Diabetes Quiz
A nurse is teaching a new diabetic client to administer insulin. How will the nurse evaluate if the teaching interventions were appropriate? Ask the client to explain the rationale for injection site rotation. Watch the client identify the appropriate method of injection site rotation on a picture. Observe the client demonstrate an insulin injection and correctly identify the injection site rotation. Listen to the client correctly describe the insulin injection procedure.
Observe the client demonstrate an insulin injection and correctly identify the injection site rotation. Evaluation consists of determining whether the desired client outcomes have been met and whether the nursing interventions were appropriate. Evaluation of the educational material and client teaching should include evaluation of the psychomotor domain, which is the motor skill of insulin injection.
A client is admitted with a diagnosis of diabetic ketoacidosis. An insulin drip is initiated with 50 units of insulin in 100 ml of normal saline solution administered via an infusion pump set at 10 ml/hour. The nurse determines that the client is receiving how many units of insulin each hour? Record your answer using a whole number.
5 To determine the number of insulin units the client is receiving per hour, the nurse must first determine the number of units in each milliliter of fluid (50 units ÷ 100 ml = 0.5 units/ml). Next, multiply the units per milliliter by the rate of milliliters per hour (0.5 units × 10 ml/hr = 5 units).
Every morning, a client with type 1 diabetes receives 15 units of Humulin 70/30. What does this type of insulin contain? 70 units of neutral protamine Hagedorn (NPH) insulin and 30 units of regular insulin 70 units of regular insulin and 30 units of NPH insulin 70% NPH insulin and 30% regular insulin 70% regular insulin and 30% NPH insulin
70% NPH insulin and 30% regular insulin Humulin 70/30 insulin is a combination of 70% NPH insulin and 30% regular insulin.
The nurse is conducting an assessment of an elderly client who is blind. What would the nurse expect to be present in the client's medical history? cerebrovascular accident cancer diabetes mellitus systemic lupus erythematosus
diabetes mellitus Type 2 diabetes is very prevalent, especially in the elderly. Diabetic retinopathy is the primary cause of blindness through destruction of retinal blood vessels. The other conditions, while they may be associated with blindness, are not common causes of blindness.
A client with newly diagnosed type 2 diabetes is admitted to the metabolic unit. The primary goal for this admission is education. Which goal should the nurse incorporate into their teaching plan? maintenance of blood glucose levels between 180 and 200 mg/dl (9.9 and 11.1 mmol/L) smoking reduction but not complete cessation an eye examination every 2 years until age 50 weight reduction through diet and exercise
weight reduction through diet and exercise Type 2 diabetes is commonly obesity-related; therefore, weight reduction may enhance the normalization of the blood glucose level. Weight reduction should be achieved by a healthy diet and exercise to increase carbohydrate metabolism. Blood glucose levels should be maintained within normal limits to prevent the development of diabetic complications. Clients with type 1 or 2 diabetes shouldn't smoke at all because of the increased risk of cardiovascular disease. A funduscopic examination should be done yearly to identify early signs of diabetic retinopathy.
A school-age child experiences symptoms of excessive polyphagia, polyuria, and weight loss. The physician diagnoses type 1 diabetes and admits the child to the facility for insulin regulation. The physician orders an insulin regimen of insulin and isophane insulin administered subcutaneously. How soon after administration can the nurse expect the regular insulin to begin to act? ½ to 1 hour 1 to 2 hours 4 to 8 hours 8 to 10 hours
½ to 1 hour Regular insulin, a rapid-acting insulin, begins to act in ½ to 1 hour, reaches peak concentration levels in 2 to 10 hours, and has a duration of action of 5 to 15 hours.
A nurse in a diabetes clinic receives phone calls from four clients with type 1 diabetes. The nurse returns the call of the client reporting what symptoms as highest priority? "I'm thirsty all the time, and I'm urinating a lot." "I noticed that my urine has a foul odor, and I have a fever." "I'm nauseated this morning and can keep only fluids down." "My blood sugar was 55 mg/dL (3 mmol/L) , so I didn't take my insulin."
"I noticed that my urine has a foul odor, and I have a fever." Urination can be increased with diabetes, but the urine should not have a foul odor. Diabetics are more at risk for urinary tract infections. The client with foul-smelling urine could have an active urinary tract infection and should be the priority for the nurse because a urinary tract infection in a diabetic client may quickly progress to sepsis.
The nurse has been assigned to a client who has had diabetes for 10 years. The nurse gives the client's usual dose of regular insulin at 7 a.m. At 10:30 a.m., the client has light-headedness and sweating. The nurse should contact the physician, report the situation, background, and assessment, and recommend intervention for: Metabolic acidosis. Hyperglycemia. Hypoglycemia. Ketoacidosis.
Hypoglycemia The peak action of regular insulin is approximately 2 to 3 hours after administration. The client is having typical hypoglycemic symptoms. Acidosis results from uncontrolled diabetes mellitus, with hyperpnea (Kussmaul respirations) as the outstanding symptom. The hallmark symptoms of hyperglycemia are increased thirst, fruity breath, and glycosuria. The signs and symptoms of diabetic ketoacidosis include Kussmaul respirations, fruity breath, tachycardia, abdominal pain, nausea, vomiting, headache, thirst, dry skin, and dehydration.
A client with diabetes is being tested for glycosylated hemoglobin. How would the nurse explain the reason for this diagnostic test? It determines the fasting blood glucose level. It determines the average blood glucose level in the previous 2-3 months. It determines the ratio of glucose to hemoglobin. It is used to identify a reduction in hemoglobin because of high glucose levels.
It determines the average blood glucose level in the previous 2-3 months. Blood glucose levels can be monitored with a glucometer and indicate the present state of blood glucose. Glycosylated hemoglobin gives a measure of blood glucose controls over the previous 3 months. This is a better indicator for how effectively the diabetes is being controlled. This diagnostic test is a longer-term monitor of diabetes control compared to the fasting glucose levels. It does not compare levels of glucose to hemoglobin or measure reduced hemoglobin.
A client who has been newly diagnosed with type 1 diabetes asks the nurse, "Why do I have to take two shots of insulin? One shot isn't enough?" What should the nurse should tell the client? "A single shot of long-acting insulin would be preferable." "You might be able to change to oral medications soon." "Two shots will give you better control and decrease complications." "I'll ask the health care provider (HCP) to change your insulin schedule."
"Two shots will give you better control and decrease complications." Research has shown that at least two injections daily provide improved blood glucose control and decreased incidence of target end-organ damage. Type 1 diabetes requires insulin replacement and cannot be managed with oral medications alone. It would be inappropriate to ask the health care provider to change the insulin schedule.
A nurse is teaching a client about type 2 diabetes mellitus. What information would reduce a client's risk of developing this disease? "You should stop cigarette smoking." "Follow a high-protein diet including meat, dairy, and eggs." "Maintain weight within normal limits for your body size and muscle mass." "Prevent developing hypertension by reducing stress and limiting salt intake."
"Maintain weight within normal limits for your body size and muscle mass." The most important factor predisposing to the development of type 2 diabetes mellitus is obesity. Insulin resistance increases with obesity. Cigarette smoking is not a predisposing factor, but it is a risk factor that increases complications of diabetes mellitus. A high-protein diet does not prevent diabetes mellitus, but it may contribute to hyperlipidemia. Hypertension is not a predisposing factor, but it is a risk factor for developing complications of diabetes mellitus.
An adolescent with insulin-dependent diabetes is being taught the importance of rotating the sites of insulin injections. The nurse should judge that the teaching was successful when the adolescent identifies which complication that can result of using the same site? destruction of the fat tissue and poor absorption damage to nerves and painful neuritis thickening of the subcutis and too-rapid insulin uptake development of resistance to insulin and need for increased amounts
destruction of the fat tissue and poor absorption Repeated use of the same injection site can result in atrophy of the fat in the subcutaneous tissue and lead to poor insulin absorption. The neuritis that develops from diabetes is related to microvascular changes that occur. Subcutaneous tissue may thicken and harden, but this leads to decreased, not rapid, insulin absorption. Resistance to insulin is caused by an immune response to the insulin protein.
A client concerned about being diagnosed with type 2 diabetes tells a nurse, "My parent suffered with diabetes for many years and finally died of kidney failure in spite of treatment. Why should I try if I'm going to go through the same thing?" What is the nurse's most appropriate response? "It sounds like your parent's diabetes wasn't under very good control." "Your parent didn't get the proper treatment." "There are no guarantees about how diabetes will progress." "Are you worried that you'll have the same experience as your parent?"
"Are you worried that you'll have the same experience as your parent?" Asking if the client feels they will have the same experience as their parent gives the client an opportunity to vent underlying anxiety. There's nothing to indicate that the client's parent's diabetes wasn't under good control or that the parent had substandard care. Saying there's no guarantee about how diabetes will progress doesn't appropriately address the client's concerns and may increase their anxiety. After the nurse has addressed the client's anxiety, the nurse can more easily address more-specific teaching needs.
The laboratory comes to draw an Hgb A1c. The client asks the nurse what this test represents. Which statement would be correct? "This blood test is done to measure hyperglycemia in your system for 3 to 4 days after you were diagnosed with diabetic ketoacidosis (DKA)." "This test reflects the average blood glucose over a period of approximately 2-3 months." "This test is done to determine length of time that will be needed to correct the diabetic ketoacidosis (DKA) state." "This test is needed to determine which insulin will be needed to prevent another diabetic ketoacidosis (DKA) episode."
"This test reflects the average blood glucose over a period of approximately 2-3 months." Hgb A1c is a measurement of blood glucose over the life of a red blood cell. It measures the percentage of glycated hemoglobin in the blood. All the other choices do not accurately represent the purpose of the test.
An adolescent with well-controlled type 1 diabetes has assumed complete management of the disease and wants to participate in gymnastics after school. To ensure safe participation, the nurse should instruct the client to adjust the therapeutic regimen by: eating a snack before each gymnastics practice. measuring urine glucose level before each gymnastics practice. measuring blood glucose level after each gymnastics practice. increasing morning dosage of intermediate-acting insulin.
eating a snack before each gymnastics practice. Because exercise decreases the blood glucose level, the nurse should instruct the client to eat a snack before engaging in physical activity to prevent a hypoglycemic episode. Measuring urine glucose level before each gymnastics practice is incorrect because the urine glucose level doesn't reflect the current blood glucose level. To prevent hypoglycemia, the blood glucose level should be measured before the activity, not after the activity. Increasing the morning dosage of intermediate-acting insulin may lead to hypoglycemia during gymnastics practice; to avoid this condition, the adolescent may need to decrease, not increase, the morning dosage of intermediate-acting insulin.
Which combination of adverse effects should a nurse monitor for when administering I.V. insulin to a client with diabetic ketoacidosis? hypokalemia and hypoglycemia hypocalcemia and hyperkalemia hyperkalemia and hyperglycemia hypernatremia and hypercalcemia
hypokalemia and hypoglycemia Blood glucose needs to be monitored in clients receiving I.V. insulin because of the risk of hyperglycemia or hypoglycemia. Hypoglycemia might occur if too much insulin is administered. Hypokalemia, not hyperkalemia, might occur because I.V. insulin forces potassium into cells, thereby lowering the plasma level of potassium. Calcium and sodium levels aren't affected by I.V. insulin administration.
A nurse is teaching a school-age child with diabetes and her parents about managing diabetes during illness. The nurse determines that the parents understand the instruction when they indicate that they will make which treatment plan modification on days when the child is ill? holding all carbohydrate-containing foods increasing the frequency of blood glucose monitoring decreasing the sliding scale insulin monitoring morning ketone levels
increasing the frequency of blood glucose monitoring During an illness, cells become more insulin resistant, increasing the risk for hyperglycemia. Clients are advised to check their blood glucose more frequently, as often as every 2 to 3 hours. Clients should continue to take their insulin and are likely to need more during illness to achieve a normal blood glucose level. Simple carbohydrates are often the nutrient source best tolerated if nausea is present, and clients must consume sufficient amounts of carbohydrates to prevent burning fat. Clients are advised that they should check blood or urine ketones every 4 hours to ensure they are not developing ketoacidosis.
When referred to a podiatrist, a client newly diagnosed with diabetes mellitus asks, "Why do you need to check my feet when I'm having a problem with my blood sugar?" The nurse's most helpful response to this statement is "The physician wants to be sure your shoes fit properly so you won't develop pressure sores." "The circulation in your feet can help us determine how severe your diabetes is." "Diabetes can affect sensation in your feet and you can hurt yourself without realizing it." "It's easier to get foot infections if you have diabetes."
"Diabetes can affect sensation in your feet and you can hurt yourself without realizing it" The nurse should make the client aware that diabetes affects sensation in the feet and that they might hurt their foot but not feel the wound. Although it's important that the client's shoes fit properly, this isn't the only reason the client's feet need to be checked. Telling the client that diabetes mellitus increases the risk of infection or stating that the circulation in the client's feet indicates the severity of their diabetes doesn't provide the client with complete information.
A client is coming to the clinic for a follow-up appointment after taking metformin for 9 months. After reviewing the client's HbA1C level of 8.5%, the nurse anticipates what response from the healthcare provider? Refer to diabetes education for an insulin pump. Switch the client to a different oral antidiabetic agent. Order an additional oral antidiabetic agent. Satisfaction with the medication's effectiveness.
Order an additional oral antidiabetic agent. The nurse should anticipate that the healthcare provider will order an additional oral antidiabetic agent, specifically a sulfonylurea. As many as 40% of clients do not experience blood glucose control on one medication. It would not be appropriate to initiate an insulin pump at this time. However, if a combination of oral antidiabetic agents are unsuccessful in keeping glucose levels at an acceptable level, insulin may be used in addition to metformin. The medication has not satisfactorily reduced the client's HbA1C, so the healthcare provider will not be satisfied.
After being sick for three days, a client with a history of diabetes mellitus is admitted to the hospital with diabetic ketoacidosis (DKA). Which diagnostic test will the nurse prioritize in monitoring? serum potassium level serum calcium level serum sodium level serum chloride level
serum potassium level The nurse would prioritize the monitoring of the client's potassium level because potassium leaves the cell during periods of acidosis, causing hyperkalemia, which may cause cardiac arrhythmias. As blood glucose levels normalize with treatment, potassium reenters the cell, causing hypokalemia if levels aren't monitored closely. Hypokalemia places the client at risk for cardiac arrhythmias such as ventricular tachycardia.
Mr. Jay presents with a day of severe abdominal pain. He is scheduled for a CT scan with contrast. One of his home medications is metformin (Glucophage). Once the test is completed the nurse anticipates: Placing Mr. Jay on a regular diet Giving the metformin (Glucophage) immediately Placing Mr. Jay on a fluid restriction Holding the metformin (Glucophage) for 48 hours
Holding the metformin (Glucophage) for 48 hours
A nurse is planning care for a client newly diagnosed with diabetes mellitus type 1. Which statement illustrates an appropriate outcome criterion? The client will correctly demonstrate blood glucose testing prior to discharge. The client will not experience any complications. The client will take medication as scheduled. The client will follow verbal instructions.
The client will correctly demonstrate blood glucose testing prior to discharge. During the planning step of the nursing process, the nurse determines care priorities, develops goals of care, and selects appropriate interventions to achieve these goals. Outcome criterion should be specific and measurable. The other answers have no measurable time frame and are not specific to the disease process of diabetes mellitus.
A nurse is providing dietary instructions to a client with diabetes. What is most important for the nurse to include in teaching for prevention of hypoglycemia? Increase protein intake in the morning. Reduce carbohydrate intake when drinking alcohol. Drink orange juice if lightheadedness occurs. Avoid delaying or skipping meals.
Avoid delaying or skipping meals Hypoglycemia is an important complication in the treatment of diabetes. The risk of hypoglycemia increases as nutritional intake decreases, so it is most important to teach the client to avoid delaying or skipping meals. Carbohydrate intake has the greatest influence on blood glucose levels, so increasing protein in the morning will not prevent hypoglycemic episodes. Drinking alcohol inhibits the release of glucose from the liver; therefore it would be important to increase carbohydrate intake when drinking alcohol. Lightheadedness is a manifestation of hypoglycemia, and drinking orange juice would be the means to treat the hypoglycemia, not prevent it.
A client with diabetes begins to cry and says, "I just can't stand the thought of having to give myself a shot every day." What would be the best response by the nurse? "If you don't give yourself your insulin shots, you'll be at greater risk for complications." "We can teach a family member to give the shots so you won't have to do it." "I can arrange to have a home care nurse give you the shots every day." "What is it about giving yourself the insulin shots that bothers you?"
"What is it about giving yourself the insulin shots that bothers you?" The best response is to allow the client to verbalize fears about performing self-injection. Tactics that increase fear such as threatening the client about complications are not effective in changing behavior. If possible, the client needs to be responsible for self care, including giving self-injections. A nurse for home-care visits is not justified if the client is capable of self-administration.
The nurse is receiving results of a blood glucose level from the laboratory over the telephone. What should the nurse do? Write down the results, read back the results to the caller from the laboratory, and receive confirmation from the caller. Repeat the results to the caller from the laboratory, write the results on scrap paper, and then transfer the results to the medical record. Indicate to the caller that the nurse cannot receive results from lab tests over the telephone and ask the lab to bring the written results to the nurses' station. Request that the laboratory send the results by e-mail to transfer to the client's medical record.
Write down the results, read back the results to the caller from the laboratory, and receive confirmation from the caller. To assure client safety, the nurse first writes the results on the chart, then reads them back to the caller and waits for the caller to confirm that the nurse has understood the results. The nurse may receive results by telephone; and although electronic transfer to the client's medical record is appropriate, the nurse can also accept the telephone results if the laboratory has called the results to the nurses station.
