Diabetes prep pt2
For a diabetic male client with a foot ulcer, the physician orders bed rest, a wet-to-dry dressing change every shift, and blood glucose monitoring before meals and bedtime. Why are wet-to-dry dressings used for this client? They contain exudate and provide a moist wound environment. They protect the wound from mechanical trauma and promote healing. They debride the wound and promote healing by secondary intention. They prevent the entrance of microorganisms and minimize wound discomfort.
They debride the wound and promote healing by secondary intention. For this client, wet-to-dry dressings are most appropriate because they clean the foot ulcer by debriding exudate and necrotic tissue, thus promoting healing by secondary intention. Moist, transparent dressings contain exudate and provide a moist wound environment. Hydrocolloid dressings prevent the entrance of microorganisms and minimize wound discomfort. Dry sterile dressings protect the wound from mechanical trauma and promote healing.
A male client with type 1 diabetes mellitus has a highly elevated glycosylated hemoglobin (Hb) test result. In discussing the result with the client, nurse Sharmaine would be most accurate in stating: A "The test needs to be repeated following a 12-hour fast." B "It looks like you aren't following the prescribed diabetic diet." C "It tells us about your sugar control for the last 3 months." D "Your insulin regimen needs to be altered significantly."
"It tells us about your sugar control for the last 3 months." The glycosylated Hb test provides an objective measure of glycemic control over a 3-month period. The test helps identify trends or practices that impair glycemic control, and it doesn't require a fasting period before blood is drawn. The nurse can't conclude that the result occurs from poor dietary management or inadequate insulin coverage.
During a class on exercise for diabetic clients, a female client asks the nurse educator how often to exercise. The nurse educator advises the clients to exercise how often to meet the goals of planned exercise? At least once a week At least three times a week At least five times a week Every day
At least three times a week
Nurse Wayne is aware that a positive Chvostek's sign indicate? Hypocalcemia Hyponatremia Hypokalemia Hypermagnesemia
Hypocalcemia Chvostek's sign is elicited by tapping the client's face lightly over the facial nerve, just below the temple. If the client's facial muscles twitch, it indicates hypocalcemia. Hyponatremia is indicated by weight loss, abdominal cramping, muscle weakness, headache, and postural hypotension. Hypokalemia causes paralytic ileus and muscle weakness. Clients with hypermagnesemia exhibit a loss of deep tendon reflexes, coma, or cardiac arrest.
A client with type 1 diabetes is admitted to an acute care facility with diabetic ketoacidosis. To correct this acute diabetic emergency, which measure should the health care team take first? Initiate fluid replacement therapy. Administer insulin. Correct diabetic ketoacidosis. Determine the cause of diabetic ketoacidosis.
Initiate fluid replacement therapy. The health care team first initiates fluid replacement therapy to prevent or treat circulatory collapse caused by severe dehydration. Although diabetic ketoacidosis results from insulin deficiency, the client must have an adequate fluid volume before insulin can be administered; otherwise, the drug won't circulate throughout the body effectively. Therefore, insulin administration follows fluid replacement therapy. Determining and correcting the cause of diabetic ketoacidosis are important steps, but the client's condition must first be stabilized to prevent life-threatening complications.
Which category of oral antidiabetic agents exerts the primary action by directly stimulating the pancreas to secrete insulin? Thiazolidinediones Biguanides Alpha-glucosidase inhibitors Sulfonylureas
Sulfonylureas A functioning pancreas is necessary for sulfonylureas to be effective. Thiazolidinediones enhance insulin action at the receptor site without increasing insulin secretion from the beta cells of the pancreas. Biguanides facilitate the action of insulin on peripheral receptor sites. Alpha-glucosidase inhibitors delay the absorption of glucose in the intestinal system, resulting in a lower postprandial blood glucose level.
The nurse is administering an insulin drip to a patient in ketoacidosis. What insulin does the nurse know can be used intravenously? short-acting rapid acting intermediate-acting long-acting
short-acting
Dr. Kennedy prescribes glipizide (Glucotrol), an oral antidiabetic agent, for a male client with type 2 diabetes mellitus who has been having trouble controlling the blood glucose level through diet and exercise. Which medication instruction should the nurse provide? "Be sure to take glipizide 30 minutes before meals." "Glipizide may cause a low serum sodium level, so make sure you have your sodium level checked monthly." "You won't need to check your blood glucose level after you start taking glipizide." "Take glipizide after a meal to prevent heartburn."
"Be sure to take glipizide 30 minutes before meals." The client should take glipizide twice a day, 30 minutes before a meal, because food decreases its absorption. The drug doesn't cause hyponatremia and therefore doesn't necessitate monthly serum sodium measurement. The client must continue to monitor the blood glucose level during glipizide therapy.
Acarbose (Precose), an alpha-glucosidase inhibitor, is prescribed for a female client with type 2 diabetes mellitus. During discharge planning, nurse Pauleen would be aware of the client's need for additional teaching when the client states: "If I have hypoglycemia, I should eat some sugar, not dextrose." "The drug makes my pancreas release more insulin." "I should never take insulin while I'm taking this drug." "It's best if I take the drug with the first bite of a meal."
"If I have hypoglycemia, I should eat some sugar, not dextrose." Acarbose delays glucose absorption, so the client should take an oral form of dextrose rather than a product containing table sugar when treating hypoglycemia. The alpha-glucosidase inhibitors work by delaying the carbohydrate digestion and glucose absorption. It's safe to be on a regimen that includes insulin and an alpha-glucosidase inhibitor. The client should take the drug at the start of a meal, not 30 minutes to an hour before.
When the dawn phenomenon occurs, the patient has relatively normal blood glucose until approximate what time of day? 3 AM 5 AM 7 AM 9 AM
3 AM During the dawn phenomenon, the patient has a relatively normal blood glucose level until about 3 AM, when the level begins to rise.
A female adult client with a history of chronic hyperparathyroidism admits to being noncompliant. Based on initial assessment findings, the nurse formulates the nursing diagnosis of Risk for injury. To complete the nursing diagnosis statement for this client, which "related-to" phrase should the nurse add? Related to bone demineralization resulting in pathologic fractures Related to exhaustion secondary to an accelerated metabolic rate Related to edema and dry skin secondary to fluid infiltration into the interstitial spaces Related to tetany secondary to a decreased serum calcium level
Related to bone demineralization resulting in pathologic fractures Poorly controlled hyperparathyroidism may cause an elevated serum calcium level. This, in turn, may diminish calcium stores in the bone, causing bone demineralization and setting the stage for pathologic fractures and a risk for injury.
When caring for a female client with a history of hypoglycemia, nurse Ruby should avoid administering a drug that may potentiate hypoglycemia. Which drug fits this description? sulfisoxazole (Gantrisin) mexiletine (Mexitil) prednisone (Orasone) lithium corbonate (Lithobid)
sulfisoxazole (Gantrisin) Sulfisoxazole and other sulfonamides are chemically related to oral antidiabetic agents and may precipitate hypoglycemia. Mexiletine, an antiarrhythmic, is used to treat refractory ventricular arrhythmias; it doesn't cause hypoglycemia. Prednisone, a corticosteroid, is associated with hyperglycemia. Lithium may cause transient hyperglycemia, not hypoglycemia.
An agitated, confused female client arrives in the emergency department. Her history includes type 1 diabetes mellitus, hypertension, and angina pectoris. Assessment reveals pallor, diaphoresis, headache, and intense hunger. A stat blood glucose sample measures 42 mg/dl, and the client is treated for an acute hypoglycemic reaction. After recovery, the nurse teaches the client to treat hypoglycemia by ingesting: 2 to 5 g of a simple carbohydrate. 10 to 15 g of a simple carbohydrate. 18 to 20 g of a simple carbohydrate.
10 to 15 g of a simple carbohydrate. To reverse hypoglycemia, the American Diabetes Association recommends ingesting 10 to 15 g of a simple carbohydrate, such as three to five pieces of hard candy, two to three packets of sugar (4 to 6 tsp), or 4 oz of fruit juice. If necessary, this treatment can be repeated in 15 minutes. HELPS RAISE BS
Nurse Perry is caring for a female client with type 1 diabetes mellitus who exhibits confusion, light-headedness, and aberrant behavior. The client is still conscious. The nurse should first administer: I.M. or subcutaneous glucagon. I.V. bolus of dextrose 50%. 15 to 20 g of a fast-acting carbohydrate such as orange juice. 10 U of fast-acting insulin.
15 to 20 g of a fast-acting carbohydrate such as orange juice. This client is having a hypoglycemic episode. Because the client is conscious, the nurse should first administer a fast-acting carbohydrate, such as orange juice, hard candy, or honey. If the client has lost consciousness, the nurse should administer either I.M. or subcutaneous glucagon or an I.V. bolus of dextrose 50%. The nurse shouldn't administer insulin to a client who's hypoglycemic; this action will further compromise the client's condition.
A nurse knows to assess a patient with type 1 diabetes for postprandial hyperglycemia. The nurse knows that glycosuria is present when the serum glucose level exceeds: 120 mg/dL 140 mg/dL 160 mg/dL 180 mg/dL
180 mg/dL Glycosuria occurs when the renal threshold for sugar exceeds 180 mg/dL. Glycosuria leads to an excessive loss of water and electrolytes (osmotic diuresis).
A nurse is assigned to care for a patient who is suspected of having type 2 diabetes. Select all the clinical manifestations that the nurse knows could be consistent with this diagnosis. Blurred or deteriorating vision Fatigue and irritability Polyuria and polydipsia Sudden weight loss and anorexia Wounds that heal slowly or respond poorly to treatment
Blurred or deteriorating vision Fatigue and irritability Polyuria and polydipsia Wounds that heal slowly or respond poorly to treatment All the options are correct except for weight loss and anorexia. Obesity is almost always associated with type 2 diabetes.
What HbA1c level is diagnostic for type II diabetes? Possible Answers: Greater than 6.3% Greater than 5.7% Greater than 7.0% Greater than 6.5%
Greater than 6.5% A hemoglobin A1c level of 6.5% or greater is considered diagnostic of type II diabetes. A HgA1c level of less than 6.5% does not exclude a diagnosis of diabetes, however, and should be looked at alongside fasting blood glucose and oral glucose tolerance testing.
A patient is prescribed Glucophage, an oral antidiabetic agent classified as a biguanide. The nurse knows that a primary action of this drug is its ability to: Stimulate the beta cells of the pancreas to secrete insulin. Decrease the body's sensitivity to insulin. Inhibit the production of glucose by the liver. Increase the absorption of carbohydrates in the intestines.
Inhibit the production of glucose by the liver. The action of the biguanides can be found in Table 30-6 in the text.
