DIABETES (TYPE 1 &2)

17. 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. Administer 50% dextrose (IVP). 17. 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. 2. The health-care provider may or may not need to be notified, but this is not the first intervention. 3. The client should be left in the client's room, and 50% dextrose should be administered first. 4. The serum glucose level requires a venipuncture, which will take too long. A blood glucometer reading may be obtained, but the nurse should first treat the client, not the machine. The glucometer only reads "low" after a certain point, and a serum level is needed to confirm the exact glucose level. TEST-TAKING HINT: The question is requesting the test taker to select which intervention should be implemented first. All four options could be possible interventions, but only one intervention should be implemented first. The test taker should select the intervention directly treating the client; do not select a diagnostic test.

7. 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 the small print. 2. Monitor the client's serum prothrombin time (PT) level. 3. Teach the client how to perform a hemoglobin A1c test daily. 4. Instruct the client to check the feet weekly.

1. Assess the client's ability to read the small print. 7. 1. Age-related visual changes and diabetic retinopathy could cause the client to have difficulty in reading and drawing up insulin dosage accurately. 2. The PT level is monitored for clients receiving warfarin (Coumadin), an anticoagulant, which is not ordered for clients diagnosed with diabetes, type 1 or 2. 3. Glycosylated hemoglobin is a serum blood test usually performed in a laboratory, not in the client's home. The hemoglobin A1c is performed every 3 months. Self-monitoring blood glucose should be taught to the client. 4. The client's feet should be checked daily, not weekly. In a week, the client could develop gangrene from an unnoticed injury. TEST-TAKING HINT: Always notice the age of a client if it is provided because this is important when determining the correct answer for the question. Be sure to note the adverbs, such as "weekly" instead of "daily."

3. The nurse administered 28 units of insulin isophane 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. Ensure the client eats the bedtime snack. 3. 1. Insulin isophane (Humulin N), intermediate-acting insulin, peaks in 4 to 6 hours (Vallerand & Sanoski, 2019). The client will be at risk for hypoglycemia before midnight, which is why the client should receive a bedtime snack. This snack will prevent nighttime hypoglycemia. 2. The food intake at lunch will not affect the client's blood glucose level at midnight. 3. The client's glucometer reading should be done around 2100 to assess the effectiveness of insulin given at 1600. 4. The onset of insulin isophane (Humulin N), intermediate-acting insulin, is 2 to 4 hours, but it does not peak until 4 to 6 hours. TEST-TAKING HINT: The test taker must be familiar with the five types of insulins (rapid-acting, short-acting, intermediate-acting, long-acting, and combinations); the peak, onset, and duration of the five types of insulins; and the generic names of the insulins in each category. In this case, memorization is required.

91. The nurse identified a concept of metabolism for a client diagnosed with diabetes. Which antecedent would be identified as placing the client at risk for diabetes? 1. Nutrition. 2. Sensory perception. 3. pH regulation. 4. Medication.

1. Nutrition. 91. 1. Nutrition encompasses obesity, and obesity is a risk factor for developing diabetes mellitus type 2. 2. Sensory perception may be a problem for clients diagnosed with diabetes because ophthalmological issues occur as a result of high blood glucose levels for a prolonged period of time but are not antecedents. 3. The concept of pH is a situation that can occur as a result of DM1 but not DM2 because acidosis results from lactic acid buildup from no insulin production from the pancreas. Type 2 diabetes clients still produce some insulin. Insulin resistance is an issue in type 2 diabetes. 4. Medication is given to treat diabetes but not to cause it. TEST-TAKING HINT: The test taker must know risk factors for developing a disease process.

94. The nurse is teaching the client diagnosed with diabetes. Which should the nurse teach to limit the complications of diabetes? 1. Teach the client to keep the blood glucose under 140 mg/dL. 2. Demonstrate how to test the urine for ketones. 3. Instruct the client to apply petroleum jelly between the toes. 4. Allow the client to eat meals as desired and then take insulin.

1. Teach the client to keep the blood glucose under 140 mg/dL. 94. 1. To limit the complications of diabetes, the client should keep the blood glucose levels under 140 mg/dL. This can be done with medications, diet, and exercise. Self-monitoring of glucose allows the client to monitor glucose levels. 2. Testing for urine ketones will not help to keep the blood glucose level controlled. 3. Petroleum jelly is rubbed on the feet but not between the toes. 4. The client should administer sliding-scale insulin when needed but not eat whatever the client wishes. The client should still attempt to control the number of carbohydrates. TEST-TAKING HINT: The nurse must recommend measures to control or treat disease processes.

12. 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 noncompliance 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 an appropriate insulin injection technique. 3. The nurse will monitor the client's blood glucose levels four times a day. 4. The client will maintain normal kidney function with 30 mL/hr urine output.

1. The client will have a blood glucose level between 90 and 140 mg/dL. 12. 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 noncompliant client. 2. This is an appropriate goal for a knowledge-deficit nursing diagnosis. Noncompliance is not always the result of a knowledge deficit. 3. The nurse is implementing an intervention, and the question asks for a goal that addresses the problem of "high risk for hyperglycemia." 4. The question asks for a short-term goal, and this is an example of a long-term goal. TEST-TAKING HINT: Remember, the nursing diagnosis consists of a problem related to an etiology. The goals must address the problem, and the interventions must address the etiology. The test taker should always remember a short-term goal is usually a goal met during the hospitalization, and the long-term goal may take weeks, months, or even years.

86. The nurse is administering medications at the beginning of the day shift. Which should the nurse implement first? Client Name: Mr. C.A.MR# 3456789Diagnosis: Diabetes Mellitus Type 2 Age: 63 years Allergies: NKDA 0701-1900 1901-0700 Regular insulin Subcutaneously a.c. and h.s. 0-60 = 1 amp D50 61-150 = 0 units 151-300 = 5 units 301-450 = 10 units Greater than 450 = Call HCP 0730 1130 1630 2100 Glargine 15 units SQ a.c. 0730 Metformin 500 mg PO bid 0800 1930 Signature of Nurse: Day Nurse RN/DN Night Nurse RN/NN 1. The nurse should determine the blood glucose level. 2. The nurse should combine the sliding scale insulin with the glargine. 3. The nurse should prepare to give both insulins and metformin. 4. The nurse should check the client's health record for new orders.

1. The nurse should determine the blood glucose level. 86. 1. The nurse should know the blood glucose level before making any decision about the administration of either insulin. Insulin is due at this time. 2. Glargine (Lantus) insulin is not combined with any other insulin in the same syringe. 3. The nurse should prepare to give the insulins but not before knowing the current blood glucose. 4. This is not needed at this time. TEST-TAKING HINT: The nurse must know the rules of medication administration and must know the medications and when they are due.

11. The nurse at a freestanding health-care clinic is caring for a homeless 56-year-old male client diagnosed with type 2 diabetes 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. Arrange for someone to give him insulin at a local homeless shelter. 11. 1. This is an example of interviewing the client; it is not an example of client advocacy. 2. Client advocacy focuses support on the client's autonomy. Even if the nurse disagrees 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 his choices. 3. Adult Protective Services is an organization investigating any actual or potential abuse in adults. This client is not being abused by anyone. 4. The client needs the insulin to control diabetes, and talking to the HCP about taking him off a needed medication is not an example of advocacy. TEST-TAKING HINT: Remember, the test taker must understand what the question is asking and the definition of the terms.

8. The client diagnosed with type 2 diabetes, controlled with biguanide medication, and a history of liver disease, is scheduled for a computed tomography (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 before the test. 2. Hold the biguanide medication for 48 hours before the test. 3. Obtain an informed consent form for the test. 4. Administer pancreatic enzymes before the test.

2. Hold the biguanide medication for 48 hours before the test. 8. 1. High-fat diets are not recommended for clients diagnosed with diabetes, and food does not have an effect on a CT scan with contrast. 2. According to the Food and Drug Administration (FDA), biguanides, oral diabetic medications such as metformin, must be held for a test with contrast medium in clients with a glomerular filtration rate below 60 mL/min/1.73 m2 or a history of liver disease, alcoholism, or heart failure. In these clients, biguanides combined with contrast mediums increase the risk of lactic acidosis, which leads to renal problems. Before 2016, the FDA required metformin to be discontinued for all clients, regardless of medical history (Lipska, Flory, Hennessy, & Inzucchi, 2016). 3. Informed consent is not required for a CT scan. The admission consent covers routine diagnostic procedures. 4. Pancreatic enzymes are administered when the pancreas cannot produce amylase and lipase, not when the beta cells cannot produce insulin. TEST-TAKING HINT: The test taker could eliminate option "1" because high-fat diets are not recommended for any client. Because the stem specifically refers to the biguanide medication and CT contrast, a good choice addresses both of these. Option "2" discusses both the medication and the test.9.

85. The nurse is administering morning medications. Which medications should the nurse question administering? 1. The oral sucralfate to a client before the breakfast meal. 2. The subcutaneous insulin to a client refusing blood glucose checks. 3. The levothyroxine PO to a client diagnosed with hypothyroidism. 4. The sliding scale insulin to a client with a 320 mg/dL blood glucose level.

2. The subcutaneous insulin to a client refusing blood glucose checks. 85. 1. Sucralfate (Carafate) is a mucosal barrier agent and should be administered on an empty stomach so the medication can coat the mucosa. The nurse would not question administering this medication. 2. The nurse cannot administer sliding-scale insulin without knowing the current blood glucose. The nurse should talk with the client to try and obtain the client's cooperation and, if not, then notify the HCP that the medication cannot be administered. 3. Levothyroxine is an appropriate treatment for hypothyroidism. 4. The sliding scale usually begins at 150 mg/dL; the nurse would not question administering this medication. TEST-TAKING HINT: The test taker must know normal and abnormal diagnostic laboratory values. Medications are administered per sliding scale in response to blood glucose levels. The nurse must also recognize accepted treatments for diseases.

1. An 18-year-old female client, 5ʹ4″ tall, weighing 113 kg, comes to the clinic for a nonhealing wound, which she has had for 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. 1. 1. Type 1 diabetes usually occurs in young, underweight clients. In this disease, there is no production of insulin from the beta cells in the pancreas. People with type 1 diabetes are insulin-dependent with a rapid onset of symptoms, including polyuria, polydipsia, and polyphagia. 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. Nonhealing wounds are a sign of type 2 diabetes (Salazar, Ennis, & Koh, 2016). This client weighs 248.6 pounds and is short. 3. Gestational diabetes occurs during pregnancy. 4. Acanthosis nigricans (AN), dark pigmentation and skin creases in the neck, is a sign of hyperinsulinemia. The pancreas is secreting excess amounts of insulin as a result of excessive caloric intake. It is identified in young children and is a precursor to the development of type 2 diabetes. TEST-TAKING HINT: The test taker must be aware of kilograms and pounds. The stem is asking about a disease process, and acanthosis nigricans is a clinical manifestation of a disease, not a disease itself. Therefore, the test taker should not select this as a correct answer.

4. The client diagnosed with type 1 diabetes is receiving insulin lispro by sliding scale. The unlicensed assistive personnel (UAP) reports to the nurse the client's glucometer reading is 189. How much insulin should the registered nurse (RN) administer to the client? Client Name: Mr. A.G.MR# 3456889Diagnosis: Diabetes Mellitus Type 1 Age: 60 years Allergies: NKDA Medication 0701-1900 1901-0700 Insulin lispro Subcutaneously a.c. and h.s. 0-150 = 0 units 151-200 = 3 units 201-250 = 6 units Greater than 250 = Call HCP 0730 1130 1630 2100

3 units The client's result is 189, which is between 151 and 200, so the nurse should administer 3 units of insulin lispro (Humalog), rapid-acting insulin, subcutaneously. TEST-TAKING HINT: The test taker must be aware of the way HCPs write medication orders. HCPs order insulin on a sliding scale according to a range of blood glucose levels.

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

3. Go to the client's room and assess the client for hypoglycemia. 10. 1. The blood glucose level should be obtained, but it is not the first intervention. 2. If it is determined the client is having a hypoglycemic reaction, orange juice is appropriate. 3. Regular insulin (Humulin R), fast-acting insulin, peaks in 2 to 4 hours. Therefore, the registered nurse (RN) 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. 4. Dextrose 50% is only administered if the client is unconscious, and the nurse suspects hypoglycemia. TEST-TAKING HINT: When answering a question requiring the nurse to decide which intervention to implement first, all four options are plausible for the situation, but only one answer should be implemented first. The test taker must apply the nursing process; assessment is the first step of the nursing process.

93. The client diagnosed with diabetes reports a curtain being drawn across the eyes. Which should the nurse implement first? 1. Assess the eyes using an ophthalmoscope. 2. Tell the client to keep the eyes closed. 3. Notify the health-care provider (HCP). 4. Call the rapid response team (RRT).

3. Notify the health-care provider (HCP). 93. 1. The HCP and not the nurse should perform this assessment. The nurse has an unusual and potentially life-changing issue identified. 2. Keeping the eyes closed will not change the outcome of retinal detachment. This is an ophthalmological emergency. 3. This is an emergency; this indicates retinal detachment. The nurse should notify the HCP. 4. The RRT will help to prevent cardiac or respiratory arrest. The HCP should be notified to arrange for an ophthalmologist consult. TEST-TAKING HINT: The test taker should recognize life-changing or life-threatening complications of a disease process. Failure to intervene immediately can result in a "failure to rescue" situation.

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

3. The client diagnosed with DKA having multifocal premature ventricular contractions. 22. 1. This blood glucose level is elevated, but not life-threatening, in the client diagnosed with type 2 diabetes. Therefore, a less experienced nurse could care for this client. 2. Hypoglycemia is an acute complication of type 1 diabetes, but it can be managed by frequent monitoring, so a less experienced nurse could care for this client. 3. Multifocal PVCs, which are secondary to hypokalemia and can occur in clients diagnosed with DKA, are a potentially life-threatening emergency. This client needs an experienced nurse. 4. A plasma osmolarity of 275 to 295 mOsm/kg is within normal limits; therefore, a less experienced nurse could care for this client. TEST-TAKING HINT: The test taker must select the client with an abnormal, unexpected, or a life-threatening clinical manifestation for the disease process and assign this client to the most experienced nurse.

6. The nurse is assessing the feet of a client diagnosed 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. The client has a necrotic big toe. 6. 1. Crumbling toenails indicate tinea unguium, which is a fungus infection of the toenail. 2. Athlete's foot is not a life-threatening fungal infection. 3. A necrotic big toe indicates "dead" tissue. 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 of developing an infection. 4. Big, thick toenails are fungal infections and do not require immediate intervention by the nurse. TEST-TAKING HINT: The test taker should select the option indicating this is possibly a life-threatening complication or some type of assessment data the health-care provider should be informed of immediately. Remember, "warrants immediate intervention."

2. 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 the recommended levels. 4. This result is dangerously high.

3. This result is above the recommended levels. 2. 1. The acceptable level for an A1c for a client diagnosed with diabetes is less than 7%, which corresponds to a 154 mg/dL average blood glucose level. 2. This result is not within acceptable levels for the client diagnosed with diabetes, which is less than 7%. 3. This result parallels a serum blood glucose level of approximately 185 mg/dL. An A1c is a blood test reflecting average blood glucose levels over a period of 3 months; clients with elevated blood glucose levels are at risk for developing long-term complications (American Diabetes Association, 2020). 4. An A1c of 13% is dangerously high; it reflects a 326-mg/dL average blood glucose level over the past 3 months. TEST-TAKING HINT: The test taker must know normal and abnormal diagnostic laboratory values. Laboratory values may vary depending on which laboratory performs the test.

5. The nurse is discussing the importance of exercising with a client diagnosed with type 2 diabetes 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 times a week. 4. Perform warm-up and cool-down exercises.

4. Perform warm-up and cool-down exercises. 5. 1. The client diagnosed with type 2 diabetes, not taking insulin or oral agents, does not need extra food before exercise. 2. The client diagnosed with diabetes at risk for hypoglycemia when exercising should carry a simple carbohydrate, but this client is not at risk for hypoglycemia. 3. Clients with diabetes controlled by diet and exercise must exercise daily at the same time and in the same amount to control the glucose level. 4. All clients should perform warm-up and cool-down routines to help prevent muscle strain and injury while exercising. TEST-TAKING HINT: Options "1" and "2" apply directly to clients diagnosed with diabetes, and options "3" and "4" do not directly address clients diagnosed with diabetes. The reader could narrow the choices by either eliminating or including the two similar options.

96. Which client would the nurse identify as being at risk for developing diabetes? 1. The client with a diet of mostly candy and potatoes. 2. The 22-year-old client taking birth control pills. 3. The client having a cousin diagnosed with diabetes 2 years ago. 4. The 38-year-old female after delivering a 10-pound infant.

4. The 38-year-old female after delivering a 10-pound infant. 96. 1. Eating sweets and high-carbohydrate foods can lead to obesity, but eating candy does not cause diabetes. 2. Birth control pills do not increase the risk of developing diabetes. 3. Type 2 diabetes can be more prevalent in families, but having one cousin with diabetes does not increase the risk of diabetes for the client. 4. Research shows that women are at greater risk of developing diabetes after delivering a large infant. TEST-TAKING HINT: The test taker must know the antecedents of developing disease processes.

9. 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 (HCP) 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 HCP if glucose levels are higher than 180 mg/dL.

9. Correct answers are 1, 2, and 5. 1. The most important issue to teach clients is to take insulin, even if they are unable to eat. Glucose levels are increased with illness and stress. 2. The client should drink liquids such as regular cola or orange juice or eat regular gelatin, which provides enough glucose to prevent hypoglycemia when receiving insulin. 3. Ketones indicate a breakdown of fat and must be reported to the HCP because they can lead to metabolic acidosis. 4. Blood glucose levels and ketones must be checked every 3 to 4 hours, not daily. 5. The HCP should be notified if the blood glucose level is this high. Regular insulin may need to be prescribed to keep the blood glucose level within an acceptable range. TEST-TAKING HINT: This is an alternate-type question having more than one correct answer. The test taker should read all options and determine if each is an appropriate intervention.

95. Which interrelated concepts could be identified as actual or potential for a 56-year-old male client diagnosed with diabetes mellitus type 2? Select all that apply. 1. Nutrition. 2. Metabolism. 3. Infection. 4. Male reproduction. 5. Skin integrity.

95. Correct answers are 1, 2, 3, 4, and 5. 1. Obesity is included in the concept of nutrition. Obesity is an antecedent of diabetes mellitus type 2. 2. Diabetes is a problem of glucose metabolism. 3. The client is at greater risk for developing infections resulting from the high circulating glucose levels. Bacteria utilize glucose for energy, as do mammals. 4. Diabetes affects the ability of the blood vessels to respond to the circulatory need. For a middle-aged male, this can result in erectile dysfunction. 5. Skin integrity is an issue if a pressure sore or a blister occurs on the feet. If not noted and treated early, then an infection can result in amputation. TEST-TAKING HINT: The test taker must know the disease process and potential complications.