - The nurse should identify hypoglycemia as an indication that the client's dosage is too low. 3 - The nurse should identify weight loss as an indication that the client's dosage is too low. 4 - Fat redistribution or a moon face appearance are Cushingoid findings. The nurse should identify fat redistribution as an indication that the client's dosage is too high.

A nurse is caring for a client who is taking metformin to treat type 2 diabetes mellitus and reports muscle pain. Which of the following adverse reactions should the nurse suspect? 1 - Lactic acidosis 2 - Anticholinergic effects 3 - Extrapyramidal effects 4 - Hypophosphatemia

1 - Lactic acidosis Rational 1 - Metformin, a biguanide, can cause lactic acidosis, which is a life-threatening complication that manifests as muscle aches, sleepiness, malaise, and hyperventilation. The client should stop taking the drug and seek medical care immediately. 2 - Metformin, a biguanide, is unlikely to cause anticholinergic effects, but it can cause nausea, diarrhea, and anorexia. The nurse should inform the client that these effects should diminish with continued therapy. 3 - Metformin, a biguanide, is unlikely to cause extrapyramidal effects, but it can cause dizziness and fatigue. 4 - Metformin, a biguanide, is unlikely to cause hypophosphatemia, but it can cause vitamin B12 or folic acid deficiencies, which would manifest as weakness, fatigue, pallor, or a reddened tongue

A nurse is collecting data from a client who has diabetes mellitus. Which of the following indicates that the client is experiencing DKA? 1 - Polydipsia 2 - Clammy skin 3 - Confusion 4 - Rapid pulse

1 - Polydipsia Rational 1 - Polydipsia, or increased thirst, is a manifestation of DKA. 2 - Clammy skin a manifestation of hypoglycemia. 3 - Confusion is a manifestation of hypoglycemia. 4 - Rapid pulse is a manifestation of hypoglycemia.

A nurse is reinforcing teaching about insulin injections with a client who is newly diagnosed with type 1 diabetes mellitus. Which of the following information should the nurse include about site selection? 1 - Rotate the injection site to keep insulin levels consistent 2 - Use cold insulin for injection to minimize site pain 3 - Insulin is absorbed most rapidly when injected in the thigh. 4 - Massage the site after injection to promote absorption.

1 - Rotate the injection site to keep insulin levels consistent Rational 1 - The nurse should educate the client to rotate injection sites in the same anatomic area to decrease lipoatrophy, which is a loss of fat under the skin in the area of the injections. 2 - The nurse should instruct the client to warm the insulin to room temperature to minimize injection pain. 3 - The nurse should inform the client that insulin is absorbed most rapidly from the abdominal tissue. It is absorbed a little slower from the arms, then the thighs, with the buttocks being the site of slowest absorption. 4 - The nurse should instruct the client not to massage the injection site because it can decrease insulin absorption.

A nurse is reinforcing teaching with a client who has a new prescription for metformin. The nurse should instruct the client to report which of the following manifestations as an adverse effect of metformin? 1 - Somnolence 2 - Constipation 3 - Fluid retention 4 - Weight gain

1 - Somnolence

A nurse is caring for a client who has capillary blood glucose 48 mg/dL. Which of the following findings should the nurse expect? 1 - Tremors 2 - Flushed skin 3 - Bradycardia 4 - Decreased appetite

1 - Tremors Rational 1 - This finding is below the expected reference range. Hypoglycemic effects on the autonomic nervous system include tremors, irritability, and anxiety. 2 - This finding is below the expected reference range. The nurse should expect the client to have pale skin. 3 - This finding is below the expected reference range. The nurse should expect the client to have tachycardia. 4 - This finding is below the expected reference range. The nurse should expect the client to report hunger.

A nurse is caring for a client who has gestational diabetes and reports feeling shaky, sweaty, and having blurred vision. The client's blood glucose level is 48 mg/dL. Which of the following foods should the nurse give to the client? (Select all) 1 - 120 mL unsweetened fruit juice 2 - 1 tbsp honey 3 - 5 hard candies 4 - 240 mL regular soda 5 - 120 mL milk

1, 2, & 3 Rational 120 mL of unsweetened fruit juice is correct.It is appropriate for the nurse to give 120 mL of unsweetened fruit juice, which contains 10 to 15 g of simple carbohydrate, to the client to treat hypoglycemia. 1 tbsp honey is correct. It is appropriate for the nurse to give 1 tbsp of honey, which contains 10 to 15 g of simple carbohydrates, to the client to treat hypoglycemia. 5 hard candies is correct. Five to six hard candies contain 10 to 15 g of simple carbohydrates and are appropriate for the nurse to give to the client to treat hypoglycemia. 240 mL regular soda is incorrect. The nurse should not give the client 240 mL of regular soda, as this provides 20 to 30 g of simple carbohydrates, which can lead to a rebound hypoglycemia. The nurse should give the client 120 mL of regular soda, which has 10 to 15 g of simple carbohydrate. 120 mL milk is incorrect. The nurse should not give the client 120 mL of milk as this does not provide a sufficient amount of simple carbohydrates to treat hypoglycemia. The nurse should give 420 mL of milk in order to administer 10 to 15 g of simple carbohydrates.

A nurse is providing teaching to a client who is about to begin exenatide therapy to treat type 2 diabetes mellitus. Which of the following instructions should the nurse include? (Select all) 1 - Inject the drug subcutaneously 2 - Expect the peak effect in 2 hr 3 - Use the drug as a supplement to an oral hypoglycemic 4 - Inject the drug 1 hr after a meal 5 - Discard used pens 10 days after the first use

1, 2, & 3 Rational Inject the drug subcutaneously is correct. The client should inject exenatide, an incretin mimetic, into the subcutaneous tissue of the thigh, upper arm, or abdomen. Expect the peak effect in 2 hr is correct. Levels of exenatide peak 2 hr after administration and then decrease gradually, with a half-life of 2.4 hr. Use the drug as a supplement to an oral hypoglycemic is correct. Exenatide supplements the action of an oral hypoglycemic, such as a sulfonylurea or metformin. Inject the drug 1 hr after a meal is incorrect. The client should inject exenatide twice per day up to 60 min prior to the morning and evening meals, rather than after a meal. Discard used pens 10 days after the first use is incorrect. The client can keep prefilled exenatide injector pens in use at room temperature for up to 30 days.

A nurse is providing teaching to a client about taking fludrocortisone to treat adrenocortical insufficiency. Which of the following instructions should the nurse include? (Select all) 1 - Obtain weight measurement daily 2 - Report weakness or palpitations 3 - Have blood pressure checked regularly 4 - Eat more iron-rich foods 5 - Avoid drinking grapefruit juice

1, 2, & 3 Rational Obtain weight measurement daily is correct. Fludrocortisone, a mineralocorticoid, can cause fluid and electrolyte imbalances, such as hypernatremia. Tracking weight on a daily basis can help identify weight gain and edema; reporting it can expedite any essential interventions. Report weakness or palpitations is correct. Fludrocortisone can cause hypokalemia. The nurse should monitor the client's potassium levels and tell the client to report muscle weakness or palpitations. Have blood pressure checked regularly is correct. Fludrocortisone can cause fluid retention and hypertension. The nurse should monitor the client's fluid balance and blood pressure to expedite any essential interventions. Eat more iron-rich foods is incorrect. Fludrocortisone does not cause iron-deficiency anemia. However, it can cause thrombocytopenia. Avoid drinking grapefruit juice is incorrect. Grapefruit juice is unlikely to alter the effects of fludrocortisone.

People with diabetes may face several eye problems and diseases as a complication of their illness. Which of the following can cause sever vision loss or blindness in a person with diabetes (Select all) 1 - Glaucoma 2 - Retinopathy 3 - Presbyopia 4 - Cataracts

1, 2, & 4 Rational Diabetics may face a group of eye diseases, including (1) glaucoma, (4) cataracts, and (2) retinopathy. While diabetics may also experience (3) presbyopia, it is not associated with blindness and diabetics are not at increased risk.

A nurse is determining a client's ability to learn self monitoring of blood glucose using a glucometer. Which of the following abilities should the nurse confirm that the client has before proceeding with instructions (Select all) 1 - Finger dexterity 2 - Visual acuity 3 - Color vision 4 - Basic literacy 5 - Demonstration ability

1, 2, & 5 1 - Finger dexterity 2 - Visual acuity 5 - Demonstration ability Rational 3 - client who has color blindness can have difficulty interpreting the colors on the reagent strip for urine glucose testing. However the client should be able to preform blood glucose testing accurately 4 - The client needs only to recognize numeral for basic use of a glucometer to monitor blood glucose. Reading skills are not necessary.

A nurse is reviewing the health record of a client who has hyperglycemic-hyperosmolar state (HHS). Which of the following factors can cause HHS? (Select all) 1 - Evidence of recent myocardial infarction 2 - BUN 35 mg/dL 3 - Takes a calcium channel blocker 4 - Age 77 years 5 - Fluid volume excess

1, 2, 3, & 4 1 - Evidence of recent myocardial infarction 2 - BUN 35 mg/dL 3 - Takes a calcium channel blocker 4 - Age 77 years Rational 5 - The nurse should recognize that inadequate fluid intake is a risk factor for HHS

A nurse is assisting with a presentation about nutrition habits that prevent type 2 diabetes mellitus for a group of clients. Which of the following should the nurse include? (Select all) 1 - Eat less meat and processed foods 2 - Decrease intake of saturated fats 3 - Increase daily fiber intake 4 - Limit unsaturated fat intake to 15% of daily caloric intake 5 - Include omega-3 fatty acids in the diet.

1, 2, 3, & 5 1 - Eat less meat and processed foods 2 - Decrease intake of saturated fats 3 - Increase daily fiber intake 5 - Include omega-3 fatty acids in the diet.

A nurse is caring for a client who is about to begin taking propylthiouracil (PTU) to treat hyperthyroidism. The nurse should instruct the client to report which of the following adverse effects? (Select all) 1 - Sore throat 2 - Joint pain 3 - Insomnia 4 - Bradycardia 5 - Rash

1, 2, 4 & 5 Rational Sore throat is correct. Propylthiouracil, an antithyroid drug, can cause agranulocytosis. The nurse should monitor the client's CBC and instruct the client to report fever or sore throat. Joint pain is correct. Propylthiouracil can cause arthralgia and myalgia. The nurse should instruct the client to report these effects and take over-the-counter analgesics for pain relief. Insomnia is incorrect. Propylthiouracil is more likely to cause drowsiness than insomnia. Bradycardia is correct. Propylthiouracil can cause hypothyroidism, which manifests as bradycardia, drowsiness, and weight gain. The nurse should instruct the client to report these effects. Rash is correct. Propylthiouracil can cause urticaria or a skin rash. The nurse should instruct the client to report these effects.

A patient newly diagnosed with diabetes is given diet instructions. What should the nurse do to effectively motivate the patient to comply with dietary recommendations (Select all) 1 - Emphasize good food choices 2 - Apply diet prescriptions to patient-preferred foods 3 - Instill guilt to self-regulate when "cheating" occurs. 4 - Focus on the benefits of diet compliance 5 - Involve meal preparers in diet teaching

1, 2, 4 & 5 Rational These options are good strategies. Fear and guilt create a situation where the patient will be reluctant to tell the truth to others. There will be times when the patient will not follow the diet (e.g., it may be very difficult during the holidays); however, the patient should be able to admit the deviation from the plan and then get back on schedule.

Which teaching technique(s) would be most useful for an older adult patient with diabetes? (Select all) 1 - Set a time for the teaching session that is agreeable to the patient 2 - Invite the patient to join a teaching session for patients newly diagnoses with diabetes 3 - Allow time for the patient to jot down important points 4 - Use bold-type printed materials with a white type on a dark blue or black background 5 - Keep the sessions at a limit of 1 to 2 hours and give frequent breaks 6 - Teach all necessary information in one session 7 - Repeat key concepts frequently; if the patient does not understand, try rephrasing the concept

1, 3 & 7 Rational Setting a specific time, allowing additional time to write down information, and repeating key concepts are good strategies. Group learning may work for some older patients, but generally it is more advisable to have less distraction and more time for individualized attention. Use dark type on white backgrounds for optimal visual clarity. Attempting to cover all material in long sessions is not ideal, even if you give the patient frequent breaks.

A nurse is reviewing a sick-day management with a parent of a child who has type 1 diabetes mellitus. Which of the following instructions should the nurse include in the teaching? (Select all) 1 - Monitor blood glucose level every 3 hr 2 - Discontinue taking insulin until feeling better 3 - Drink 8 oz of fruit juice every hour 4 - Test urine for ketones 5 - Call the provider if blood glucose is greater than 240 mg/dL

1, 4 & 5 1 - Monitor blood glucose level every 3 hr 4 - Test urine for ketones 5 - Call the provider if blood glucose is greater than 240 mg/dL Rational 2 - A client who is experiencing illness should continue taking insulin during to prevent hyperglycemic episodes. 3 - A client who is experiencing illness should drink fluid without sugar

A nurse is contributing to the plan of care for a client who has a new diagnosis of type 2 diabetes mellitus. Which of the following interventions should the nurse include? (Select all) 1 - Assist the client to develop an individualized meal plan 2 - Give the client an extra dose of insulin for a blood glucose level of 50 mg/dL 3 - Instruct the client to soak his feet daily 4 - Off the client 240 mL (8 oz) of skim milk if the client's skin becomes cool and clammy 5 - Check the client's blood glucose level before meals and bedtime

1, 4 & 5 Rational​ Assist the client to develop an individualized meal plan is correct. A client who has a new diagnosis of type 2 diabetes mellitus will need assistance to develop a meal plan that will help him achieve his weight goals, maintain his lifestyle, and meet his food preferences. Give the client an extra dose of insulin for a blood glucose level of 50 mg/dL is incorrect. A blood glucose level of 50 mg/dL is below the expected reference range. Giving an extra dose of insulin can further lower the client's blood glucose level. Instruct the client to soak his feet daily is incorrect. Soaking the feet daily can cause skin impairment and lead to cracking of the skin. This can increase the client's risk for infection. The client should wash his feet in warm water and mild soap and dry them thoroughly before putting on socks. Offer the client 8 oz of skim milk if the client's skin becomes cool and clammy is correct. Cool, clammy skin, pallor, irritability, and shakiness can indicate the client's blood glucose is below the expected reference range and that the client is having hypoglycemia. The nurse should offer the client a snack of 15 to 20 g of carbohydrate, such as 8 oz of skim milk, 1 small box of raisins, or 4 oz of juice. Check the client's blood glucose level before meals and bedtime is correct. The nurse should check the client's blood glucose level at least before each meal and at bedtime to monitor glucose control and identify the need for medication.

A nurse is reinforcing teaching with a client who has a prescription for pramlintide for type 1 diabetes mellitus. Which of the following instructions should the nurse include? (Select all) 1 - "Take oral medications 1 hr before injection." 2 - "Use upper arms as preferred injection sites." 3 - "Mix pramlintide with the breakfast dose of insulin." 4 - "Inject pramlintide just before a meal." 5 - "Discard open vials after 28 days."

1, 4 &5 1 - "Take oral medications 1 hr before injection." 4 - "Inject pramlintide just before a meal." 5 - "Discard open vials after 28 days." Rational 2 - the thigh or abdomen, rather than the upper arms, are preferred sites for pramlintide injections 3 - Pramlintide should not be mixed in a syringe with any type of insulin

A nurse is caring for a client who is about to begin taking pioglitazone to treat type 2 diabetes mellitus. The nurse should explain to the client about the need to monitor which of the following laboratory values? (Select all) 1 - Thyroid-stimulating hormone (TSH) 2 - Alanine aminotransferase (ALT) 3 - LDL 4 - CBC 5 - Creatinine clearance

2 & 3 Rational Thyroid-stimulating hormone (TSH) is incorrect. Pioglitazone, a thiazolidinedione, is unlikely to alter T4 or TSH. Levothyroxine, a thyroid hormone replacement, is an endocrine-system drug that requires monitoring of T4 and TSH. Alanine aminotransferase (ALT) is correct. Pioglitazone can cause liver injury. The nurse should monitor ALT at the start of therapy and then every 3 to 6 months thereafter. The nurse should tell the client to report jaundice, dark-colored urine, or abdominal pain. LDL is correct. Pioglitazone can cause elevations in both high-density lipoproteins, which is a beneficial effect, and LDLs, which is a detrimental effect. The nurse should monitor the client's plasma lipid levels at baseline and periodically throughout drug therapy. CBC is incorrect. It is not necessary to monitor CBC for clients who are taking pioglitazone. Hydrocortisone, a glucocorticoid, is an endocrine-system drug that requires monitoring of CBC. Creatinine clearance is incorrect. It is not necessary to monitor creatinine clearance for clients who are taking pioglitazone. Desmopressin, an antidiuretic hormone, is an endocrine-system drug that requires monitoring of creatinine clearance.

A nurse is reinforcing teaching with an adolescent who has diabetes mellitus about manifestations of hypoglycemia. Which of the following findings should the nurse include? (Select all) 1 - Increases urination 2 - Hunger 3 - Manifestations of dehydration 4 - Irritability 5- Sweating and pallor 6 - Kussmaul respirations

2 , 4, & 5 2 - Hunger 4 - Irritability 5- Sweating and pallor Rational 1 - An increase of urination is a manifestation of hyperglycemia 3 - Dehydration is a manifestation of hyperglycemia 6 - Kussmaul respirations are a manifestation of hyperglycemia

A nurse is reinforcing teaching with a client who has type 1 diabetes mellitus about self-care during illness. Which of the following instructions should the nurse include in the teaching? 1 - "Test your blood glucose level every 6 hours." 2 - "Administer your usual daily dose of insulin." 3 - "Report a blood glucose level greater than 300." 4 - "Limit juices, soda, and gelatin."

2 - "Administer your usual daily dose of insulin." Rational 1 - The nurse should instruct the client to test his blood glucose level every 3 to 4 hr. 2 - The nurse should instruct the client to continue his usual daily dose of insulin during illness and to eat small meals of carbohydrates to maintain blood glucose levels. 3 - The nurse should instruct the client to report a blood glucose level that is greater than 200 mg/dL. 4 - The nurse should the client to drink frequent carbohydrate drinks to prevent dehydration and supply calories.

A nurse is reinforcing teaching with a client who has diabetes about which dietary source should provide the greatest percentage of her calories. Which of the following client statements indicates an understanding of the teaching? 1 - "Most of my calories each day should be from fats." 2 - "I should eat more calories from complex carbohydrates than anything else." 3 - "Simple sugars are needed more than other calorie sources." 4 - "Protein should be my main source of calories."

2 - "I should eat more calories from complex carbohydrates than anything else." Rational 1 - The client who has diabetes should limit fat to 7% of total calories because there is a higher risk for cardiovascular disease when a client has diabetes. 2 - The client who has diabetes should consume 45% of the total calories per day from complex carbohydrates, such as whole grains, fruits, and vegetables for better glycemic control. 3 - The client who has diabetes should limit her intake of simple sugars, such as foods containing sucrose and replace with sugar substitutes because sugar is nutrient poor and food that contain sugar are often high in fat too. 4 - The client who has diabetes should consume 15% of her calories from protein sources.

A nurse is reinforcing teaching about the manifestations of hyperglycemia with a client who has diabetes mellitus. Which of the following statements by the client indicates an understanding of the teaching? 1 - "I might experience blurry vision at times." 2 - "I will be more thirsty than usual." 3 - "My breath may have a fruity odor." 4 - "My appetite will be deceased."

2 - "I will be more thirsty than usual." Rational 1 - This statement indicates a need for additional teaching because blurred vision is a manifestation of hypoglycemia, rather than hyperglycemia. 2 - This statement indicates the client understands the teaching as increased thirst is a manifestation of hyperglycemia. 3 - This statement indicates a need for additional teaching because acetone or fruity breath odor is an indication of ketoacidosis, rather than hyperglycemia. 4 - This statement indicates a need for additional teaching because a decreased appetite is a manifestation of hypoglycemia, rather than hyperglycemia. A client who has hyperglycemia will be hungry despite increased food intake.

A child who has diabetes mellitus asks why he cannot take insulin orally instead of by subcutaneous injections. The best response of the nurse would be that: 1 - Pills are only for adults 2 - Digestive enzymes destroy insulin 3 - Insulin can cause a stomach ulcer 4 - Insulin interacts with food in the stomach

2 - Digestive enzymes destroy insulin Rationale Insulin cannot be taken orally because it is a protein and would be broken down by gastric juices. Page reference: Page 713 Answer from quizlet - do not have quiz bank

A patient newly diagnosed with diabetes is learning to administer his injections of NPH and regular insulin. Which statement indicates that the patient understands the nurse's teaching regarding proper insulin administration? 1 - "I will draw up the NPH before the regular insulin." 2 - "I will draw up the regular insulin before the NPH." 3 - "I will give myself the NPH and the regular insulin in two different injections." 4- "It doesn't matter which insulin I draw up first, as long as the amount is correct."

2 - "I will draw up the regular insulin before the NPH." Rational The dose of regular insulin is drawn up into the syringe before the NPH to prevent accidentally contaminating the rapid-acting insulin (regular) with time-released insulin (NPH). Regular and NPH can be given mixed in one injection, as long as the regular insulin is drawn up before the NPH.

A nurse is reinforcing teaching with a client who is in her second trimester and has a new diagnosis of gestational diabetes. Which of the following statements by the client indicates a need for further teaching? 1 - "I should limit my carbohydrates to 50% of my daily caloric intake." 2 - "I will reduce my exercise schedule to 3 days a week." 3 - "I will take my glyburide daily with breakfast." 4 - "I know I am at an increased risk to develop type 2 diabetes."

2 - "I will reduce my exercise schedule to 3 days a week." Rational 1 - ​Carbohydrate intake should be limited to 50% of caloric intake. 2 - Increased exercise benefits the client and can result in improved management of gestational diabetes. 3 -Glyburide is appropriate for a pregnant client and minimal amounts of the medication cross the placenta. 4 - Women who have gestational diabetes have a 15% to 50% risk for developing type 2 diabetes mellitus within the next 20 years.

A nurse is reinforcing teaching with a client who has type 2 diabetes mellitus and is starting repaglinide. Which of the following statements by the client indicates understanding? 1 - "I'll take this medication once a day." 2 - "I'll take this medicine within 30 minutes before eating." 3 - "I'll take this medicine just before I go to bed." 4 - "I'll take this medication at least 1 hour before I eat."

2 - "I'll take this medicine within 30 minutes before eating."

A nurse is reinforcing teaching with a client who has diabetes mellitus and a new prescription for lispro and Lantus insulins. Which of the following statements by the client indicates an understanding of the teaching? 1 - "Insulin injected into the thigh is the most rapidly absorbed." 2 - "Unopened vials of insulin should be kept in my refrigerator." 3 - "I should shake the bottle of insulin before withdrawing the medication." 4 - "I will use Lantus insulin immediately before each meal."

2 - "Unopened vials of insulin should be kept in my refrigerator." Rational 1 - Insulin injected into the abdomen is the most rapidly absorbed, followed by the arms, thighs, and buttocks. 2 - Prior to opening vials of insulin, they should be stored in the refrigerator. After opening, insulin can be stored in a cool place for up to 4 weeks. 3 - The client should roll the insulin vial to ensure that it is adequately suspended and to avoid the bubbles that are created by shaking the vial. 4 - The client should use lispro insulin prior to eating because it is a short-acting insulin with an onset of 15 min and duration of 3 to 4 hr. Lantus insulin is a long-acting (basal) insulin with an onset of 2 hr and duration of 24 hr.

A patient with diabetes asks if a slice of cake can be added to the meal for dessert. The best response by the nurse would be: 1 - "Diabetic patients should not eat cake." 2 - "Yes, but you must omit other carbohydrates of equal value from the meal." 3 - "You will have to check with your primary care provider." 4 - "Yes, but don't do this too ofter."

2 - "Yes, but you must omit other carbohydrates of equal value from the meal." Rationale Sweets can be consumed by a person with diabetes, but moderation is the key, since carbohydrate value of foods must be understood and consistent in the diet in order to avoid hyperglycemia. It is advised that sweets be limited because they are usually limited in protein and other nutrients.

A nurse is preparing to administer a morning dose of insulin aspart to a client who has type 1 diabetes mellitus. Which of the following actions should the nurse take? 1 - Check blood glucose immediately after breakfast 2 - Administer insulin when breakfast arrives 3 - Hold breakfast for 1 hr after insulin administration 4 - Clarify the prescription because insulin should not be administered at this time.

2 - Administer insulin when breakfast arrives Rational 1 - Blood glucose should be checked prior to insulin admin to prevent an episode of hypoglycemia 2 - Admin insulin as part when breakfast arrives can prevent a hypoglycemic episode. Insulin aspart is rapid-acting, and should be administered 5 - 10 min before breakfast 3 - Insulin aspart is rapid-acting and is admin 5-10 min before breakfast 4 - Insulin aspart is admin at breakfast and may be prescribed for admin 2-3 times a day

A nurse is teaching a client who has a prescription for pramlintide therapy to treat type 1 diabetes mellitus. Which of the following instructions should the nurse include? 1 - Mix pramlintide with insulin in the syringe 2 - Administer pramlintide before meals 3 - Take pramlintide once daily at bedtime 4 - Inject pramlintide into upper arm

2 - Administer pramlintide before meals Rational 1- Pramlintide, an amylin mimetic, supplements the effects of insulin and oral hypoglycemic drugs. However, clients should not mix it in the same syringe with insulin. 2 - The nurse should instruct the client to inject pramlintide, an amylin mimetic, 20 min before any meal that contains at least 30 g of carbohydrates. 3 - Clients should take pramlintide, an amylin mimetic, three times per day with meals. Metformin, a biguanide, is an endocrine-system drug that clients take orally once per day with their evening meal. 4 - Clients should inject pramlintide, an amylin mimetic, subcutaneously into the abdomen or thigh, rather than the upper arm.

A nurse determines the finger stick blood glucose reading for a patient with diabetes is 750 mg/dL. What is the nurse's priority action? 1 - Immediately notify the RN and the health care provider 2 - Assess the vital signs of the patient 3 - Check the record to verify whether the patient has type 1 or type 2 diabetes 4 - Asminister prescribed sliding scale insulin

2 - Assess the vital signs of the patient Rational The patient should be assessed immediately for responsiveness and additional signs and symptoms. Notifying the RN and the physician after the patient has been assessed are appropriate actions. Checking the record to verify type 1 or type 2 diabetes is not incorrect, but hopefully the nurse would know this information from shift report. Administering the insulin should not happen until further assessment is completed.

A nurse is reinforcing teaching for a client who has type 2 diabetes mellitus and is prescribed glipizide. The client should be taught that glipizide works in which of the following ways? 1 - Glipizide promotes the breakdown of glycogen to glucose. 2 - Glipizide stimulates the pancreas to release adequate insulin 3 - Glipizide blocks glucose production in the liver 4 - Glipizide slows gastric emptying and decreases appetite.

2 - Glipizide stimulates the pancreas to release adequate insulin Rational 1 - Glucagon is used for the hypoglycemia of insulin overdose by promoting the breakdown of glycogen to glucose. 2 - Glipizide is a sulfonylurea agent. It helps lower blood glucose levels by increasing insulin secretion from the beta cells of the pancreas. 3- Metformin, a biguanide medication for type 2 diabetes mellitus, blocks glucose production in the liver. 4 - Exenatide, an incretin mimetic, is an injectable medication for type 2 diabetes, which among other actions, slows gastric emptying and decreases appetite.

A nurse is in a provider's office is collecting data from an older adult client who has type 2 diabetes mellitus. Which of the following findings is a manifestation of hyperglycemia? 1 - Clammy skin 2 - History of poor wound healing 3 - Report of decreased urinary output 4 - Random blood glucose 126 mg/dL

2 - History of poor wound healing Rational 1 - Clammy skin is a manifestation of hypoglycemia. An expected finding for a client who has hyperglycemia is warm, moist skin. 2 - The presence of hyperglycemia leads to poor wound healing due to decreased blood supply to the tissue. 3 - Polyuria is a manifestation of hyperglycemia. 4 - A random blood glucose level of 126 mg/dL is within the expected reference rage. A random blood glucose level of 200 mg/dL is a manifestation of hyperglycemia.

When considering replacement therapy options for a client who has chronic adrenocortical insufficiency, a nurse should recognize that the provider will chose which of the following drugs? 1 - Somatropin 2 - Hydrocortisone 3 - Glucagon 4 - Desmopressin

2 - Hydrocortisone Rational 1 - Somatropin, a growth hormone, treats growth hormone deficiencies, such as Turner's syndrome, rather than adrenocortical insufficiency. 2 - Hydrocortisone, a glucocorticoid, provides replacement therapy for acute and chronic adrenocortical insufficiency, such as Addison's disease. Hydrocortisone is identical to cortisol, the primary glucocorticoid the adrenal cortex generates. 3 - Glucagon, a hyperglycemic, treats severe hypoglycemia from insulin toxicity, rather than adrenocortical insufficiency. 4 - Desmopressin, an antidiuretic hormone, treats diabetes insipidus, rather than adrenocortical insufficiency.

A nurse is caring for a client who is taking propylthiouracil (PTU) and reports weight gain, drowsiness, and depression. The nurse should identify that the client is experiencing which of the following adverse reactions to the drug? 1 - Thyrotoxicosis 2 - Hypothyroidism 3 - Lactic acidosis 4 - Radiation sickness

2 - Hypothyroidism Rational 1 - Propylthiouracil, an antithyroid drug, treats thyrotoxicosis, or hyperthyroidism. Indications of thyrotoxicosis include anxiety, palpitations, and weight loss. 2 - Propylthiouracil, an antithyroid drug, can cause hypothyroidism, which manifests as drowsiness, depression, weight gain, edema, and bradycardia. The nurse should request that the provider prescribe a lower dosage of the drug for the client. 3 - Propylthiouracil, an antithyroid drug, is unlikely to cause lactic acidosis. Sitagliptin is an endocrine-system drug that can cause lactic acidosis, which manifests as muscle aches, sleepiness, malaise, and hyperventilation. 4- Propylthiouracil, an antithyroid drug, is unlikely to cause radiation sickness. Radioactive iodine-131 is an endocrine-system drug that can cause radiation sickness, which manifests as hematemesis, epistaxis, and intense nausea and vomiting.

A nurse is preparing to administer insulin lispro to a client who has type 1 diabetes mellitus. Which of the following actions should the nurse plan to take? 1 - Check the client for hypoglycemia 4 hr after the insulin lispro injection 2 - Inject insulin lispro 15 min before a meal 3 - Monitor the client for polyuria after the insulin lispro injection 4 - Administer insulin lispro in the same syringe as a short-acting insulin

2 - Inject insulin lispro 15 min before a meal Rational 1 - The nurse should check the client for hypoglycemia 30 min to 2.5 hr after injecting insulin lispro. 2 - The nurse should administer insulin lispro 15 min before a meal because it is a rapid-acting insulin. For some clients, it might be necessary to inject insulin lispro after the meal to prevent manifestations of hypoglycemia. 3 - Polyuria is a manifestation of hyperglycemia. The nurse should monitor for manifestations of hypoglycemia—such as diaphoresis, dizziness and confusion—after injecting a client with insulin lispro. 4 - Insulin lispro is a rapid-acting insulin. It can be given with a longer-acting insulin in the same syringe, but not with a short-acting insulin due to the high risk for hypoglycemia

Durning a routine checkup, the health care provider tells a patient with diabetes that test results reveal albuminuria. Which long-term complication is specific to the test result? 1 - Metabolic syndrome 2 - Nephropathy 3 - Retinopathy 4 - Peripheral vascular disease

2 - Nephropathy Rational Albuminuria indicates that protein is passing into the urine because the filtering mechanism of the kidney has sustained damage from filtering blood with elevated glucose. The other complications are likely to be simultaneously occurring over time because of the damage to blood vessels and other organs.

A nurse is reinforcing teaching with an adolescent who has type 1 diabetes mellitus. Which of the following instructions should the nurse include in the teaching? 1 - Administer glucagon for hyperglycemia 2 - Obtain an influenza vaccine annually 3 - Inject insulin in the deltoid muscle 4 - Take glyburide with breakfast

2 - Obtain an influenza vaccine annually Rational 1 - ​Glucagon is administered for hypoglycemia, not hyperglycemia. 2 - ​The client should obtain an influenza vaccine annually. 3 - ​Insulin should be injected subcutaneously, not intramuscularly. 4 - Glyburide is contraindicated for clients who have type 1 diabetes mellitus.

A nurse is speaking with a client who is taking glipizide to treat type 2 diabetes mellitus and has called to report feeling shaky, hungry, and fatigues. Which of the following actions should the nurse instruct the client to take? 1 - Drink 16 oz of water 2 - Perform a fingerstick blood glucose check 3 - Take another glipizide table 4 - Lie down and rest

2 - Perform a fingerstick blood glucose check Rational 1 - Glipizide, a sulfonylurea, can cause diarrhea. Clients who develop this adverse reaction should maintain hydration by drinking plenty of fluids. However, the client's symptoms indicate a different adverse reaction to the drug. 2 - Glipizide, a sulfonylurea, can cause hypoglycemia, which can manifest as diaphoresis, shakiness, hunger, and fatigue. The nurse should tell the client to check their blood glucose level and, if it indicates hypoglycemia, to consume a snack of 15 to 20 g (0.5 to 0.7 oz) of carbohydrates, retest in 15 to 20 min, and repeat if their blood glucose level is still low. 3 - Glipizide, a sulfonylurea, treats hyperglycemia from type 2 diabetes mellitus. Clients do not take the drug PRN, but rather on a fixed, once-daily dosing schedule. It would be inappropriate to double the dosage within the same 24-hr period, even if the client were experiencing hyperglycemia. 4 - Lying down and resting can help the client feel less fatigued, but these actions do not address the adverse reaction the client is having to glipizide, a sulfonylurea.

The home health nurse is visiting an older adult patient who has successfully managed her type 2 diabetes for years. During the visit, the nurse notes that the patient has severe arthritis; poor vision; and several dry, red areas on the lower extremities. What is the priority patient problem? 1 - Potential for noncompliance due to social circumstances 2 - Potential for ineffective self-health management due to aging 3 - Potential for infection due to poor peripheral perfusion. 4 - Potential for disturbed sensory perception due to degenerative changes

2 - Potential for ineffective self-health management due to aging Rational This patient has had type 2 diabetes for years, but now changes related to aging place the patient at risk for ineffective self-health management. Risk for noncompliance is an inappropriate diagnosis. Patient does not have a history of noncompliance but now needs interventions related to aging to maximize self-care. Patient does have risk for infection and problems with sensory input; however, again, the nurse should use interventions that address the problems of aging, so that the patient can continue self-care.

The nurse teaches the diabetic child to rotate sites of insulin injections so as to: 1 - Prevent subcutaneous deposit of the drug 2 - Prevent lipoatrophy of subcutaneous fat 3 - Reduce the pain of injection 4 - Increase absorption of insulin 5 - All of the above

2 - Prevent lipoatrophy of subcutaneous fat Rationale Lipoatrophy and lipohypertrophy refer to changes that can occur in the subcutaneous tissue at the injection site. Proper rotation of injection sites and the availability of the newer purified insulins have helped eliminate this condition. Page reference:Page 714 Answer from quizlet - do not have quiz bank

What may indicate a need for insulin in a diabetic child? 1 - Diaphoresis and tremors 2 - Red lips and fruity odor to the breath 3 - Confusion and lethargy 4 - Headache and pallor

2 - Red lips and fruity odor to the breath Rationale: Signs and symptoms of hyperglycemia (ketoacidosis) include blood glucose levels above 160 mg/dL, polyuria, polydipsia, polyphagia, a fruity odor to the breath, fatigue, abdominal pain, red lips, flushed face, dehydration, disorientation, drowsiness progressing to coma, and deep and rapid (Kussmaul's) respirations. Page reference: Page 709; Table 31-4 Answer from quizlet - do not have quiz bank

A nurse is collecting data from a client who has diabetes mellitus. The client is confused, flushed, and has an acetone odor on his breath. The nurse should anticipate a prescription for which of the following types of insulin to treat the client? 1 - Detemir 2 - Regular 3 - Glargine 4 - NPH

2 - Regular Rational 1 - Insulin detemir is a long-acting insulin and is contraindicated for use in clients who are experiencing diabetic ketoacidosis. 2 - Regular insulin is the type of insulin used in the emergency treatment of diabetic ketoacidosis to reduce hyperglycemia and acidosis. It is the only insulin that can be given by IV and it has an onset of action as rapid as 30 min. 3 - Insulin glargine is a long-acting insulin that is used in the treatment of diabetes mellitus. However, it is not used for the treatment of diabetic ketoacidosis. 4 - NPH insulin is an intermediate-acting insulin and is contraindicated for use in clients who are experiencing diabetic ketoacidosis.

A patient who is undergoing surgery will have an intravenous solution to which insulin will be added. Which type of insulin must be used? 1 - Lente 2 - Regular 3 - Ultralente 4 - Neutral protamine Hagedorn (NPH)

2 - Regular Rational Regular insulin is the only type that may be administered intravenously. NPH, Lantus, and Ultralente may be administered only subcutaneously.

A nurse is discussing the care of a client who has type 1 diabetes mellitus with an assistive personnel (AP). Which of the following situations should the nurse instruct the AP to report immediately? 1 - The client reports dizziness when standing 2 - The client refuses breakfast requests to sleep 3 - The client asks the AP to trim his broken toenail 4 - The client reports urine that is dark yellow in color.

2 - The client refuses breakfast requests to sleep Rational 1 - The client is at risk for orthostatic hypotension due changing positions. However, another situation should be reported immediately to the nurse. It is not unusual for a client with chronic disease to experience transient dizziness when changing positions, due to orthostatic hypotension. 2 - The greatest risk to this client is hypoglycemia which could be caused by the client's refusal to eat and request to sleep. Therefore, the AP should report this situation to the nurse immediately. 3 - The client is at risk for infection due to impaired peripheral circulation as a result of the diabetes. However, another situation should be reported immediately to the nurse. 4 - The client is at risk for mild dehydration and should be encouraged to increase fluid intake. However, another situation should be reported immediately to the nurse.

A nurse is caring for a client who is taking desmopressin. The nurse should make which of the following assessments to evaluate the drug's effectiveness? 1 - Peripheral pulses 2 - Urine output 3 - Skin integrity 4 - Blood glucose

2 - Urine output Rational 1 - Desmopressin, an antidiuretic hormone, is unlikely to alter peripheral pulses. Vasopressin, another antidiuretic hormone, can cause vasoconstriction and angina pectoris. Desmopressin does not alter hemodynamics. 2 - Desmopressin, an antidiuretic hormone, treats diabetes insipidus. The nurse should monitor the client's fluid intake and urine output along with urine and serum osmolality and blood pressure. 3 - Desmopressin, an antidiuretic hormone, is unlikely to alter skin integrity. Propylthiouracil (PTU), an antithyroid drug, is an endocrine-system drug that requires integumentary monitoring because it can cause a rash. 4 - Desmopressin, an antidiuretic hormone, is unlikely to alter blood glucose. However, it can cause hyponatremia. The nurse should monitor the client's sodium levels.

An adult client newly diagnosed with type 2 diabetes mellitus asks a nurse to explain how he developed the condition. Which of the following responses should the nurse make? 1 - Your body's immune system has destroyed cells in your pancreas 2 - Your body doesn't process glucose well 3 - Your body will continue producing too much insulin without medicine to counteract it 4 - Your body's hemoglobin is not binding to the sugar you consume.

2 - Your body doesn't process glucose well Rational 1 - The nurse should include this information when discussing type 1 diabetes with a client. 2 - Type 2 diabetes mellitus is characterized by insulin resistance, where insulin does not interact with glucose appropriately. As a result, the body makes more insulin, until it eventually loses the ability for insulin production. 3 - The nurse should inform the client that clients who have type 2 diabetes might produce increased amounts of insulin initially, but then the body gradually loses the ability to produce it. 4 - Circulating glucose in the blood automatically binds to hemoglobin. The amount present on red blood cells is measured to determine the effectiveness of diabetes mellitus treatment (hemoglobin A1C testing).

A nurse is reinforcing teaching with a client who has type 2 diabetes mellitus. The nurse determines that teaching has been effective when the client identifies which of the following manifestations of hypoglycemia? (Select all) 1 - Polyuria 2 - Blurry vision 3 - Tachycardia 4 - Polydipsia 5 - Sweating

2, 3, & 5 Rational Polyuria is incorrect. Hyperglycemia causes polyuria. Blurry vision is correct. Manifestations of hypoglycemia include blurry vision, tremors, anxiety, irritability, headache, and hypotension. Tachycardia is correct. Manifestations of hypoglycemia include tachycardia, tremors, anxiety, irritability, headache, and hypotension. Polydipsia is incorrect. Hyperglycemia causes polydipsia. Sweating is correct. Manifestations of hypoglycemia include sweating, tremors, anxiety, irritability, headache, and hypotension.

A nurse is collecting data from a client who has diabetic ketoacidosis and ketones in the urine. The nurse should expect which of the following findings? (Select all) 1 - Weight gain 2 - Fruity odor of breath 3 - Abdominal pain 4 - Kussmaul respirations 5 - Metabolic acidosis

2, 3, 4, & 5 2 - Fruity odor of breath 3 - Abdominal pain 4 - Kussmaul respirations 5 - Metabolic acidosis Rational 1 - Weight loss occurs when the cells are unable to use glucose because of insulin deficiency and places the body in a catabolic state

A nurse is caring for a client who is about to begin taking somatropin. The nurse should explain the need to monitor which of the following laboratory values? (Select all) 1 - Blood amylase 2 - Creatinine clearance 3 - Urine calcium 4 - Blood gluocse 5 - CBC

3 & 4 Rational Blood amylase is incorrect. Somatropin, a growth hormone, is unlikely to alter blood amylase levels. Sitagliptin, an antithyroid drug, is an endocrine-system drug that requires monitoring of blood amylase levels because it can cause pancreatitis. Creatinine clearance is incorrect. Somatropin is unlikely to alter creatinine clearance. Desmopressin, an antidiuretic hormone, is an endocrine-system drug that requires monitoring of creatinine clearance. Urine calcium is correct. Somatropin can cause hypercalciuria. The nurse should monitor the client's urine calcium and instruct the client to report flank pain, urinary frequency, or hematuria. Blood glucose is correct. Somatropin can cause hyperglycemia. The nurse should monitor the client's blood glucose levels and instruct the client to report polyphagia, polydipsia, and polyuria. CBC is incorrect. Somatropin is unlikely to alter the client's CBC. Radioactive iodine-131, an antithyroid drug, is an endocrine-system drug that requires monitoring CBC.

A 30-year-old woman is admitted for urinary tract infection with sepsis. A urinalysis reveals presence of ketones, glucose, and nitrates. Which question would the nurse ask to further assess possible diabetes mellitus? 1 - "Have you noticed an extra roundness to your face." 2 - "Have you had more gas or abdominal bloating." 3 - "Have you been thirstier than usual? Do you find you urinate more now." 4 - "Have you experienced any pain or discomfort with urination?"

3 - "Have you been thirstier than usual? Do you find you urinate more now." Rational Polydipsia, polyuria, and polyphagia (thirst, urinary frequency, and hunger, respectively) are signs of diabetes. A round moon face is characteristic of Cushing disease. Abdominal bloating is more associated with thyroid problems. Asking about pain with urination is appropriate to assess for urinary tract infection (UTI). There is an increased risk for UTI with diabetes, but asking about occurrence or frequency of UTIs is a better question to assess for possible diabetes.

A patient recently diagnosed as having hypoglycemia says, "Hypoglycemia! I can't live with that. My neighbor, Joseph, had that and he acted crazy!" Which response by the nurse is most appropriate? 1 - "You seem to be overreacting to the problem." 2 - "You're right; it would be difficult to live with hypoglycemia." 3 - "Hypoglycemia has been successfully treated by diet modifications." 4 - "Taking care of yourself years ago would have prevented the problem."

3 - "Hypoglycemia has been successfully treated by diet modifications." Rational Hypoglycemia refers to a low serum blood glucose level. It is best managed with dietary management. Telling the patient that the condition is hard to manage would be counterproductive and inaccurate. Making the patient's concerns appear trivial or discussing past self-care would not further the relationship between the nurse and patient.

A nurse is reinforcing teaching for a client who has diabetes mellitus and has a prescription for insulin detemir injections once daily. Which of the following statements by the client indicates an understanding of the teaching? 1 - "If my blood sugar is high, I can mix a dose of regular insulin with my insulin detemir." 2 - "I should inject my insulin detemir 30 min before a meal to lower my blood sugar." 3 - "I can inject my insulin in the evening before bedtime." 4 - "I don't have to worry about hypoglycemia while taking insulin detemir.

3 - "I can inject my insulin in the evening before bedtime." Rational 1 - Insulin detemir should not be mixed with any other insulin in the same syringe. 2 - Insulin detemir is absorbed slowly and does not need to be taken before a meal. 3 - When prescribed once daily, insulin detemir is injected in the evening, either with the evening meal or at bedtime. 4 - As with other types of insulin, the client should be instructed to monitor for hypoglycemia when taking insulin detemir and should also learn how to manage manifestations of hypoglycemia.

A nurse is reinforcing teaching about glucose monitoring with a client who has type 1 diabetes mellitus. Which of the following statements by the client indicates understanding of the teaching? 1 - "I will check my urine once a day for glucose." 2 - "I will notify my provider if preprandial glucose is more than 120 mg/dL." 3 - "I will check blood glucose every 4 hours while I am sick." 4 - "I will check blood glucose 20 minutes after I treat a hypoglycemic episode."

3 - "I will check blood glucose every 4 hours while I am sick." Rational 1 - ​The client should check the urine for presence of ketones if the glucose is above 240 mg/dL. 2 - ​The client's preprandial glucose should be 140 mg/dL or below. The nurse should notify the provider of glucose rates outside the expected range 3 - The client should follow specific guidelines when sick, including checking the blood glucose every 4 hr, or every 2 hr if illness is severe. Extra insulin can be required to keep the glucose below 200 mg/dL, and the provider can inform the client of adjustments to make 4 - ​The nurse should instruct the client to check the blood glucose 15 minutes after taking treatment for a hypoglycemic episode and to retreat herself if the glucose is below 70 mg/dL.

A patient with diabetes asks her nurse about foot care when she is discharged home. What is the nurse's best response? 1- "Cut your toenails in a V shape to prevent ingrown toenails." 2 - "Soak your feet in hot water each night before going to bed." 3 - "Inspect each foot daily for cuts, cracks, blisters, or abrasions." 4 - "There are no special instructions for your feet when you have diabetes."

3 - "Inspect each foot daily for cuts, cracks, blisters, or abrasions." Rational The nurse should instruct the patient to inspect each foot daily for cuts, cracks, blisters, abrasions, or discoloration of the toes and to report any abnormality to the health care provider. The patient should use a mirror if unable to bend to see the bottom of the foot. The patient should be certain to check between the toes and should wash the feet in warm (not hot) water, using mild soap. The patient should not soak the feet because this can cause cracking of the skin. The nails should be cut straight across, not in the shape of a V, to prevent ingrown toenails.

A nurse administers subcutaneous NPH insulin at 0700 to a child who has diabetes. At which of the following times should the nurse observe for hypoglycemia caused by the onset of the medication? 1 - 0715 2 - 0730 3 - 0900 4 - 1200

3 - 0900 Rational 1 - Insulin lispro, a rapid-acting insulin, has an expected onset of 15 min. NPH insulin is not a rapid-acting insulin; therefore, the nurse should not observe for hypoglycemia caused by the onset of the medication beginning at 0715. 2 - Regular insulin, a short-acting insulin, has an expected onset of 30 to 60 min. NPH insulin is not a short-acting insulin; therefore, the nurse should not observe for hypoglycemia caused by the onset of the medication beginning at 0730. 3 - NPH insulin is an intermediate-acting insulin, and has an expected onset of 1½ to 4 hr with a peak of 4 to 12 hours. Therefore, the nurse should observe for hypoglycemia caused by the onset of the medication beginning at 0900. 4 - NPH insulin is an intermediate-acting insulin, and has an expected onset of 1½ to 4 hr. Therefore, the nurse should observe for hypoglycemia caused by the onset of the medication before 1200.

A nurse is preparing to administer a client's daily dose of NPH insulin at 0730. The nurse should expect this type of insulin to peak within which of the following timeframes after administrations? 1 - 30 min to 3 hr 2 - 1 to 5 hr 3 - 4 to 14 hr 4 - 2 to 5

3 - 4 to 14 hr Rational 1 - Rapid-acting insulin peaks in 30 min to 3 hr. NPH insulin is not a rapid-acting insulin. 2 - Short-acting insulin peaks in 1 to 5 hr. NPH insulin is not short acting insulin. 3 - NPH insulin, an intermediate-acting insulin, peaks at 4 to 14 hr following administration. 4 - Long-acting insulin does not have a discernible peak level. NPH insulin is not long-acting insulin.

A nurse is caring for a client who is taking metformin and is scheduled to undergo angiography using iodine-containing contrast dye. The nurse should identify that an interaction between metformin and the IV contrast dye increases the client's risk for which of the following conditions? 1 - Hypokalemia 2 - Hyperglycemia 3 - Acute renal failure 4 - Acute pancreatitis

3 - Acute renal failure Rational 1 - Metformin, a biguanide, is unlikely to cause hypokalemia when used with iodine-containing contrast dye. Regular insulin is an endocrine-system drug that can cause hypokalemia. 2 - Metformin, a biguanide, is unlikely to cause hyperglycemia when used with iodine-containing contrast dye. Glucagon is an endocrine-system drug that can cause hyperglycemia. 3 - Metformin, a biguanide, can interact with iodine-containing contrast dye and cause acute renal failure and lactic acidosis. The nurse should withhold metformin for 48 hr prior to and following the procedure. The nurse should also monitor the client for indications of acute renal failure or lactic acidosis, such as reduced urine output, hyperventilation, and abdominal pain. 4 - Metformin, a biguanide, is unlikely to cause acute pancreatitis when used with iodine-containing contrast dye. Exenatide is an endocrine-system drug that can cause can cause acute pancreatitis.

A nurse is reinforcing teaching to a client who has diabetes mellitus and is to start taking chlorpropamide. The nurse should teach the client to avoid consumption of which of the following while taking this medication? 1 - Grapefruit 2 - Milk 3 - Alcohol 4 - Shellfish

3 - Alcohol Rational 3- Chlorpropamide is first generation sulfonylurea that can interact with alcohol to cause a disulfiram-like reaction. This can lead to flushing, palpitations, and nausea. In addition, alcohol can promote the hypoglycemic effect of chlorpropamide, causing the client's blood glucose level to decrease and cause injury.

A nurse is caring for a client who is about to begin insulin glargine therapy. The nurse should identify the need for additional precautions because the client also takes which of the following types of drugs? 1 - Oral contraceptives 2 - Calcium supplments 3 - Beta blockers 4 - Iron supplements

3 - Beta blockers Rational 1 - Oral contraceptives do not specifically interact with insulin. Exenatide, another endocrine-system drug, slows the absorption of oral contraceptives. 2 - Calcium supplements do not specifically interact with insulin. They do, however, reduce the absorption of levothyroxine, another endocrine-system drug. 3 - Clients who take both insulin and beta blockers are at risk for failing to promptly recognize the symptoms of hypoglycemia because beta blockers mask symptoms such as tachycardia and tremors. Beta blockers also increase hypoglycemic effects. 4 - Iron supplements do not specifically interact with insulin. They do, however, reduce the absorption of levothyroxine, another endocrine-system drug.

A nurse is reinforcing discharge teaching about nutrition with a client who has a new diagnosis of diabetes mellitus. Which of the following statements should be included in the teaching? 1 - Carbohydrates intake should be limited to 110 g per day 2 - Protein intake has a greatest effect on after-meal blood glucose levels 3 - Carbohydrates should comprise 45 to 65% of daily caloric intake 4 - Proteins should comprise 10% of daily caloric intake

3 - Carbohydrates should comprise 45 to 65% of daily caloric intake Rational 1 - The nurse should instruct the client not to strictly limit carbohydrates. Even a client on a 1200 calorie diet would be allowed 45 g of carbohydrates per meal and one 15 g snack (about 150 g per day). 2 - The nurse should instruct the client that the amount and type of carbohydrates consumed has the greatest effect on after-meal blood glucose levels. 3 - The nurse should instruct clients who have diabetes mellitus to consume 45 to 65% of their daily calories from carbohydrates in order to obtain balanced amounts of protein, fats, and fiber. 4 - The nurse should instruct the client that protein should comprise 15 to 20% of daily caloric intake.

A nurse mistakenly administers a dose of metformin within 1 hr of the previous dose. Which of the following findings should alert the nurse that the client is experiencing and adverse effect from the medication error? 1 - Confusion and lethargy 2 - Rapid and deep respirations 3 - Diaphoresis and tachycardia 4 - Nausea and abdominal cramping

3 - Diaphoresis and tachycardia Rational 1 - Confusion and lethargy are late manifestations of hypoglycemia. The nurse should monitor the client for early manifestations of hypoglycemia 2 - Rapid and deep respirations are manifestations of hyperglycemia 3 - Diaphoresis and tachycardia are early manifestations of hypoglycemia. Irritability, tremulousness, anxiety, and hunger are other early manifestations of hypoglycemia. 4 - Nausea and abdominal cramping are manifestations of hyperglycemia.

The nurse is teaching a class on diabetes to a group of adults in the community. The nurse should be sure to include information on which classic symptoms of diabetes? Select all that apply. 1 - Hypertension 2 - Vision changes 3 - Excessive thirst 4 - Frequent urination 5 - Increased appetite 6 - Recurrent urinary tract infections (UTIs)

3 - Excessive thirst 4 - Frequent urination 5 - Increased appetite Rational Polyuria, polydipsia, and polyphagia are the classic symptoms of diabetes. Vision changes may occur after years of poor glycemic control. Hypertension is not a symptom of diabetes. The patient may experience recurrent UTIs due to diabetes, but this is not one of the three classic symptoms.

A nurse is providing teaching to a client who is about to begin levothyroxine therapy to treat hypothyroidism. Which of the following instructions should the nurse include? 1 - Take levothyroxine with food to increase absorption 2 - Take levothyroxine with an antacid to reduce gastrointestinal effects 3 - Expect life-long therapy with the drug 4 - Carry a carbohydrate snake at all times

3 - Expect life-long therapy with the drug Rational 1 - Food reduces the absorption of levothyroxine, a thyroid replacement hormone. The nurse should instruct the client to take it on an empty stomach at least 30 min before eating. 2 - Antacids reduce the absorption of levothyroxine, a thyroid replacement hormone. The nurse should instruct the client to allow 4 hr between taking levothyroxine and taking an antacid. 3 - Therapy with levothyroxine, a thyroid replacement hormone, usually continues for life because there are no other therapies that can restore thyroid function. 4 - Levothyroxine, a thyroid replacement hormone, does not cause hypoglycemia, so this precaution is not necessary. Clients who are taking hypoglycemics, such as exenatide, should always carry a carbohydrate snack to treat hypoglycemia.

A nurse is checking the laboratory results of a client who is at risk for diabetes mellitus. Which of the following laboratory results indicates to the nurse that the client is at risk for diabetes mellitus? 1 - HbA1c 5.2% 2 - 2-hr blood glucose 132mg/dL 3 - Fasting blood glucose 155 mg/dL 4 - Casual blood glucose 178 mg/dL

3 - Fasting blood glucose 155 mg/dL Rational 1- The client who has an HbA1c of 5.2% is within the expected reference range. An HbA1c level between 5.5% and 6.0% is considered an indicator of risk for diabetes mellitus. 2 - The client who has a 2-hr blood glucose of 132 mg/dL is within the expected reference range. Values of 140 mg/dL to 199 mg/dL for a 2-hr blood glucose place the client at risk for diabetes mellitus. 3 - The client who has a fasting blood glucose level above 126 mg/dL is at risk for diabetes mellitus. 4 - The client who has a casual blood glucose level of 178 mg/dL is within the expected reference range.

A 50-year-old woman was recently diagnosed with type 2 diabetes mellitus and desires to start a healthy lifestyle to control her disease. What is the initial recommendation that the nurse should make? 1 - Engage in brisk walking 2 - Lose 10 to 15 pounds 3 - Maintain adequate glucose control 4 - Develop an exercise schedule

3 - Maintain adequate glucose control Rational Once the patient has learned how to manage and monitor her glucose level, she can begin to balance her diet with exercise and gradually lose some weight.

A nurse is caring for a client who has type 1 diabetes mellitus. Which of the following should the nurse recommend to the client as an appropriate sweetener? 1 - Corn syrup 2 - Natural honey 3 - Nonnutritive sugar substitute 4 - Agave nectar

3 - Nonnutritive sugar substitute Rational 1 - The client who has type 1 diabetes mellitus should limit carbohydrate intake. Corn syrup is high in carbohydrates and is not an appropriate choice to use as a sweetener. 2 - The client who has type 1 diabetes mellitus should limit carbohydrate intake. Honey is high in carbohydrates and is not an appropriate choice to use as a sweetener. 4 - The client who has type 1 diabetes mellitus should limit carbohydrate intake. Nonnutritive sugar substitutes allow the client to sweeten the taste of foods without increasing carbohydrate intake. 4 - The client who has type 1 diabetes mellitus should limit carbohydrate intake. Guava nectar contains carbohydrates and is not an appropriate choice to use as a sweetener

A nurse is collecting data from a client who takes metformin for type 2 diabetes. Which of the following medications is contraindicated for this client due its effect on blood glucose levels? 1 - Ranitidine 2 - Cephalexin 3 - Prednisone 4 - Levothryroxine

3 - Prednisone Rational 1 - Medications that increase plasma glucose levels are contraindicated for this client. Ranitidine can cause a reversible decreases in the WBC but does not affect blood glucose levels. 2- Medications that increase plasma glucose levels are contraindicated for this client. Cephalexin can cause a false-positive urine glucose test result but does not affect blood glucose levels. 3 - Medications that increase plasma glucose levels are contraindicated for this client. Corticosteroids, such as prednisone, increase plasma levels of glucose levels and cause hyperglycemia and glycosuria. 4 - Medications that increase plasma glucose levels are contraindicated for this client. Levothyroxine can cause insomnia and headaches but does not affect blood glucose levels.

A nurse is reinforcing teaching with clients in an outpatient facility about the use of insulin to treat type 1 diabetes mellitus. For which of the following types of insulin should clients to expect a peak effect 1 to 5 hr after administration? 1 - Insulin glargine 2 - NPH insulin 3 - Regular insulin 4 - Insulin lispro

3 - Regular insulin Rational 1 - Insulin glargine a long-acting insulin, does not have a peak effect time, but is stable in effect for 24 hr following admin 2 - NPD insulin has a peak effect of 6 to 14 hr following admin 3 - Regular insulin has a peak effect of 1-5 hr following admin 4 - Insulin lispro has a peak effect of 30 min to 2.5 hr following admin

A nurse is reviewing laboratory results from a client who is at 28 weeks of gestation and has gestational diabetes. The nurse notes that blood glucose levels taken 1 hr following a meal range from 145 mg/dL to 162 mg/dL over the past week. Which of the following actions should the nurse take? 1 - Obtain an HbA1c 2 - Schedule a 3-hr oral glucose tolerance test 3 - Reinforce instruction about insulin administration 4 - Tell the client to increase carbohydrates to 65% of daily nutritional intake

3 - Reinforce instruction about insulin administration Rational 1 - An HbA1c level reflects the average blood glucose level over a 3-month period. This value might not reflect the current high blood glucose levels, as this client might not have had altered blood glucoses for that length of time. 2 - A 3-hr oral glucose tolerance test is used to diagnose gestational diabetes. 3 - ​The nurse should anticipate the induction of insulin to a client who has gestational diabetes and is experiencing increased blood glucose levels. 4 - Carbohydrates should be restricted to 50% of daily calorie intake for clients who have gestational diabetes. Increasing carbohydrate intake will increase blood glucose levels.

A patient with type 1 diabetes mellitus (DM) plays tennis and asks if she will be able to continue with that sport. The nurse should base his response on which information? 1 - It would be better to take up walking or some quiet sport. 2 - She can play tennis, but she will need an extra dose of insulin. 3 - She can play tennis, but she will need to eat more before she plays. 4 - She cannot play tennis because heavy exercise is not permitted with this type of diabetes.

3 - She can play tennis, but she will need to eat more before she plays. Rational Exercise is recommended for the patient with diabetes. Exercise will require changes in both diet and insulin use. Eating before exercise will aid in the prevention of hypoglycemia.

A nurse is caring for a client who takes repaglinide 15 to 30 min before each meal to treat type 2 diabetes mellitus. The client asks, "If I can skip a meal, what should I do?" Which of the following responses should the nurse make? 1 - Double the dose before the next meal 2 - Take half the dose 3 - Skip the dose 4 - Take the usual dose

3 - Skip the dose Rational 1 - Taking a double dose of repaglinide, a meglitinide, before the next meal puts the client at risk for hypoglycemia. 2- Taking half the dose of repaglinide, a meglitinide, without the meal puts the client at risk for hypoglycemia. 3 - To avoid a sudden and serious drop in blood glucose level, the client should skip the dose of repaglinide, a meglitinide, whenever skipping a meal. The nurse should also instruct the client to try to avoid skipping meals. 4 - Taking the full dose of repaglinide, a meglitinide, without the meal puts the client at risk for hypoglycemia.

A nurse is reinforcing teaching with a school-age child who has type 1 diabetes mellitus and his parents about illness management. Which of the following instructions should the nurse include? 1 - Withhold insulin dose if feeling nauseous 2 - Notify the provider if blood glucose levels are over 350 mg/dL 3 - Test the urine for ketones. 4 - Limit fluid intake during meal times.

3 - Test the urine for ketones. Rational 1 -The child should never omit usual insulin doses when ill because the stress of acute illness usually results in elevated blood glucose levels. 2 - The parent should notify the provider if blood glucose levels are over 250 mg/dL in order to initiate treatment before injury can occur. 3 - The parent or child should test the urine for ketones and report the presence of them in the urine. Ketonuria can indicate that the child does not have enough glucose for energy and is breaking down fats to provide glucose to cells. 4 - Fluid intake is the most important intervention during acute illness in order to prevent dehydration and promote urinary excretion of ketones.

A nurse is providing education on how to check blood glucose levels to a client who has a new diagnosis of type 1 diabetes mellitus. The nurse should include which of the following instructions about transferring blood onto the reagent portion of the test strip? 1 - Smear the blood onto the strip 2 - Squeeze the blood onto the strip 3 - Touch the puncture to stimulate bleeding 4 - Hold the test strip next to the blood on the fingertip

3 - Touch the puncture to stimulate bleeding

A nurse is caring for a client who is taking pioglitazone to treat type 2 diabetes mellitus. The nurse should monitor for which of the following findings? 1 - Joint pain 2 - Constipation 3 - Weight gain 4 - Dilated pupils

3 - Weight gain Rational 1 - Pioglitazone, a thiazolidinedione, is more likely to cause muscle pain than joint pain. 2 - Pioglitazone, a thiazolidinedione, is more likely to cause diarrhea than constipation. 3 - Pioglitazone, a thiazolidinedione, can cause fluid retention. The nurse should monitor the client for weight gain and other indications of fluid retention or heart failure, including dyspnea, crackles, and wheezing. 4 - Pioglitazone, a thiazolidinedione, is more likely to cause blurred vision than dilated pupils.

A nurse is collecting data from a client who has type 1 diabetes mellitus. Which of the following findings should the nurse expect? 1 - Blurred vision 2 - Pruritus 3 - Weight loss 4 - Drowsiness

3 - Weight loss Rational 1 - Blurred vision is a manifestation of type 2 diabetes mellitus. 2 - Pruritus is a manifestation of type 2 diabetes mellitus. 3 - Weight loss is a manifestation of type 1 diabetes mellitus. 4 - Drowsiness is a manifestation of type 2 diabetes mellitus. The nurse should expect a client who has type 1 diabetes mellitus to exhibit irritability, rather than drowsiness.

A nurse attempts to collect a capillary blood specimen via finger stick for a blood glucose monitoring from a client who has diabetes mellitus. The nurse is unable to obtain an adequate drop of blood for the reagent strip. Which of the following actions should the nurse take first? 1 - Puncture another finger to obtain a capillary specimen 2 - Test the urine with a urine reagent strip 3 - Wrap the hand in a warm, moist cloth 4 - Perform a venipuncture to obtain a venous sample

3 - Wrap the hand in a warm, moist cloth

A nurse is caring for a child who has type 1 diabetes mellitus. The nurse should identify which of the following findings are manifestations of diabetic ketoacidosis? (Select all) 1 - Blood glucose 58 mg/dL 2 - Weight gain 3 - Dehydration 4 - Mental confusion 5 - Fruity breath

3, 4 & 5 3 - Dehydration 4 - Mental confusion 5 - Fruity breath Rational 1 - DKA is classified as a blood glucose level greater than 300 mg/dL 2 - Clients who have DKA display weight loss

The nurse is providing discharge teaching to a patient recently diagnosed with type 2 DM. The nurse should include information on which long-term consequences of poor glycemic control? (Select all that apply) 1 - Depression 2- Hypertension 3 - Recurrent infections 4 - Delayed wound healing 5 - Peripheral vascular disease

3, 4 & 5 3 - Recurrent infections 4 - Delayed wound healing 5 - Peripheral vascular disease Rational Long-term consequences of poor glycemic control can result in recurrent infections, delayed wound healing, and peripheral vascular disease. Depression and hypertension are not direct consequences of poor glycemic control.

A nurse is reinforcing teaching about foot care with a client who has diabetes mellitus. Which of the following informations should the nurse include in the teaching? (Select all) 1 - Removing calluses using over-the-counter remedies 2 - Apply lotion between toes 3 - Perform nail care after bathing 4 - Trim toenails straight across 5 - Wear closed-toed shoes

3, 4, & 5 3 - Perform nail care after bathing 4 - Trim toenails straight across 5 - Wear closed-toed shoes

A nurse is teaching self-monitoring of blood glucose (SMBG) to a client who has diabetes mellitus. Which of the following instructions should the nurse include? (Select all) 1 - Perform SMBG once daily at bedtime 2 - Wipe the hand with an alcohol swab 3 - Hold the hand in a dependent position prior to the puncture 4 - Place the puncturing device perpendicular to the site 5 - Prink the outer edge of the fingertip for the blood sample

3, 4, 5 3 - Hold the hand in a dependent position prior to the puncture 4 - Place the puncturing device perpendicular to the site 5 - Prink the outer edge of the fingertip for the blood sample Rational 1 - A client can perform SMBG as often as before each meal and at bedtime. Generally, the timing and frequency of SMBG testing correlates with the client's medication schedule. Monitoring once a day at bedtime dose not provide enough information to monitor blood glucose control effectively 2 - The client should wash his hands with warm water and soap. Alcohol can alter the blood glucose reading.

A nurse is preparing to administer 10 units of regular insulin and 20 units of NPH insulin to a client. What is the sequence of events the nurse should follow? 1 - Inject air into NPH insulin vial 2 - Withdraw short-acting insulin into syringe 3 - Inspect vials for contaminants. 4 - Inject air into regular insulin vial 5 - Roll NPH vial between palms fo hands 6 - Add intermediate insulin to syringe

3, 5, 1, 4, 2, 6 1 - Inspect vials 2 - Roll NPH 3 - Inject air into NPH 4 - Inject air into regular insulin 5 - Withdraw short-acting insulin 6 - Add intermediate insulin

A nurse is teaching a newly licensed nurse about insulin storage. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching? 1 - "I will store unopened vials of insulin in the freezer." 2 - "I will return any unused vials of insulin to the pharmacy once they have been on the unit for 1 month." 3 - "I will discard the current vial of insulin after 6 doses have been withdrawn." 4 - "I can keep the current vial of insulin in use stored at room temperature."

4 - "I can keep the current vial of insulin in use stored at room temperature." Rational 1 - Unopened vials of insulin should be stored in the refrigerator but not frozen. 2 - The nurse can use unopened vials of insulin stored under refrigeration until the date of expiration on the vial. 3 - The nurse can administer as many doses as needed from the current vial of insulin for up to 1 month 4 - The nurse can store the current vial of insulin at room temperature for up to 1 month.

A nurse is reinforcing teaching with a client who has type 1 diabetes mellitus. Which of the following statements from the client indicates to the nurse the teaching is effective? 1 - "I will shake the insulin vial vigorously to mix." 2 - "I will freeze unopened insulin vials." 3 - "I should increase my insulin when I exercise." 4 - "I should inject the insulin into my abdominal area."

4 - "I should inject the insulin into my abdominal area." Rational 1 - The client who has type 1 diabetes should gently roll the insulin vial to mix, to prevent bubbles which can alter the dose. 2 - The client should refrigerate, not freeze, unopened insulin vials. 3 - The client should monitor blood glucose closely to regulate insulin needs and prevent hypoglycemia. Exercise can reduce the client's need for insulin. 4 - The client should give insulin injections in one anatomic area for consistent day-to-day absorption. The abdomen is the area for fastest absorption.

A nurse is caring for a 7-year-old client who has an upper respiratory infection and a history of type 1 diabetes mellitus. Which of the following statements by the mother indicates a need for further instruction? 1 - "I will encourage him to drink a half a cup of water or sugar-free fluid ever 30 minutes." 2 - "I will report a changes in breathing or signs of confusion." 3 - "I will notify the doctor if his temperature is not controlled with acetaminophen." 4 - "I will continue to check his blood sugar two times every day.

4 - "I will continue to check his blood sugar two times every day. Rational 1 - Although managing insulin and food are important in the care of an ill child who has diabetes, increasing oral fluids is considered a priority intervention. Increasing oral fluids will help prevent dehydration and flush out ketones. The child should be encouraged to drink 120 mL (4 oz) of sugar-free fluids every 30 min during the course of the illness. 2 - Increased ketones in the blood cause acidosis. In order to release excess acid from the blood, the lungs will attempt to release as much carbon dioxide as possible by increasing the rate and depth of respirations. This type of breathing is called Kussmaul respirations. In addition, acidosis can cause a change in mental status. A change in breathing accompanied by confusion can indicate the development of diabetic ketoacidosis and should be reported to the provider immediately. 3 - An elevated temperature increases the metabolic demands of the body and increases the risk of dehydration, particularly in children. If the child develops a temperature higher than 38.8° C (102° F), a fever that does not respond to acetaminophen, or that lasts longer than 12 hr, the provider should be notified. 4 - A client who has type 1 diabetes mellitus is at risk of developing diabetic ketoacidosis (DKA), a life-threatening complication of diabetes. DKA occurs when glucose levels become extremely elevated, resulting in severe hyperglycemia, fluid volume depletion, acidosis, and electrolyte imbalances. During this process, the body will begin to break down fat for energy, which results in the development of ketones in the blood known as ketoacidosis. These ketones are excreted in the urine, and this is called ketonuria. Illness increases the risk of a client developing DKA. Because acute illness increases glucose levels, the glucose and the urine ketones should be checked every 3 hr. Some elevations in glucose and ketones are to be expected during illness and should be managed with increased insulin. Insulin should never be withheld during an acute illness, but dosage requirements may change.

A nurse is reinforcing teaching with a client who has diabetes mellitus and self-administers insulin. The client reports drinking an occasional glass of wine. Which of the following is an appropriate response by the nurse? 1 - "Wine is loaded with carbohydrates, so you should try to avoid it." 2 - "You may have no more than three drinks a day." 3 - "Drinking plenty of water with your wine will lessen its effects." 4 - "It is best for you to drink an occasional glass of wine with a meal."

4 - "It is beset for you to drink an occasional glass of wine with a meal." Rational 1 - Wine contains carbohydrates in varying amounts and may raise the client's blood glucose level or place the client at risk of nighttime hypoglycemia. Limiting the number of drinks per day can prevent diabetic complications. 2 - The client who has diabetes mellitus may drink alcohol in moderation. For women, that means one drink or less per day and for men, two drinks or less per day because of the high carbohydrate content. 3 - Water will not reduce the client's risk of hypoglycemia when drinking alcohol. Alcohol beverages are high in carbohydrates even when diluted. 4 - Ingesting alcohol with a meal helps reduce the risk of nighttime hypoglycemia for clients who receive insulin therapy.

A nurse is reinforcing discharge teaching with a parent of a child who has a new diagnosis of diabetes mellitus. Which of the following statements by the parent requires a clarification of the teaching? 1 - "The onset of low blood glucose usually occurs rapidly." 2 - "My son might complain of feeling shaky when he has a low blood glucose level." 3 - "Sweating can occur with hypoglycemia." 4 - "My son might have nausea and vomiting with hypoglycemia."

4 - "My son might have nausea and vomiting with hypoglycemia." Rational​ 1- Hypoglycemia typically occurs rapidly, within minutes. 2 - ​A shaky feeling is consistent with a finding of hypoglycemia. 3 -The appearance of pallor and sweating occurs with hypoglycemia. 4 - This statement requires clarification as nausea and vomiting occur with hyperglycemia.

A nurse is reinforcing reaching with a school-age child who has diabetes mellitus about insulin administration. Which of the following instructions should the nurse include? 1 - "You should inject the needle at a 30-degree angle." 2 - "You should combine glargine and regular insulin in the same syringe." 3 - "You should aspirate for blood before injecting the insulin." 4 - "You should give four to five injections in one area before switching sites."

4 - "You should give four to five injections in one area before switching sites."

A nurse is caring for a client who is prescribed 15 units of NPH insulin to be administered at 0700. At which of the following times a day is most appropriate for the nurse plan to offer a snack? 1 - 0730 2 - 0900 3 - 1230 4 - 1500

4 - 1500 Rational 1 - The client is at risk for hypoglycemia due to taking insulin. However, since the onset of action for NPH insulin is 1 to 2 hr after administration, there is another time that is more appropriate for the nurse to offer a snack. Clients taking rapid acting insulin, such as insulin lispro, can require food just before or immediately after insulin administration. 2 - The client is at risk for hypoglycemia due to taking insulin. However, since the onset of action for NPH insulin is 1 to 2 hr after administration and the 0900 time frame falls just after breakfast, there is another time is more appropriate for the nurse to plan to offer a snack. Clients taking regular insulin are at high risk for hypoglycemia 2 hr after administration. 3 - The client is at risk for hypoglycemia due to taking insulin. However, since the peak action for NPH insulin begins 4 to 6 hr after administrations and the 1230 time frame falls just after lunch, there is another time is more appropriate for the nurse to plan to offer a snack. 4 - Taking NPH insulin indicates that this client is at greatest risk for hypoglycemia about 8 hr after administration, in the middle of the peak action time. The nurse should plan to offer the client a snack during the middle of the afternoon between lunch and dinner to maintain the client's blood glucose level.

A nurse is preparing to administer morning insulin to a client who has a persecution for 14 units of regular insulin and 28 units of NPH insulin subcutaneous daily. What is the total number of units of insulin that the nurse should prepare in the insulin syringe? 1 - 14 units 2 - 28 units 3 - 32 units 4 - 42 units

4 - 42 units Rational 4 - The nurse should combine the 14 units of regular insulin and the 28 units of NPH insulin in the same syringe for a combined total of 42 units of insulin in the syringe.

The nurse teaches a patient with diabetes to limit saturated fat and sodium intake because: 1 - All diabetic patients are at risk for obesity. 2 - These foods contribute to higher glucose levels 3 - These nutrients are nonessential 4 - Diabetic patients are at risk for cardiovascular disease

4 - Diabetic patients are at risk for cardiovascular disease Rationale Patients with diabetes are at a greater risk of developing cardiovascular disease, so it is recommended that they follow American Heart Association guidelines. However, some experts recommend reduction of cholesterol to an even greater extent for people with diabetes (200 mg/day).

A nurse is teaching the parents of a child who has diabetes mellitus about the manifestations of hypoglycemia. Which of the following manifestations should the nurse include in the teaching? 1 - Fruity breath odor 2 - Dry mucous membranes 3 - Polyuria 4 - Diaphoresis

4 - Diaphoresis Rational 1 - A fruity breath odor is a manifestation of hyperglycemia. 2- Dry mucous membranes are a manifestation of hyperglycemia. 3 - Polyuria is a manifestation of hyperglycemia. 4 - Diaphoresis is a manifestation of hypoglycemia.

A nurse is reinforcing teaching with a client who is to self-administer regular insulin and NPH insulin from the same syringe. Which of the following instructions should the nurse provide? 1 - Draw up the NPH insulin into the syringe first 2 - Inject air into the regular insulin first 3 - Shake the NPH insulin until it is well-mixed 4 - Discard regular insulin if it appears cloudy

4 - Discard regular insulin if it appears cloudy Rational 1 - The nurse should teach the client that when mixing regular and NPH insulin in the same syringe, the client should draw up the regular insulin into the syringe first to prevent contamination of the vial of short acting insulin. 2- The nurse should teach the client that air should be injected into the NPH vial first and that he should avoid allowing the end of the needle from coming in contact with the NPH insulin. 3 - The nurse should teach the client to roll the vial of NPH insulin between the palms of the hands. The client should avoid shaking the insulin vial because this will cause the insulin solution to form bubbles, which can result in inaccurate dosage. 4 - The nurse should teach the client to discard regular insulin that appears cloudy. All insulin preparations except NPH should be clear. NPH insulin has a cloudy appearance.

A nurse is preparing to administer subcutaneous regular insulin to a client before he eats breakfast at 0800. Which of the following actions should the nurse take? 1- Give the insulin at 0700 2 - Give the insulin when the breakfast tray arrives 3 - Give the insulin 30 min after breakfast with other routine medicines. 4 - Give the insulin at 30 min before breakfast.

4 - Give the insulin at 30 min before breakfast. Rational 1- This time is too soon for the nurse to administer insulin to the client. The nurse should administer regular insulin 30 min before meals. 2 - Administering insulin when the client's breakfast tray arrives is too late. The nurse should administer regular insulin 30 min before meals. 3- Administering insulin 30 minutes after the client has ate breakfast it too late. The nurse should administer regular insulin 30 min before meals. 4 - The nurse should administer regular insulin 30 min before meals.

Which of the following drugs should a nurse have available for a client who is experiencing insulin toxicity? 1 - Naloxone 2 - Diphenhydramine 3 - Acetylcysteine 4 - Glucagon

4 - Glucagon Rational 1 - Naloxone, an opiate antagonist, treats opioid toxicity, not insulin toxicity. 2 - Diphenhydramine, a cholinergic antagonist and an antihistamine, treats drug-induced extrapyramidal effects. Diphenhydramine is ineffective for insulin toxicity. 3 - Acetylcysteine, a mucolytic, treats acetaminophen toxicity, not insulin toxicity. 4 - Glucagon, a hyperglycemic that can be given subcutaneously, IM, or IV, is used to treat severe hypoglycemia from insulin toxicity in clients who are unconscious and for whom IV glucose is not readily available. If the client does not respond to glucagon, the nurse should administer a glucose solution IV.

In discussing DM with a patient, it is important to base the discussion on which information regarding the disease? 1 - It can often be cured by insulin therapy. 2 - It has no cure and is considered "hopeless." 3 - It has no specific treatment other than use of insulin. 4 - It can often be controlled by diet and regular exercise.

4 - It can often be controlled by diet and regular exercise. Rational DM can be controlled with diet, exercise, and medications. The condition is not hopeless; many people lead productive lives after having the diagnosis. Treatments are multifaceted. Each patient's plan of care is individualized based on the type of diabetes and specific health history. Diabetes is a chronic condition and is not curable but managed.

A nurse is teaching a client about self-administering regular insulin. The nurse should instruct the client to rotate injection sites to prevent which of the following? 1 - Rapid absorption 2 - Intradermal injection 3 - Injection pain 4 - Lipohypertrophy

4 - Lipohypertrophy Rational 1 - Rotating insulin injection sites does not prevent rapid absorption. Using the same injection site, specifically the abdomen, speeds absorption, while using the thigh allows for the slowest absorption. 2 - Rotating insulin injection sites does not affect the risk for intradermal injection because the appropriate areas for insulin injection contain adequate subcutaneous tissue in most clients. 3 - Rotating insulin injection sites is unlikely to affect injection pain. The depth of the injection affects pain; deeper IM injections are more painful and are also inappropriate for insulin injection. 4 - Lipohypertrophy is a proliferation of fat at the sites of repeated insulin injections. It affects skin sensitivity and appearance. To prevent it, the client should rotate injection sites, keeping them at least 2.5 cm (1 in) apart, and avoid using the same spot within the same month.

A nurse is caring for a client in an outpatient facility who has been taking acarbose for type 2 diabetes mellitus. Which of the following laboratory test should the nurse monitor? 1 - WBC 2 - Serum potassium 3 - Platelet count 4 - Liver function tests

4 - Liver function tests Rational 1 - infection is not an adverse effect of acarbose. It is not necessary to monitor WBC while the client is taking this medication. 2 - Acarbose does not affect potassium levels. 3 - Acarbose does not affect platelet levels. 4 - Acarbose can cause liver toxicity when taken long-term. Liver function tests should be monitored periodically while the client takes this medication

Which of the following statements is true regarding diabetes mellitus (DM)? 1 - T2DM usually develops after age 20 2 - Asian Americans are at greater risk for development of DM 3 - The majority of carbohydrates should be from simple carbohydrates 4 - Patients with DM are at higher risk for kidney disease.

4 - Patients with DM are at higher risk for kidney disease. Rational Diabetic patients are at higher risk for cardiovascular disease, hypertension, kidney disease, blindness, and stroke. T2DM usually develops after age 40. Americans of African-American and Hispanic ethnic background are at greater risk for development of DM. The majority of carbohydrates should be complex.

A nurse is assessing a client who has a new prescription for levothyroxine. The nurse should identify which of the following findings as a contraindication for this drug? 1 - Bacterial skin infections 2 - Diabetes insipidus 3 - Immunosuppression 4 - Recent myocardial infarction

4 - Recent myocardial infarction Rational 1 - Clients who have bacterial skin infections can take levothyroxine, a thyroid replacement hormone. Fludrocortisone is an endocrine-system drug that requires cautious use with clients who have bacterial skin infections. 2 - Clients who have diabetes insipidus can take levothyroxine, a thyroid replacement hormone. It requires cautious use with clients who have diabetes mellitus. 3 - Clients who are immunosuppressed can take levothyroxine, a thyroid replacement hormone. Propylthiouracil (PTU) is an endocrine-system drug that requires cautious use with clients who are immunosuppressed. 4 - Levothyroxine, a thyroid replacement hormone, can cause tachycardia, palpitations, and hypertension, especially when the client requires a dosage adjustment. Therefore, it is contraindicated for clients who have recently had a myocardial infarction.

A nurse should recognize that a provider will prescribe a lower dose of sitagliptin for a client who has type 2 diabetes mellitus and who also has which of the following? 1 - Thyroid disease 2 - Bronchitis 3 - Heart failure 4 - Renal impairment

4 - Renal impairment Rational 1 - Clients who have thyroid disease can take a regular prescribed dose of sitagliptin, a gliptin. Glipizide is an endocrine-system drug that requires cautious use with clients who have thyroid disease. 2 - Clients who have bronchitis can take a regular prescribed dose of sitagliptin, a gliptin. The drug requires cautious use with clients who have a history of pancreatitis. 3 - Clients who have heart failure can take a regular prescribed dose of sitagliptin, a gliptin. Metformin is an endocrine-system drug that is contraindicated for clients who have heart failure. 4 - Sitagliptin, a gliptin, requires cautious use with clients who have renal dysfunction and low creatinine clearance because the kidneys eliminate the drug virtually intact. The provider should prescribe a lower dose for this client or prescribe a different hypoglycemic drug.

A nurse is reinforcing teaching of a female client who has a family history of type 2 diabetes mellitus. The nurse should include which of the following risk factors for developing type 2 diabetes mellitus in the teaching? 1 - Recent viral infection 2 - Blood glucose of 98 mg/dL 3 - Triglyceride level of 100 mg/dL 4 - Sedentary lifestyle

4 - Sedentary lifestyle Rational 1 - Viral infections have been linked to the development of type 1 diabetes mellitus, but are not associated with type 2 diabetes mellitus. 2 - The client is not at risk for type 2 diabetes mellitus with a blood glucose of 98 mg/dL, which is within the normal reference range. 3 - The client is not at risk for type 2 diabetes mellitus with triglyceride level of 100 mg/dL, which is within the normal reference range. 4 - Risk factors for the development of type 2 diabetes mellitus include obesity, a sedentary lifestyle, and a high-calorie diet.

When teaching a patient with type 1 diabetes about home care, the LPN/LVN would be sure to include which signs of diabetic ketoacidosis? 1 - Dark, scanty urine, and diarrhea 2 - Cool, clammy skin, and nervousness 3- Hunger, headache, and tremulousness 4 - Thirst, dry mucous membranes, and dry skin

4 - Thirst, dry mucous membranes, and dry skin Rational Diabetic ketoacidosis is a condition associated with excessively high blood glucose levels. It may be caused by illness, stress, or significant lack of insulin. Early manifestations include thirst, dry mucous membranes, and dry skin. Cool, clammy skin; headache; and hunger are noted with hypoglycemia. Diarrhea and low urine output are not linked to ketoacidosis.

A patient who works as a personal trainer is diagnosed with insulin-dependent diabetes. What should the nurse teach regarding self-administration of regular insulin. 1 - If you have a strenuous workout, skip your insulin for the day 2 - Inject the insulin before moderate exercise 3 - Exercise during the insulin peak of action 4 - Use the abdomen as an insulin injection site.

4 - Use the abdomen as an insulin injection site. Rational The abdomen is a good site for insulin injection as absorption is steady, rapid, and not affected by exercise. Do not encourage the patient to skip insulin doses. Diabetics must learn to balance their nutrition, exercise, and insulin doses. Instruct the patient to eat a light snack before exercising. Depending on the type of insulin and the onset of action, injecting the insulin before exercise may cause a hypoglycemic reaction. Exercising during the peak of insulin will increase the chances of hypoglycemia.

The nurse answers the call light for a patient with diabetes. The patient states she feels shaky and weak. The nurse notes pallor and moist skin. List in priority order the actions of the nurse 1 - Give patient 6 oz of juice 2 - Document interventions 3 - Check finger stick glucose 4 - Assess level of consciousness

4, 3, 1, 2 Assess, finger stick, juice, and document Rational The level of consciousness determines the glucose intervention. If the patient is not able to swallow, injectable forms of glucose will be utilized. If the patient is unconscious, treatment should be initiated immediately, not taking time for checking the blood glucose level. For the conscious patient, fingerstick glucose should be done and treatment given and actions documented. Fifteen minutes after treatment, the glucose should be rechecked.