Diabetes

Which arterial blood gas results should the nurse expect in the client diagnosed with diabetic ketoacidosis? 1. pH 7.34, PaO299, PaCO2 48, HCO324. 2. pH 7.38, PaO295, PaCO240, HCO322. 3. pH 7.46, PaO285, PaCO230, HCO326. 4. pH 7.30, PaO290, PaCO230, HCO318.

4.This ABG indicates metabolic acidosis,which is expected in a client diagnosedwith diabetic ketoacidosis.

The nurse assesses a newly diagnosed patient for short-term complications of diabetes. What does this assessment include? a. Evaluation for hyperglycemia, hypoglycemia, and ketoacidosis b. Cranial nerve testing for peripheral neuropathy c. Pedal pulse palpation for arterial insufficiency d. Auscultation of the carotids for bruits associated with atherosclerosis

A. High blood sugar, low blood sugar, and ketoacidosis are short-term complications of diabetes. Microvascular and macrovascular complications, such as peripheral neuropathy, are long-term complications of diabetes. Arterial insufficiency and atherosclerosis also are long-term complications of diabetes.

The patient with HHS presented with a glucose level of 800 mg/dL and is started on IV fluids and insulin. What action do you anticipate when the patient's glucose reaches 250 mg/dL? A. Administer an intravenous (IV) solution with 5% dextrose. B. Administer sodium polystyrene sulfate (Kayexalate). C. Slow the IV infusion rate to 40 mL/hour. D. Assess cardiac monitoring for peaked T waves.

A. Administer an intravenous (IV) solution with 5% dextrose. When blood glucose levels fall to approximately 250 mg/dL, IV fluids containing glucose are administered to prevent hypoglycemia. Kayexalate (for cation exchange) is used in the treatment of hyperkalemia, which causes peaked T waves on cardiac monitoring. In HHS hypokalemia may result from insulin moving the potassium intracellularly. Fluid replacement remains a priority, but it is given with dextrose. The infusion rate of 40 mL/hour keeps the vein open, but it is not the appropriate replacement rate.

Which patient population is most at risk for DKA?* A. Middle-aged adults who are obese B. Older-adults with Type 2 diabetes C. Newly diagnosed diabetes D. None of the options

A. Middle-aged adults who are obese

You are providing care to a patient experiencing diabetic ketoacidosis. The patient is on an insulin drip and their current glucose level is 300. In addition, to the insulin drip the patient also has 5% Dextrose 0.45% NS infusing in the right antecubital vein. Which of the following patient signs/symptoms causes concern?* A. Patient has a potassium level of 2.3 B. Patient complains of thirst. C. Patient is nauseous. D. Patient's skin and mucous membranes are dry

A. Patient has a potassium level of 2.3

The patient presents to the emergency department with a glucose level of 400 mg/dL, ketone result of 2+, and rapid respirations with a fruity odor. What finding do you anticipate? A. pH below 7.30 B. Urine specific gravity below 1.005 C. High sodium bicarbonate levels D. Low blood urea nitrogen (BUN) level

A. pH below 7.30 The patient is in metabolic acidosis, which is a pH below 7.35. Dehydration results in a high urine specific gravity (at the upper end of the normal range, or above 1.025 to 1.030). Sodium bicarbonate levels are low in metabolic acidosis. The dehydration that occurs with DKA elevates the BUN level.

"1. A patient with newly diagnosed type 2 diabetes mellitus asks the nurse what ""type 2"" means in relation to diabetes. The nurse explains to the patient that type 2 diabetes differs from type 1 diabetes primarily in that with type 2 diabetes a. the pt is totally dependent on an outside source of insulin b. there is a decreased insulin secretion and cellular resistance to insulin that is produced c. the immune system destroys the pancreatic insulin-producing cells d. the insulin precurosr that is secreted by the pancreas is not activated by the liver

Answer B - Rationale: In type 2 diabetes, the pancreas produces insulin, but the insulin is insufficient for the body's needs or the cells do not respond to the insulin appropriately. The other information describes the physiology of type 1 diabetes

A nurse is educating the staff nurses about ketoacidosis. To evaluate the group's understanding, the nurse asks, "Which sign or symptom would not be consistent with ketoacidosis?" The group gives which correct answer? a. Blood glucose level of 600 mg/dL b. Blood glucose level of 60 mg/dL c. Acidosis d. Ketones in the urine

B. A patient with diabetic ketoacidosis (DKA) has a high glucose level (at least 500 mg/dL or higher); therefore, a glucose level of 60 mg/dL would not be consistent with DKA. A blood glucose level of 600 mg/dL, acidosis, and ketones in the urine are consistent with DKA.

The patient with type 1 diabetes arrives in the emergency department with a glucose level of 390 mg/dL and positive result for ketones. Vital signs are 110/70 mm Hg, 120 beats/minute, and 28 deep, sighing respirations/minute. What is the priority need for the patient? A. Oxygen B. Intravenous (IV) fluids C. Albuterol (Ventolin) D. Metformin (Glucophage)

B. Intravenous (IV) fluids A patient in diabetic ketoacidosis (DKA) needs IV fluids and insulin to stop the tissue breakdown resulting in ketone bodies and acidosis. The initial goal is fluid and electrolyte balance. Kussmaul respirations indicate the body is attempting to compensate by blowing off the carbon dioxide, but it is ineffective as long as the body continues to break down the ketone bodies and remains in metabolic acidosis.

A patient with type 1 diabetes recently became pregnant. The nurse plans a blood glucose testing schedule for her. What is the recommended monitoring schedule? a. Before each meal and before bed b. In the morning for a fasting level and at 4:00 PM for the peak level c. Six or seven times a day d. Three times a day, along with urine glucose testing

C. A pregnant patient with type 1 diabetes must have frequent blood sugar monitoring (eg, six or seven times a day) to manage both the patient and the fetus so that no teratogenic effects occur. Monitoring the blood sugar level before meals and at bedtime is not significant enough to provide the necessary glycemic control. Morning and 4:00 PM monitoring is not enough to provide glycemic control. Urine glucose testing is not sensitive enough to aid glycemic control, and monitoring three times a day is not enough.

Insulin glargine is prescribed for a hospitalized patient who has diabetes. When will the nurse expect to administer this drug? a. Approximately 15 to 30 minutes before each meal b. In the morning and at 4:00 PM c. Once daily at bedtime d. After meals and at bedtime

C. Glargine insulin is indicated for once daily subcutaneous administration to treat adults and children with type 1 diabetes and adults with type 2 diabetes. According to the package labeling, the once-daily injection should be given at bedtime. Glargine insulin should not be given more than once a day, although some patients require bid dosing to achieve a full 24 hours of basal coverage.

Which of the following is NOT a medical treatment for DKA and HHNS?* A. IV regular insulin B. Isotonic fluids C. Bicarbonate D. IV potassium Solution

C. Bicarbonate

What is a finding in DKA that is not seen in hyperosmolar hyperglycemic syndrome (HHS)? A. Glucose level above 400 mg/dL B. Hyperkalemia C. Ketones in blood D. Urine output of 30 mL/hr

C. Ketones in blood The main difference between the two conditions is that ketone bodies are absent or minimal in HHS because the body has enough insulin to prevent ketoacidosis. Both have high glucose levels, although the level in HHS tends to be higher (above 600 mg/dL). Hypokalemia is possible in both, although it is more likely and serious in DKA. Urine output of 30 mL/hr is normal obligatory output; both conditions are likely to have dehydration and decreased output.

A client is brought to the emergency department in an unresponsive state, and a diagnosis of hyperglycemic hyperosmolar nonketotic syndrome is made. The nurse would immediately prepare to initiate which of the following anticipated physician's prescriptions? 1. Endotracheal intubation 2. 100 units of NPH insulin 3. Intravenous infusion of normal saline 4. Intravenous infusion of sodium bicarbonate

CORRECT ANSWER: 3. Intravenous infusion of normal saline Rationale: The primary goal of treatment is hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is to rehydrate the client to restore the fluid volume and to correct electrolyte deficiency. Intravenous fluid replacement is similar to that administered in diabetic keto acidosis (DKA) and begins with IV infusion of normal saline. Regular insulin, not NPH insulin, would be administered. The use of sodium bicarbonate to correct acidosis is avoided because it can precipitate a further drop in serum potassium levels. Intubation and mechanical ventilation are not required to treat HHNS.

Hyperglycemic Hyperosmolar Nonketotic Syndrome would have all of the following signs and symptoms EXCEPT?* A. Dry mucous membranes B. Polyuria C. Blood glucose >600 mg/dL D. Kussmaul breathing

D. Kussmaul breathing

The client diagnosed with type 1 diabetes is receiving Humalog, a rapid-acting insulin,by sliding scale. The order reads blood glucose level: <150, zero (0) units; 151 to 200,three (3) units; 201 to 250, six (6) units; >251, contact health-care provider. The UAP reports to the nurse the client's glucometer reading is 189. How much insulin should the nurse administer to the client?

Three (3) units. The client's result is 189, which is between151 and 200, so the nurse should administer3 units of Humalog insulin subcutaneously

A client with diabetes melllitus has a blood glucose of 644mg/dl. The nurse intreprets that this client is most at risk of developing which type of acid base imbalance? " A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory Acidosis D. Respiratory Alkalosis"

"Correct Answer: A, Metabolic Acidosis Rationale: DM can lead to metabolic acidosis. When the body does not have sufficient circulating insulin, the blood glucose level rises. At the same time, the cells of the body use all available glucose. The body then breaks down glycogen and fat for fuel. The by-products of fat metabolism are acidotic and can lead to the condition known as diabetic ketoacidosis."

A 54-year-old patient admitted with type 2 diabetes, asks the nurse what "type 2" means. Which of the following is the most appropriate response by the nurse? "1. ""With type 2 diabetes, the body of the pancreas becomes inflamed." 2. "With type 2 diabetes, insulin secretion is decreased and insulin resistance is increased." 3. "With type 2 diabetes, the patient is totally dependent on an outside source of insulin." 4. "With type 2 diabetes, the body produces autoantibodies that destroy b-cells in the pancreas.""

"Right Answer: 2 Rationale: In type 2 diabetes mellitus, the secretion of insulin by the pancreas is reduced and/or the cells of the body become resistant to insulin"

"A client who is started on metformin and glyburide would have initially presented with which symptoms? "a. Polydispisa, polyuria, and weight loss b. weight gain, tiredness, & bradycardia c. irritability, diaphoresis, and tachycardia d. diarrhea, abdominal pain, and weight loss

"a. Polydispisa, polyuria, and weight loss"Symptoms of hyperglycemia include polydipsia, polyuria, and weight loss. Metformin and sulfonylureas are commonly ordered medications. Weight gain, tiredness, and bradycardia are symptoms of hypothyroidism. Irritability, diaphoresis, and tachycardia are symptoms of hypoglycemia. Symptoms of Crohn's disease include diarrhea, abdominal pain, and weight loss."

The client is admitted to the ICU diagnosed with DKA. Which interventions shouldthe nurse implement? Select all that apply. 1. Maintain adequate ventilation. 2. Assess fluid volume status. 3. Administer intravenous potassium. 4. Check for urinary ketones. 5. Monitor intake and output.

1, 2, 3, 4, 5

The diabetic educator is teaching a class on diabetes type 1 and is discussing sick-day rules. Which interventions should the diabetes educator include in the discussion?Select all that apply. 1. Take diabetic medication even if unable to eat the client's normal diabetic diet. 2. If unable to eat, drink liquids equal to the client's normal caloric intake. 3. It is not necessary to notify the health-care provider if ketones are in the urine. 4. Test blood glucose levels and test urine ketones once a day and keep a record. 5. Call the health-care provider if glucose levels are higher than 180 mg/dL.

1, 2, 5 1.The most important issue to teachclients is to take insulin even if they areunable to eat. Glucose levels are in-creased with illness and stress. 2.The client should drink liquids such asregular cola or orange juice, or eat regular gelatin, which provide enoughglucose to prevent hypoglycemia whenreceiving insulin. 5.The HCP should be notified if the bloodglucose level is this high. Regular insulinmay need to be prescribed to keep theblood glucose level within acceptablerange

"A client is admitted to the hospital with signs and symptoms of diabetes mellitus. Which findings is the nurse most likely to observe in this client? Select all that apply: "1. Excessive thirst 2. Weight gain 3. Constipation 4. Excessive hunger 5. Urine retention 6. Frequent, high-volume urination

1, 4, 6 Rationale: Classic signs of diabetes mellitus include polydipsia (excessive thirst), polyphagia (excessive hunger), and polyuria (excessive urination). Because the body is starving from the lack of glucose the cells are using for energy, the client has weight loss, not weight gain. Clients with diabetes mellitus usually don't present with constipation. Urine retention is only a problem is the patient has another renal-related condition.

The home health nurse is completing the admission assessment for a 76-year-old client diagnosed with type 2 diabetes controlled with 70/30 insulin. Which intervention should be included in the plan of care? 1. Assess the client's ability to read small print. 2. Monitor the client's serum PT level. 3. Teach the client how to perform a hemoglobin A1c test daily. 4. Instruct the client to check the feet weekly.

1. Age-related visual changes and diabetic retinopathy could cause the client to have difficulty in reading and drawing up insulin dosage accurately.

The nurse administered 28 units of Humulin N, an intermediate-acting insulin, to a client diagnosed with type 1 diabetes at 1600. Which intervention should the nurse implement? 1. Ensure the client eats the bedtime snack. 2. Determine how much food the client ate at lunch. 3. Perform a glucometer reading at 0700. 4. Offer the client protein after administering insulin.

1. Humulin N peaks in 6 to 8 hours, making the client at risk for hypoglycemia around midnight, which is why the client should receive a bedtime snack.This snack will prevent nighttime hypoglycemia.

The client diagnosed with type 1 diabetes is found lying unconscious on the floor of the bathroom. Which intervention should the nurse implement first? 1. Administer 50% dextrose IVP. 2. Notify the health-care provider. 3. Move the client to the ICU. 4. Check the serum glucose level.

1. The nurse should assume the client is hypoglycemic and administer IVP dextrose, which will rouse the client immediately. If the collapse is the result of hyperglycemia, this additional dextrose will not further injure the client.

The elderly client is admitted to the intensive care department diagnosed with severe HHNS. Which collaborative intervention should the nurse include in the plan of care? 1. Infuse 0.9% normal saline intravenously. 2. Administer intermediate-acting insulin. 3. Perform blood glucometer checks daily. 4. Monitor arterial blood gas results.

1.The initial fluid replacement is 0.9%normal saline (an isotonic solution) intravenously, followed by 0.45% saline.The rate depends on the client's fluid volume status and physical health, especially of the heart.

The nurse is developing a care plan for the client diagnosed with type 1 diabetes.The nurse identifies the problem "high risk for hyperglycemia related to non compliance with the medication regimen." Which statement is an appropriate short-term goal for the client? 1. The client will have a blood glucose level between 90 and 140 mg/dL. 2. The client will demonstrate appropriate insulin injection technique. 3. The nurse will monitor the client's blood glucose levels four (4) times a day. 4. The client will maintain normal kidney function with 30-mL/hr urine output.

1.The short-term goal must address the response part of the nursing diagnosis,which is "high risk for hyperglycemia,"and this blood glucose level is within acceptable ranges for a client who is non compliant.

The nurse teaches a client with diabetes mellitus about differentiating between hypoglycemia and ketoacidosis. The client demonstrates an understanding of the teaching by stating that a form of glucose should be taken if which symptoms develop? Select all that apply 1.Polyuria 2.Shakiness 3.Palpitations 4.Blurred vision 5.Lightheadedness 6.Fruity breath odor

2 3 6 Shakiness, palpitations, and lightheadedness are signs of hypoglycemia and would indicate the need for food or glucose. Polyuria, blurred vision, and a fruity breath odor are signs of hyperglycemia.

The UAP on the medical floor tells the nurse the client diagnosed with DKA wants something else to eat for lunch. Which intervention should the nurse implement? 1. Instruct the UAP to get the client additional food. 2. Notify the dietitian about the client's request. 3. Request the HCP increase the client's caloric intake. 4. Tell the UAP the client cannot have anything else.

2. The client will not be compliant with the diet if he or she is still hungry.Therefore, the nurse should request the dietitian talk to the client to try to adjust the meals so the client will adhere to the diet.

An 18-year-old female client, 5′4′′tall, weighing 113 kg, comes to the clinic for a non healing wound on her lower leg, which she has had for two (2) weeks. Which disease process should the nurse suspect the client has developed? 1. Type 1 diabetes.' 2. Type 2 diabetes. 3. Gestational diabetes. 4. Acanthosis nigricans.

2. Type 2 diabetes is a disorder usually occurring around the age of 40, but it is now being detected in children and young adults as a result of obesity and sedentary lifestyles. Non healing wounds are a hallmark sign of type 2 diabetes.This client weighs 248.6 pounds and is short.

The client with type 2 diabetes controlled with biguanide oral diabetic medication is scheduled for a (CT) scan with contrast of the abdomen to evaluate pancreatic function. Which intervention should the nurse implement? 1. Provide a high-fat diet 24 hours prior to test. 2. Hold the biguanide medication for 48 hours prior to test. 3. Obtain an informed consent form for the test .4. Administer pancreatic enzymes prior to the test.

2.Biguanide medication must be held for a test with contrast medium because it increases the risk of lactic acidosis,which leads to renal problems.

The nurse at a free standing health care clinic is caring for a 56-year-old male client who is homeless and is a type 2 diabetic controlled with insulin. Which action is an example of client advocacy? 1. Ask the client if he has somewhere he can go and live. 2. Arrange for someone to give him insulin at a local homeless shelter. 3. Notify Adult Protective Services about the client's situation. 4. Ask the HCP to take the client off insulin because he is homeless.

2.Client advocacy focuses support on theclient's autonomy. Even if the nursedisagrees with his living on the street,it is the client's right. Arranging for someone to give him his insulin provides for his needs and allows hischoices

Which electrolyte replacement should the nurse anticipate being ordered by thehealth-care provider in the client diagnosed with DKA who has just been admitted tothe ICU? 1. Glucose. 2. Potassium. 3. Calcium. 4. Sodium

2.The client in DKA loses potassium fromincreased urinary output, acidosis, cata-bolic state, and vomiting. Replacementis essential for preventing cardiac dys-rhythmias secondary to hypokalemia

Which assessment data indicate the client diagnosed with diabetic ketoacidosis is responding to the medical treatment? 1. The client has tented skin turgor and dry mucous membranes. 2. The client is alert and oriented to date, time, and place. 3. The client's ABG results are pH 7.29, PaCO2 44, HCO315. 4. The client's serum potassium level is 3.3 mEq/L.

2.The client's level of consciousness can be altered because of dehydration and acidosis. If the client's sensorium is intact, the client is getting better and responding to the medical treatment.

A client is admitted to a hospital with a diagnosis of diabetic ketoacidosis (DKA). The initial blood glucose level was 950 mg/dL. A continuous intravenous infusion of short-acting insulin is initiated, along with intravenous rehydration with normal saline. The serum glucose level is now 240 mg/dL. The nurse would next prepare to administer which item? 1.Ampule of 50% dextrose 2.NPH insulin subcutaneously 3.Intravenous fluids containing dextrose 4.Phenytoin (Dilantin) for the prevention of seizures

3 During management of DKA, when the blood glucose level falls to 250 to 300 mg/dL, the infusion rate is reduced and a dextrose solution is added to maintain a blood glucose level of about 250 mg/dL, or until the client recovers from ketosis. Fifty percent dextrose is used to treat hypoglycemia. NPH insulin is not used to treat DKA. Phenytoin (Dilantin) is not a usual treatment measure for DKA.

A client is brought to the emergency department in an unresponsive state, and a diagnosis of hyperglycemic hyperosmolar state (HHS) is made. The nurse would immediately prepare to initiate which anticipated health care provider's prescription 1.Endotracheal intubation 2.100 units of NPH insulin 3.Intravenous infusion of normal saline 4.Intravenous infusion of sodium bicarbonate

3 The primary goal of treatment in hyperglycemic hyperosmolar state (HHS) is to rehydrate the client to restore fluid volume and to correct electrolyte deficiency. Intravenous fluid replacement is similar to that administered in diabetic ketoacidosis (DKA) and begins with IV infusion of normal saline. Regular insulin, not NPH insulin, would be administered. The use of sodium bicarbonate to correct acidosis is avoided because it can precipitate a further drop in serum potassium levels. Intubation and mechanical ventilation are not required to treat HHS.

A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the emergency department. Which findings would the nurse expect to note as confirming this diagnosis? Select all that apply. 1 Increase in pH 2.Comatose state 3.Deep, rapid breathing 4.Decreased urine output 5.Elevated blood glucose level 6.Low plasma bicarbonate level

3 5 6 In DKA, the arterial pH is lower than 7.35, plasma bicarbonate is lower than 15 mEq/L, the blood glucose level is higher than 250 mg/dL, and ketones are present in the blood and urine. The client would be experiencing polyuria, and Kussmaul's respirations (deep and rapid breathing pattern) would be present. A comatose state may occur if DKA is not treated, but coma would not confirm the diagnosis.

The charge nurse is making client assignments in the intensive care unit. Which client should be assigned to the most experienced nurse? 1. The client with type 2 diabetes who has a blood glucose level of 348 mg/dL. 2. The client diagnosed with type 1 diabetes who is experiencing hypoglycemia. 3. The client with DKA who has multifocal premature ventricular contractions. 4. The client with HHNS who has a plasma osmolarity of 290 mOsm/L.

3. Multifocal PVCs, which are secondary to hypokalemia and can occur in clients with DKA, are a potentially life-threatening emergency. This client needs an experienced nurse.

The client received 10 units of Humulin R, a fast-acting insulin, at 0700. At 1030 the UAP tells the nurse the client has a headache and is really acting "funny." Which intervention should the nurse implement first? 1. Instruct the UAP to obtain the blood glucose level. 2. Have the client drink eight (8) ounces of orange juice. 3. Go to the client's room and assess the client for hypoglycemia. 4. Prepare to administer one (1) ampule 50% dextrose intravenously.

3. Regular insulin peaks in 2 to 4 hours.Therefore, the nurse should think about the possibility the client is having a hypoglycemic reaction and should assess the client. The nurse should not delegate nursing tasks to a UAP if the client is unstable.

The emergency department nurse is caring for a client diagnosed with HHNS who has a blood glucose of 680 mg/dL. Which question should the nurse ask the client to determine the cause of this acute complication? 1. "When is the last time you took your insulin?" 2. "When did you have your last meal?" 3. "Have you had some type of infection lately?" 4. "How long have you had diabetes?"

3. The most common precipitating factoris infection. The manifestations may beslow to appear, with onset rangingfrom 24 hours to 2 weeks

The client diagnosed with type 1 diabetes has a glycosylated hemoglobin (A1c) of 8.1%. Which interpretation should the nurse make based on this result? 1. This result is below normal levels. 2. This result is within acceptable levels. 3. This result is above recommended levels. 4. This result is dangerously high.

3. This result parallels a serum blood glucose level of approximately 180 to200 mg/dL. An A1c is a blood test reflecting average blood glucose levels over a period of three (3) months; clients with elevated blood glucose levels are at risk for developing long-term complications.

A client with type I diabetes is placed on an insulin pump. The most appropriate short-term goal when teaching this client to control the diabetes is: " 1) adhere to the medical regimen 2) remain normoglycemic for 3 weeks 3) demonstrate the correct use of the administration equipment. 4) list 3 self care activities that are necessary to control the diabetes"

3.) is correct "1) this is not a short-term goal 2) this is measurable, but it's a long-term goal 3) this is a short-term goal, client oriented, necessary for the client to control the diabetes, and measurable when the client performs a return demonstration for the nurse 4) although this is measurable and a short-term goal, it is not the one with the greatest priority when a client has an insulin pump that must be mastered before discharge"

The nurse is assessing the feet of a client with long-term type 2 diabetes. Which assessment data warrant immediate intervention by the nurse? 1. The client has crumbling toenails. 2. The client has athlete's foot. 3. The client has a necrotic big toe. 4. The client has thickened toenails.

3.A necrotic big toe indicates "dead" tis-sue. The client does not feel pain, does not realize the injury, and does not seek treatment. Increased blood glucose levels decrease the oxygen supply needed to heal the wound and increase the risk for developing an infection

The client diagnosed with type 2 diabetes is admitted to the intensive care unit with hyperosmolar hyperglycemic nonketonic syndrome (HHNS) coma. Which assessment data should the nurse expect the client to exhibit? 1. Kussmaul's respirations. 2. Diarrhea and epigastric pain. 3. Dry mucous membranes. 4. Ketone breath odor.

3.Dry mucous membranes are a result of the hyperglycemia and occur with both HHNS and DKA.

The nurse is discussing ways to prevent diabetic keto acidosis with the client diagnosed with type 1 diabetes. Which instruction is most important to discuss with the client? 1. Refer the client to the American Diabetes Association. 2. Do not take any over-the-counter medications. 3. Take the prescribed insulin even when unable to eat because of illness. 4. Explain the need to get the annual flu and pneumonia vaccines.

3.Illness increases blood glucose levels;therefore, the client must take insulinand consume high-carbohydrate foodssuch as regular Jell-O, regular popsi-cles, and orange juice

The nurse is discussing the importance of exercising with a client diagnosed with type 2 diabetes whose diabetes is well controlled with diet and exercise. Which information should the nurse include in the teaching about diabetes? 1. Eat a simple carbohydrate snack before exercising. 2. Carry peanut butter crackers when exercising. 3. Encourage the client to walk 20 minutes three (3) times a week. 4. Perform warm up and cool-down exercises.

4. All clients who exercise should perform warmup and cool-down exercises to help prevent muscle strain and injury.

A client with diabetes mellitus demonstratees acute anxiety when first admitted for the treatment of hyperglycemia. The most appropriate intervention to decrease the client's anxiety would be to 1. administer a sedative 2. make sure the client knows all the correct medical terms to understand what is happening 3. ignore the signs and symptoms of anxiety so that they will soon disappear 4. convey empathy, trust, and respect toward the client

4. The most appropriate intervention is to address the client's feelings related to the anxiety

The client diagnosed with HHNS was admitted yesterday with a blood glucose level of 780 mg/dL. The client's blood glucose level is now 300 mg/dL. Which intervention should the nurse implement? 1. Increase the regular insulin IV drip. 2. Check the client's urine for ketones. 3. Provide the client with a therapeutic diabetic meal. 4. Notify the HCP to obtain an order to decrease insulin.

4. When the glucose level is decreased to around 300 mg/dL, the regular insulin infusion therapy is decreased. Subcutaneous insulin will be administered per sliding scale.

An adolescent patient recently attended a health fair and had a serum glucose test. The patient telephones the nurse and says, "My level was 125 mg/dL. Does that mean I have diabetes?" What is the nurse's most accurate response? a. "Unless you were fasting for longer than 8 hours, this does not necessarily mean you have diabetes." b. "At this level, you probably have diabetes. You will need an oral glucose tolerance test this week." c. "This level is conclusive evidence that you have diabetes." d. "This level is conclusive evidence that you do not have diabetes."

A. If a person has not fasted for 8 hours, a blood sugar level of 125 mg/dL would be considered normal, because it is less than 200 mg/dL for a random sampling. Also, a person must have positive outcomes on two separate days to be diagnosed with diabetes. This patient does not need to have an oral glucose tolerance test, because the 125 mg/dL reading is so far below 200 mg/dL, which would require further work-up. No conclusive evidence indicates that this patient has diabetes, because the random sample value is so low, and the patient has not had two separate tests on different days. However, this also is not conclusive evidence that the patient does not have diabetes.

A patient with type 1 diabetes reports mixing NPH and regular insulin to allow for one injection. What should the nurse tell the patient? a. This is an acceptable practice. b. These two forms of insulin are not compatible and cannot be mixed. c. Mixing these two forms of insulin may increase the overall potency of the products. d. NPH insulin should only be mixed with insulin glargine.

A. NPH insulin is the only insulin suitable for mixing with short-acting insulins, such as insulin aspart [NovoLog]. These insulins are compatible and are mixed frequently for management of diabetics. The overall potency of each insulin is not increased by mixing them. Insulin glargine cannot be mixed with any other insulin for administration.

The nurse working on a high-acuity medical-surgical unit is prioritizing care for four patients who were just admitted. Which patient should the nurse assess first? a. The NPO patient with a blood glucose level of 80 mg/dL who just received 20 units of 70/30 Novolin insulin b. The patient with a pulse of 58 beats per minute who is about to receive digoxin [Lanoxin] c, The patient with a blood pressure of 136/92 mm Hg who complains of having a headache d. The patient with an allergy to penicillin who is receiving an infusion of vancomycin [Vancocin]

A. The NPO patient with hypoglycemia who just received 70/30 Novolin insulin takes priority, because this patient needs to consume a good source of glucose immediately or perhaps the NPO status will be discontinued for this shift. The digoxin may be withheld for the patient with a pulse of 58 beats per minute, but this is not a priority action. The patient with a headache needs to be followed up, but because the blood pressure is 136/92 mm Hg, the headache is probably not caused by hypertension. The patient with an allergy to penicillin will not have a reaction to the vancomycin.

Which statement is correct about the contrast between acarbose and miglitol? a. Miglitol has not been associated with hepatic dysfunction. b. With miglitol, sucrose can be used to treat hypoglycemia. c. Miglitol is less effective in African Americans. d. Miglitol has no gastrointestinal side effects.

A. Unlike acarbose, miglitol has not been associated with hepatic dysfunction. Sucrose should not be used to treat hypoglycemia with miglitol. Miglitol is more effective in African American patients. Miglitol has gastrointestinal side effects.

The nurse assisting in the admission of a client with diabetic ketoacidosis will anticipate the physician ordering which of the following types of intravenous solution if the client cannot take any fluids orally? " a. 0.45% normal saline solution b. Lactated Ringer's solution c. 0.9 normal saline solution d. 5% dextrose in water (D5W

A. 0.45% normal saline solution 0.45% NS Helps to hydrate patient and keep electrolyte levels balanced

The elderly patient with type 2 diabetes mellitus presents to the clinic with a fever and productive cough. The diagnosis of pneumonia is made. You notice tenting skin, deep tongue furrows, and vital signs of 110/80 mm Hg, 120 beats/minute, and 24 breaths/minute. What assessment is important for you to obtain? A. Blood glucose B. Orthostatic blood pressures C. Urine ketones D. Temperature

A. Blood glucose HHS is typically seen in patients with type 2 diabetes and infection, such as pneumonia. The main presenting sign is a glucose level above 600 mg/dL. Enough evidence of dehydration already exists that orthostatic vital sign assessments are not a priority, and they are often inaccurate in the elderly due to poor vascular tone. Patients with HHS do not have elevated ketone levels, which is a key distinction between HHS and DKA. Temperature will eventually be taken but is often blunted in the elderly and diabetics. An infectious diagnosis has already been made. The glucose level for appropriate fluid and insulin treatment is the priority.

Which of the following statements are INCORRECT about Diabetic Ketoacidoisis?* A. Extreme Hyperglycemia that presents with blood glucose >600 mg/dL B. Ketones are present in the urine C. Metabolic acidosis is present with Kussmaul breathing D. Potassium levels should be at least 3.3 or higher during treatment of DKA with insulin therapy

A. Extreme Hyperglycemia that presents with blood glucose >600 mg/dL

Which of the following statements are INCORRECT about Diabetic Ketoacidosis? A. Extreme Hyperglycemia that presents with blood glucose >600 mg/dL B. Ketones are present in the urine C. Metabolic acidosis is present with Kussmaul breathing D. Potassium levels should be at least 3.3 or higher during treatment of DKA with insulin therapy

A. Extreme hyperglycemia that presents with blood glucose above 600 mg/dL Extreme hyperglycemia that presents with blood glucose >600 mg/dL is present only in Hyperglycemic Hyperosmolar Nonketotic Syndrome

Laboratory results are available for a 54-year-old patient with a 15-year history of diabetes. Which result follows the expected pattern accompanying macrovascular disease as a complication of diabetes? A. Increased triglyceride levels B. Decreased low-density lipoprotein levels C. Increased high-density lipoprotein levels D. Decreased very-low-density lipoprotein levels

A. Increased triglyceride levels Macrovascular complications of diabetes include changes in medium- and large-sized blood vessels. They include cerebrovascular, cardiovascular, and peripheral vascular disease. Increased triglyceride levels are associated with these macrovascular changes. For this reason, the patient should limit the amount of fat in the diet.

The patient with diabetes and shortness of breath is brought from the nursing home to the hospital emergency department. The electrocardiogram (ECG) shows evidence of a myocardial infarction (MI), but the patient denied ever having chest pain. Which is the best explanation of what happened? A. The patient had a "silent" MI related to autonomic neuropathy. B. The patient had chest pain but forgot because of dementia. C. The patient minimized the chest pain because he was worried about costs. D. The patient has the psychologic defense mechanism of denial.

A. The patient had a "silent" MI related to autonomic neuropathy. Cardiovascular abnormalities associated with autonomic neuropathy include painless myocardial infarction. Shortness of breath related to decreased cardiac functioning can be the first overt sign or symptom.

True or False: Osmotic diuresis is present in HHNS and DKA due to the kidney's inability to reabsorb the excessive glucose which causes glucose to leak into the urine which in turn causes extra water and electrolytes to be excreted.* A. True B. False

A. True

True or False: When priming the tubing for an Insulin infusion it is best practice to waste 50cc to 100cc of insulin prior to starting the infusion because insulin absorbs into the plastic lining of the tubing.* A. True B. False

A. True

What therapies are appropriate for patients with diabetes mellitus (select all that apply)? A. Use of statins to treat dyslipidemia B. Use of diuretics to treat nephropathy C. Use of angiotensin-converting enzyme (ACE) inhibitors to treat nephropathy D. Use of laser photocoagulation to treat retinopathy E. Use of protein restriction in patients with early signs of nephropathy

A. Use of statins to treat dyslipidemia C. Use of angiotensin-converting enzyme (ACE) inhibitors to treat nephropathy D. Use of laser photocoagulation to treat retinopathy In patients with diabetes who have microalbuminuria or macroalbuminuria, ACE inhibitors (-prils) or angiotensin II receptor antagonists (ARBs) (-sartans) should be used. Both of these drug classes are used to treat hypertension. The statin drugs are the most widely used lipid-lowering drugs. Laser photocoagulation therapy is indicated to reduce the risk of vision loss in patients with proliferative retinopathy, macular edema, and in some cases of nonproliferative retinopathy.

An elderly patient who has type 2 diabetes has a history of severe hypoglycemia. The patient's spouse asks the nurse what the optimum A1c level is for the patient. Which is correct? a. Between 6.5 and 7.0 b. Below 7.0 c. Below 8.0 d. Between 7.0 and 8.5

B. For patients with a history of severe hypoglycemia and those with a limited life expectancy or advanced micro- and macrovascular complications, the target A1c level should be below 8.0. For most other patients with diabetes, the target is 7.0 and below.

A patient is being discharged home after recovering from HHNS. Which statement by the patient requires patient re-education about this condition?* A. "I will monitor my blood glucose levels regularly." B. "This condition happens suddenly without any warning signs." C. "If I become sick I will monitor my blood glucose more frequently and drink lots of fluids." D. "It is important I take my medication as prescribed."

B. "This condition happens suddenly without any warning signs."

Which patient is MOST likely to develop Diabetic Ketoacidosis?* A. A 25 year old female newly diagnosed with Cushing's Disease taking glucocorticoids. B. A 36 year old male with diabetes mellitus who has been unable to eat the past 2 days due to a gastrointestinal illness and has been unable to take insulin. C. A 35 year old female newly diagnosed with Type 2 diabetes. D. None of the options are correct.

B. A 36 year old male with diabetes mellitus who has been unable to eat the past 2 days due to a gastrointestinal illness and has been unable to take insulin.

The patient has diabetes mellitus and macroalbuminuria. The patient asks you why the physician is prescribing the angiotensin-converting enzyme (ACE) inhibitor lisinopril (Zestril) for him even though his blood pressure is well-controlled. What is your response? A. It helps prevent hypertension as diabetics are prone to it. B. ACE inhibitors delay the progression of nephropathy in patients with diabetes. C. ACE inhibitors prevent macrovascular complications. D. ACE inhibitors help prevent atherosclerosis.

B. ACE inhibitors delay the progression of nephropathy in patients with diabetes. ACE inhibitors and angiotensin II receptor antagonists (ARBs) are used to treat hypertension and delay the progression of nephropathy in patients with diabetes. ACE inhibitors are not used prophylactically. ACE inhibitors do not affect macrovascular complications. Nephropathy is a microvascular complication.

The patient is managed with NPH and regular insulin injections before breakfast and before dinner. When is the patient most likely to have a hypoglycemic reaction? A. After breakfast B. Before lunch C. During lunch D. After lunch

B. Before lunch The regular insulin peak occurs about 2 to 3 hours with a duration of 5 to 6 hours. If too much insulin or not enough food is given, the most likely time of hypoglycemia is before lunch, when the regular insulin is still present, the NPH has its onset, and the breakfast food has been metabolized.

A patient has an infection and reports not checking their blood glucose or regularly taking Metformin. What condition is this patient MOST at risk for?* A. HHNS B. DKA C. Metabolic alkalosis D. Metabolic acidosis

B. DKA

A patient is admitted with Diabetic Ketoacidosis. The physician orders intravenous fluids of 0.9% Normal Saline and 10 units of intravenous regular insulin IV bolus and then to start an insulin drip per protocol. The patient's labs are the following: pH 7.25, Glucose 455, potassium 2.5. Which of the following is the most appropriate nursing intervention to perform next?* A. Start the IV fluids and administer the insulin bolus and drip as ordered B. Hold the insulin and notify the doctor of the potassium level of 2.5 C. Hold IV fluids and administer insulin as ordered D. Recheck the glucose level

B. Hold the insulin and notify the doctor of the potassium level of 2.5

You are beginning to teach a diabetic patient about the vascular complications of diabetes. Which information is appropriate for you to include? A. Macroangiopathy does not occur in type 1 diabetes but does affect type 2 diabetics who have severe disease. B. Microangiopathy is specific to diabetes and most commonly affects the capillary membranes of the eyes, kidneys, and skin. C. Renal damage resulting from changes in large and medium-sized blood vessels can be prevented by careful glucose control. D. Macroangiopathy causes slowed gastric emptying and the sexual impotency experienced by most patients with diabetes.

B. Microangiopathy is specific to diabetes and most commonly affects the capillary membranes of the eyes, kidneys, and skin. Microangiopathy occurs in type 1 and type 2 diabetes mellitus. When it affects the eyes, it is called diabetic retinopathy. When kidneys are affected, the patient has nephropathy. When the skin is affected, it can lead to diabetic foot ulcers. Sexual impotency and slowed gastric emptying result from microangiopathy.

Which of the following is not a sign or symptom of Diabetic Ketoacidosis?* A. Positive Ketones in the urine B. Oliguria C. Polydipsia D. Abdominal Pain

B. Oliguria

1. Which of the following is not a sign or symptom of Diabetic Ketoacidosis? A. Positive ketones in the urine B. Oliguria C. Polydipsia D. Abdominal Pain

B. Oliguria oliguria means low urinary outpu. In DKA you have high urinary output (polyuria)

You are providing care to a patient experiencing diabetic ketoacidosis. The patient is on an insulin drip and their current glucose level is 300. In addition to this, the patient also has 5% Dextrose 0.45% NS infusing in the right antecubital vein. Which of the following patient signs/symptoms causes concern?* A. Patient complains of thirst. B. Patient has a potassium level of 2.3 C. Patient's skin and mucous membranes are dry. D. Patient is nauseous

B. Patient has a potassium level of 2.3

You are providing care to a patient experiencing diabetic ketoacidosis. The patient is on an insulin drip and their current glucose level is 300. In addition to this, the patient also has 5% Dextrose 0.45% NS infusing in the right antecubital vein. Which of the following patient signs/symptoms causes concern? A. Patient complains of thirst B. Patient has a potassium level of 2.3 C. Patient's skin and mucous membranes are dry D. Patient is nauseous

B. Patient has a potassium level of 2.3 Insulin causes potassium to enter back into the cell; therefore removing it from the blood. If the potassium is already 2.3, the patient can bottom out their potassium level. Therefore, the patient needs potassium supplements which requires a doctor's order.

What is a typical finding of hyperosmolar hyperglycemic syndrome (HHS)? A. Occurs in type 1 diabetes as the presenting symptom B. Slow onset resulting in a blood glucose level greater than 600 mg/dL C. Ketone bodies higher than 4+ in urine D. Signs and symptoms of diabetes insipidus

B. Slow onset resulting in a blood glucose level greater than 600 mg/dL HHS has a slower onset than diabetic ketoacidosis. HHS is often related to impaired thirst sensation, inadequate fluid intake, or functional inability to replace fluids. Because of the slower onset, the blood glucose levels can be quite high (more than 600 mg/dL) before diagnosis. HHS is seen in type 2 diabetics, and there is enough circulating insulin to prevent ketoacidosis. Diabetes insipidus is related to inadequate antidiuretic hormone secretion or kidney response with dilute, frequent urination. It is not related to HHS.

Which elevated laboratory finding is the best indication of potential diabetic nephropathy? A. Blood urea nitrogen (BUN) level B. Urine albumin-to-creatinine ratio C. Urine specific gravity D. Chloride (Cl-) level

B. Urine albumin-to-creatinine ratio Screening for nephropathy depends on the urinary albumin-to-creatinine ratio and a serum creatinine level. BUN alone, without correction to creatinine, can indicate many other issues, including dehydration and liver function. Unless there is renal failure, urine specific gravity is more indicative of dehydration.

"A client is taking Humulin NPH insulin daily every morning. The nurse instructs the client that the most likely time for a hypoglycemic reaction to occur is: A) 2-4 hours after administration B) 4-12 hours after administration C) 16-18 hours after administration D) 18-24 hours after administration

B: Rationale: Humulin is an intermediate acting insulin. The onset of action is 1.5 hours, it peaks in 4-12 hours, and its duration is 24 hours. Hypoglycemic reactions to insulin are most likely to occur during the peak time.

"A diabetic patient has a serum glucose level of 824 mg/dL (45.7 mmol/L) and is unresponsive. Following assessment of the patient, the nurse suspects diabetic ketoacidosis rather than hyperosmolar hyperglycemic syndrome based on the finding of "a. polyuria b. severe dehydration c. rapid, deep respirations ) d. decreased serum potassium"

C is correct, Signs and symptoms of DKA include manifestations of dehydration such as poor skin turgor, dry mucous membranes, tachycardia, and orthostatic hypotension. Early symptoms may include lethargy and weakness. As the patient becomes severely dehydrated, the skin becomes dry and loose, and the eyeballs become soft and sunken. Abdominal pain is another symptom of DKA that may be accompanied by anorexia and vomiting. Kussmaul respirations (i.e., rapid, deep breathing associated with dyspnea) are the body's attempt to reverse metabolic acidosis through the exhalation of excess carbon dioxide. Acetone is identified on the breath as a sweet, fruity odor. Laboratory findings include a blood glucose level greater than 250 mg/dL, arterial blood pH less than 7.30, serum bicarbonate level less than 15 mEq/L, and moderate to large ketone levels in the urine or blood ketones.

A patient who has type 2 diabetes will begin taking glipizide [Glucotrol]. Which statement by the patient is concerning to the nurse? a. "I will begin by taking this once daily with breakfast." b. "It is safe to drink grapefruit juice while taking this drug." c. "I may continue to have a glass of wine with dinner." d. "I will need to check my blood sugar once daily or more."

C. Glipizide is a sulfonylurea antidiabetic agent and can cause a disulfiram-like reaction when combined with alcohol. Patients should be taught to avoid alcohol while taking this medication. The initial dosing is once daily with breakfast. There is no drug interaction with grapefruit juice. Patients will need to monitor their blood glucose.

Which symptoms reported by a patient with diabetes mellitus are most important to follow-up? A. "My vision has been getting fuzzier over the past year." B. "I cannot read the small print anymore." C. "There is something like a veil of blackness coming across my vision." D. "I have yellow discharge from one eye."

C. "There is something like a veil of blackness coming across my vision." Diabetic retinopathy, particularly proliferative retinopathy, can cause retinal detachment, which has the classic new symptom of a veil coming across the field of vision. This requires emergency treatment. Chronic blurry vision can be cataracts and is not emergent. Change in the ability to read things near to the eye (presbyopia or farsightedness) is an age-related change and not emergent. Conjunctivitis needs treatment but is not as emergent as retinal detachment.

The patient has type 1 diabetes mellitus and is found unresponsive with cool and clammy skin. What action is a priority? A. Obtain a serum glucose level. B. Give hard candy under the tongue. C. Administer glucagon per standing order. D. Notify the health care provider.

C. Administer glucagon per standing order. The patient has signs and symptoms of hypoglycemia for which treatment should be the priority. Glucagon stimulates a strong hepatic response to convert glycogen to glucose and therefore makes glucose rapidly available. Waiting for a serum result (up to an hour) is improper because brain cells continue to die from a lack of glucose. Nothing solid should be placed in the mouth when the patient has an altered level of consciousness and can aspirate. With obvious symptoms, emergent treatment takes priority over notifying the health care provider.

The patient had a hypoglycemic episode and is treated with a concentrated glucose oral tablet. Fifteen minutes later the capillary glucose level (Accu-Check) is 150 mg/dL. What action should you take? A. Administer a second bolus of glucose solution. B. Administer regular insulin per sliding scale. C. Have the patient eat peanut butter and toast. D. Obtain a serum glucose level.

C. Have the patient eat peanut butter and toast. The patient has had an appropriate response to the glucose. Now a complex carbohydrate is needed to prevent hypoglycemia from reoccurring. There is no need for a second bolus of glucose because the result is within normal range. Insulin is not given, even though the glucose level is slightly elevated. The short-acting glucose is metabolized and insulin administration can increase the risk of a second hypoglycemic reaction. A serum confirmation of the level can be obtained but is not the priority.

2. A patient is admitted with Diabetic Ketoacidosis. The physician orders intravenous fluids of 0.9% Normal Saline and 10 units of intravenous regular insulin IV bolus and then to start an insulin drip per protocol. The patient's labs are the following: pH 7.25, Glucose 455, potassium 2.5. Which of the following is the most appropriate nursing intervention to perform next? A. Start the IV fluids and administer the insulin bolus and drip as ordered B. Hold IV fluids and administer insulin as ordered C. Hold the insulin and notify the doctor of the potassium level of 2.5 D. Recheck the glucose level

C. Hold insulin and notify the doctor of potassium level of 2.5 Remember when insulin is given it helps take potassium back into the cell which will cause potassium blood levels to fall. Insulin therapy is to be started only if the patient's potassium level is 3.3 or greater.

Which lower extremity or foot finding is a sign of sensory neuropathy in a patient with diabetes mellitus? A. Dusky when legs are dependent B. Pitting pedal edema C. Intermittent claudication D. Strong pedal pulse

C. Intermittent claudication Peripheral arterial disease (PAD) is caused by a reduction of blood flow to the lower extremities. Classic signs include intermittent claudication, pain at rest, cold feet, loss of hair, delayed capillary filling, and dependent rubor. Dusky legs when they are dependent, pitting pedal edema, and a strong pedal pulse are signs of peripheral venous disease.

The male patient with diabetes and heart disease confides to you that he can no longer have an erection. What is the reason for these changes? A. It is a normal part of aging and is relieved with sildenafil (Viagra). B. It usually is related to emotions and is a temporary problem. C. It is often the first sign of diabetic autonomic neuropathy. D. It indicates that the patient has developed a neurogenic bladder.

C. It is often the first sign of diabetic autonomic neuropathy. Erectile dysfunction (ED) is common and often is the first manifestation of autonomic failure. ED is a common long-term complication of diabetes. Neurogenic bladder is related to urinary retention.

The patient with diabetes reports tingling and burning in the lower extremities at night. The patient asks you why the primary health care provider prescribed the selective serotonin reuptake inhibitor (SSRI) duloxetine (Cymbalta). What is the best response? A. The doctor thought the discomfort was causing the patient to be depressed. B. The drug is known to improve patients' moods and enhance coping. C. It regulates pain by affecting neurotransmitters that transmit pain through the spine. D. It deadens the sensitivity to peripheral nerve endings.

C. It regulates pain by affecting neurotransmitters that transmit pain through the spine. SSRI drugs work by inhibiting the reuptake of norepinephrine and serotonin, which are neurotransmitters that are believed to play a role in the transmission of pain through the spinal cord. Duloxetine is thought to relieve pain by increasing the levels of serotonin and norepinephrine, which improves the body's ability to regulate pain.

Which of the following is not a sign or symptom of Diabetic Ketoacidosis?* A. Positive Ketones in the urine B. Polydipsia C. Oliguria D. Abdominal Pain

C. Oliguria

A diabetic patient has a serum glucose level of 824 mg/dL (45.7 mmol/L) and is unresponsive. After assessment of the patient, you suspect DKA rather than HHS based on the finding of A. polyuria. B. severe dehydration. C. rapid, deep respirations. D. decreased serum potassium.

C. rapid, deep respirations. Rapid, deep respirations are Kussmaul's and are are the body's attempt to reverse metabolic acidosis through exhalation of excess carbon dioxide. Symptoms of DKA include manifestations of dehydration, such as poor skin turgor, dry mucous membranes, tachycardia, and orthostatic hypotension. Kussmaul respirations (rapid, deep breathing associated with dyspnea) are the body's attempt to reverse metabolic acidosis through exhalation of excess carbon dioxide. Acetone is detected on the breath as a sweet, fruity odor.

A client with DKA is being treated in the ED. What would the nurse suspect? 1. Comatose state 2. Decreased Urine Output 3. Increased respirations and an increase in pH. 4. Elevated blood glucose level and low plasma bicarbonate level.

Correct Answer: 4 Rationale: In DKA the arteriole pH is lower than 7.35, plasma bicarbonate is lower than 15 mEq/L, the blood glucose is higher than 250, and ketones are present in the blood and urine. The client would be experiencing polyuria and Kussmauls respirations would be present. A comatose state may occur if DKA is not treated.

A patient with type 1 diabetes who takes insulin reports taking propranolol for hypertension. Why is the nurse concerned? a. The beta blocker can cause insulin resistance. b. Using the two agents together increases the risk of ketoacidosis. c. Propranolol increases insulin requirements because of receptor blocking. d. The beta blocker can mask the symptoms of hypoglycemia.

D. Beta blockers can delay awareness of and response to hypoglycemia by masking signs associated with stimulation of the sympathetic nervous system (eg, tachycardia, palpitations) that hypoglycemia normally causes. Furthermore, beta blockade impairs glycogenolysis, which is one means by which the body can counteract a fall in blood glucose; beta blockers, therefore, can worsen insulin-induced hypoglycemia. Propranolol does not cause insulin resistance. The incidence of DKA is not increased by concurrent use of propranolol and insulin. Insulin requirements are not increased because of receptor blocking by propranolol.

Which statement is accurate about the long-term complications of diabetes? a. Long-term complications are almost always the result of hypoglycemia and ketoacidosis. b. The complication rates for patients with optimally controlled type 2 diabetes are the same as for those whose disease is not optimally controlled. c. Optimal control of type 1 diabetes produces excessive episodes of life-threatening hypoglycemia. d. Optimal control of both types of diabetes reduces the risk of eye, kidney, and nerve damage.

D. In both types of diabetes, optimal control of the disease slows the development of microvascular complications. Short-term complications are more apt to result from hypoglycemia and ketoacidosis. Patients with type 2 diabetes have fewer complications if their blood sugar level is optimally controlled. Hypoglycemia does not occur more frequently in patients with optimally controlled type 1 diabetes.

A nurse provides dietary counseling for a patient newly diagnosed with type 1 diabetes. Which instruction should be included? a. "You may eat any foods you want and cover the glucose increase with sliding scale, regular insulin." b. "Most of the calories you eat should be in the form of protein to promote fat breakdown and preserve muscle mass." c. "Your total caloric intake should not exceed 1800 calories in a 24-hour period." d. "You should use a carbohydrate counting approach to maintain glycemic control."

D. Patients with diabetes should be given intensive insulin therapy education using either a carbohydrate counting or experience-based estimation approach in achieving glycemic control. A patient with diabetes cannot eat any foods desired and then cover the glucose increase with a sliding scale of regular insulin. Evidence suggests that there is not an ideal percentage of calories that should be ingested from carbohydrate, fat, or protein. Every patient with diabetes must be assessed individually to determine the number of total calories the person should have daily. The total caloric intake should be spread evenly throughout the day, with meals spaced 4 to 5 hours apart.

A patient with type 1 diabetes is eating breakfast at 7:30 AM. Blood sugars are on a sliding scale and are ordered before a meal and at bedtime. The patient's blood sugar level is 317 mg/dL. Which formulation of insulin should the nurse prepare to administer? a. No insulin should be administered. b. NPH c. 70/30 mix d. Lispro [Humalog]

D. Regular insulin and short-acting are indicated for sliding scale coverage. Insulin is definitely indicated for this high blood sugar level. NPH is used for scheduled insulin doses and is a longer-acting insulin. A 70/30 mix is also used for scheduled insulin coverage.

What is the most reliable measure for assessing diabetes control over the preceding 3-month period? a. Self-monitoring blood glucose (SMBG) graph report b. Patient's report c. Fasting blood glucose level d. Glycosylated hemoglobin level

D. The glycosylated hemoglobin level tells much about what the plasma glucose concentration has been, on average, over the previous 2 to 3 months. The SMBG graph report is done by the patient and indicates each blood sugar level the patient has on a daily basis. It is not as reliable as the glycosylated hemoglobin level, because the equipment used might not be accurate and the testing may not reflect actual measurements 100% of the time. The patient's report of blood sugar levels is not considered as accurate as the glycosylated hemoglobin level for the same reason that the SMBG is not. One fasting blood glucose level indicates the patient's blood sugar level for that one time when it was obtained.

A patient diagnosed with diabetes mellitus is being discharged home and you are teaching them about preventing DKA. What statement by the patient demonstrates they understood your teaching about this condition?* A. "I should not be alarmed if ketones are present in my urine because this is expected during illness." B. "It is normal for my blood sugar to be 250-350 mg/dL while I'm sick." C. "I will hold off taking my insulin while I'm sick." D. "It is important I check my blood glucose every 3-4 hours when I'm sick and consume liquids."

D. "It is important I check my blood glucose every 3-4 hours when I'm sick and consume liquids."

Which assessment is the most sensitive indicator that the IV fluid administration may be too rapid when treating a patient with DKA and a history of renal disease? A. Pedal edema B. Tachypnea C. Urine output of 40 mL/hour D. Change in the level of consciousness

D. Change in the level of consciousness Too rapid fluid replacement can lead to hyponatremia and cerebral edema. Pedal edema is a later and relatively insignificant sign. In a bedridden patient, edema is more evident in the sacral area. The Kussmaul respirations are expected; crackles auscultated in the lungs are a more sensitive indicator. The desired urine output for adequate hydration is 30 to 60 mL/hr.

The patient in the emergency department is diagnosed with diabetic ketoacidosis. Which laboratory value is essential for you to monitor? A. Magnesium (Mg) B. Hemoglobin (Hb) C. White blood cells (WBCs) D. Potassium (K)

D. Potassium (K) Even if the patient has normal potassium levels, there can be significant hypokalemia when insulin is administered as it pushes the serum potassium intracellularly. This can lead to life-threatening hypokalemia. The other options are not as significant.

What type of insulin do you expect the doctor to order for treatment of DKA?* A. IV Novolog B. IV Levemir C. IV NPH IV D. Regular Insulin

D. Regular Insulin

What is the best teaching for a patient who is newly diagnosed with diabetes mellitus type 2? A. Read a Snellen chart yearly. B. Be checked out for presbycusis. C. Notify the doctor if your vision has color distortion. D. See an ophthalmologist for a dilated eye examination yearly.

D. See an ophthalmologist for a dilated eye examination yearly. The earliest and most treatable stages of diabetic retinopathy often produce no changes in the vision. Because of this, the patient with type 2 diabetes should have a dilated eye examination by an ophthalmologist at the time of diagnosis and annually thereafter for early detection and treatment.

What is most helpful in the prevention of nephropathy in a patient with diabetes mellitus? A. Acid-ash diet B. Ensuring adequate fluid intake for renal perfusion C. Preventing obstruction from benign prostatic hyperplasia (BPH) D. Stopping smoking

D. Stopping smoking Risk factors for diabetic nephropathy include hypertension, genetic predisposition, smoking, and chronic hyperglycemia. Diabetic nephropathy is an intrarenal microvascular complication in which the glomeruli of the kidney are damaged. The kidney receives about 25% of the cardiac output, and inadequate fluids or shock resulting in adequate perfusion is a prerenal cause. BPH is a postrenal cause of kidney pathology.

18. The benefits of using an insulin pump include all of the following except: " a. By continuously providing insulin they eliminate the need for injections of insulin b. They simplify management of blood sugar and often improve A1C c. They enable exercise without compensatory carbohydrate consumption d. They help with weight loss

D: Using an insulin pump has many advantages, including fewer dramatic swings in blood glucose levels, increased flexibility about diet, and improved accuracy of insulin doses and delivery; however, the use of an insulin pump has been associated with weight gain.