DM
What is the only insulin that can be given intravenously? Regular NPH Lantus Ultralente
Regular Explanation: Insulins other than regular are in suspensions that could be harmful if administered IV.
The nurse is caring for a client who is taking insulin. The nurse suspects the client is experiencing hypoglycemia when the client displays what signs? increased pulse rate and fruity smelling breath. increased thirst and increased urine output. weakness, sweating, and decreased mentation. decreased respiratory rate and hot, dry skin.
weakness, sweating, and decreased mentation. Explanation: Chapter 42: Antidiabetic Drugs - Page 485
Once digested, what percentage of carbohydrates is converted to glucose? 70 80 90 100
100 Explanation: Once digested, 100% of carbohydrates are converted to glucose. However, approximately 50% of protein foods are also converted to glucose, but this has minimal effect on blood glucose concentration.
A patient meets with the hospital's RN diabetic educator approximately 4 months after being diagnosed with diabetes type II to assess adherence to a nutritional and fitness regimen. Which of the following HGBA1C values reflects non-compliance to the regimen? 4% 9% 7.5% 6.5%
9%
Which information should be included in the teaching plan for a client receiving glargine, a "peakless" basal insulin? It is rapidly absorbed and has a fast onset of action. Draw up the drug first, then add regular insulin. Do not mix with other insulins. Administer the total daily dosage in two doses.
Do not mix with other insulins. Explanation: Because glargine is in a suspension with a pH of 4, it cannot be mixed with other insulins because this would cause precipitation. When administering glargine insulin, it is very important to read the label carefully and to avoid mistaking Lantus insulin for Lente insulin and vice versa.
Regular insulin is a rapidly acting insulin that has a duration of 4 to 6 hrs. False True
False
When a diabetic client is taking steroids, he should anticipate No change in glucometer readings His glucometer readings to be increased His glucometer readings to be decreased Diabetes to go into remission
His glucometer readings to be increased
When the nurse is caring for a patient with type 1 diabetes, what clinical manifestation would be a priority to closely monitor? a. hypoglycemia b. hyponatremia c. ketonuria d. polyphagia
Hypoglycemia
An elderly patient is admitted to the intensive care unit diagnosed with severe HHS. Which priority intervention should the nurse include in the plan of care? Infuse 0.9 % normal saline intravenously Perform blood glucometer checks daily Administer intermediate acting insulin Monitor arterial blood gas results
Infuse 0.9 % normal saline intravenously
The nurse is preparing a presentation for a group of adults at a local community center about diabetes. Which of the following would the nurse include as associated with type 2 diabetes? Less common than type 1 diabetes Little to no relation to pre-diabetes Onset most common during adolescence Insulin production insufficient
Insulin production insufficient Explanation: Type 2 diabetes is characterized by insulin resistance or insufficient insulin production. It is more common in aging adults, and now accounts for 20% of all newly diagnosed cases. Type 1 diabetes is more likely in childhood and adolescence although it can occur at any age. It accounts for approximately 5% to 10% of all diagnosed cases of diabetes. Pre-diabetes can lead to type 2 diabetes.
When the client asks about the lon-term effects of diabetes mellitus, the nurse is accurate in mentioning all of the following except: Renal Failure Blindness Stroke Liver Failure
Liver Failure
The pancreas continues to release a small amount of basal insulin overnight, while a person is sleeping. The nurse knows that if the body needs more sugar: Insulin will be released to facilitate the transport of sugar. The process of gluconeogenesis will be inhibited. The pancreatic hormone glucagon will stimulate the liver to release stored glucose. Glycogenesis will be decreased by the liver.
The pancreatic hormone glucagon will stimulate the liver to release stored glucose. Explanation: When sugar levels are low, glucagon promotes hyperglycemia by stimulating the release of stored glucose. Glycogenolysis and gluconeogenesis will both be increased. Insulin secretion would promote hypoglycemia.
A nurse is preparing to administer two types of insulin to a client with diabetes mellitus. What is the correct procedure for preparing this medication? The short-acting insulin is withdrawn before the intermediate-acting insulin. The intermediate-acting insulin is withdrawn before the short-acting insulin. Different types of insulin are not to be mixed in the same syringe. If administered immediately, there is no requirement for withdrawing one type of insulin before another.
The short-acting insulin is withdrawn before the intermediate-acting insulin. Explanation: When combining two types of insulin in the same syringe, the short-acting regular insulin is withdrawn into the syringe first and the intermediate-acting insulin is added next. This practice is referred to as "clear to cloudy."
A client with diabetes receives a dinner meal tray and informs you that he does not care for rice. Which of the following can the nurse substitute for the rice? cottage cheese a slice of bread a glass of juice a dish of chocolate pudding
a slice of bread
A nurse instructs a client who is elderly to eat within 30 minutes of the administration of which antidiabetic drugs to prevent hypoglycemia? acarbose glyburide metformin pioglitazone
glyburide Explanation: Chapter 42: Antidiabetic Drugs - Page 494
Mrs. Jones has been admitted to your unit.While monitoring this patient who is receiving insulin, what will you as the nurse observe for as signs of hypoglycemia? irritability, sweating and confusion decreased pulse and respiratory rate fruity acetone breath increased urine output and edema
irritability, sweating and confusion
A hospital client's medication administration record specifies a dose of NPH insulin to be administered subcutaneously at 8 AM. The nurse has checked the client's blood glucose level prior to administering the drug and it is 55 mg/dL. How should the nurse respond to this assessment finding? Withhold the insulin and facilitate a dose of metformin. Administer half of the ordered dose before breakfast and half of the dose after breakfast. Administer the scheduled dose of insulin and encourage the client to eat breakfast promptly. Hold the dose of insulin and consult with the client's primary care provider.
Hold the dose of insulin and consult with the client's primary care provider. Explanation: Chapter 42: Antidiabetic Drugs - Page 490
A 60-year-old client comes to the ED reporting weakness, vision problems, increased thirst, increased urination, and frequent infections that do not seem to heal easily. The physician suspects that the client has diabetes. Which classic symptom should the nurse watch for to confirm the diagnosis of diabetes? Dizziness Fatigue Numbness Increased hunger
Increased hunger Explanation: The classic symptoms of diabetes are the three Ps: polyuria (increased urination), polydipsia (increased thirst), and polyphagia (increased hunger). Some of the other symptoms include tingling, numbness, and loss of sensation in the extremities and fatigue.
The nurse is administering lispro insulin. Based on the onset of action, how long before breakfast should the nurse administer the injection? 10 to 15 minutes 30 to 40 minutes 1 to 2 hours 3 hours
10 to 15 minutes Explanation: The onset of action of rapid-acting lispro insulin is within 10 to 15 minutes. It is used to rapidly reduce the glucose level.
The nurse performs a fingerstick blood glucose level of a client with diabetes before lumch. The nurse would notify the physician for which blood glucose level? 115 mg/dL 130mg/dL 145 mg/dL 90 mg/dL
145 mg/dL
Capillary blood glucose levels should be tested prior to meals. It should be tested: 15 minutes prior to eating 30 minutes prior to eating 5 minutes prior to eating 40 minutes prior to eating
30 minutes prior to eating Explanation: Because hypoglycemia is more likely to occur before the client consumes food, capillary blood glucose level should be tested with a glucometer 30 minutes before each meal and at bedtime.
Hypoglycemia is defined as a blood sugar concentration lower than _______________.mg/dl. 75 70 65 60 55
60
A health care provider prescribes short-acting insulin for a patient, instructing the patient to take the insulin 20 to 30 minutes before a meal. The nurse explains to the patient that Humulin-R taken at 6:30 AM will reach peak effectiveness by: 12:30 PM. 10:30 AM. 2:30 PM. 8:30 AM.
8:30 AM. Explanation: Short-acting insulin reaches its peak effectiveness 2 to 3 hours after administration. See Table 30-3 in the text.
How soon after mixing regular insulin and isophane insulin suspension (NPH) should a client inject the mixture? within 30 minutes within 5 minutes in 8 to 10 minutes in 15 to 20 minutes
within 5 minutes
A client with type 1 diabetes has a highly elevated glycosylated hemoglobin (Hb) test result. In discussing the result with the client, the nurse is most accurate in stating: "It tells us about your sugar control for the last 3 months." "The test must be repeated following a 12-hour fast." "Your insulin regimen must be altered significantly." "It looks like you aren't following the ordered diabetic diet."
"It tells us about your sugar control for the last 3 months." Explanation: The nurse is providing accurate information to the client when she states that the glycosylated Hb test provides an objective measure of glycemic control over a 3-month period. The test helps identify trends or practices that impair glycemic control, and it doesn't require a fasting period before blood is drawn. The nurse can't conclude that the result occurs from poor dietary management or inadequate insulin coverage.
A nurse is teaching a client recovering from diabetic ketoacidosis (DKA) about management of "sick days." The client asks the nurse why it is important to monitor the urine for ketones. Which statement is the nurse's best response? "Ketones are formed when insufficient insulin leads to cellular starvation. As cells rupture, they release these acids into the blood." "When the body does not have enough insulin, hyperglycemia occurs. Excess glucose is broken down by the liver, causing acidic by-products to be released." "Excess glucose in the blood is metabolized by the liver and turned into ketones, which are an acid." "Ketones accumulate in the blood and urine when fat breaks down in the absence of insulin. Ketones signal an insulin deficiency that will cause the body to start breaking down stored fat for energy." SUBMIT ANSWER
"Ketones accumulate in the blood and urine when fat breaks down in the absence of insulin. Ketones signal an insulin deficiency that will cause the body to start breaking down stored fat for energy." Explanation: Ketones (or ketone bodies) are by-products of fat breakdown in the absence of insulin, and they accumulate in the blood and urine. Ketones in the urine signal an insulin deficiency and that control of type 1 diabetes is deteriorating. When almost no effective insulin is available, the body starts to break down stored fat for energy.
Which instruction should a nurse give to a client with diabetes mellitus when teaching about "sick day rules"? "Test your blood glucose every 4 hours." "Don't take your insulin or oral antidiabetic agent if you don't eat." "It's okay for your blood glucose to go above 300 mg/dl while you're sick." "Follow your regular meal plan, even if you're nauseous."
"Test your blood glucose every 4 hours." Explanation: The nurse should instruct a client with diabetes mellitus to check his blood glucose levels every 3 to 4 hours and take insulin or an oral antidiabetic agent as usual, even when he's sick. If the client's blood glucose level rises above 300 mg/dl, he should call his physician immediately. If the client is unable to follow the regular meal plan because of nausea, he should substitute soft foods, such as gelatin, soup, and custard.
Prior to starting an insulin infusion for a patient in DKA, the provider orders potassium Chloride 20 mEq in 100 mL at 10 mEq/hour. The concentration of the solution is _________________ mEq/mL? 50 5 0.2 10
0.2
Which is a characteristic of type 2 diabetes? insulin resistance presence of islet antibodies ketosis-prone when insulin absent little or no insulin
insulin resistance Explanation: Type 2 diabetes is characterized by either a decrease in endogenous insulin or an increase accompanied by insulin resistance. Type 1 diabetes is characterized by production of little or no insulin; the client with type 1 diabetes is ketosis-prone when insulin is absent and often has islet cell antibodies.
Doctor's order: Lantus 22 units SC at bedtime (hs)Humalog Sliding Scale SC AC/HS:Blood sugar 151-200 give 1 unitBlood sugar 201-250 give 2 unitsBlood sugar 251-300 give 4 unitsBlood sugar 301-350 give 5 unitsBlood sugar > 350 call MDIt is bedtime and your patient's blood sugar is 150. How much insulin will be administered? 22 Units of Lantus 21 Units of Lantus and 3 Units of Humalog Hold all insulin 22 Units of Lantus and 1 Unit of Humalog
22 Units of Lantus
Your client is being evaluated for diabetes. He asks you what the blood glucose results mean. Your best response is: Two AIC results of 6 or more is diagnostic of diabetes. A fasting blood sugar result of 126 mg/dL or more on two separate occasions is diagnostic of diabetes. A fasting blood sugar result of 100 mg/dL or more on two separate occasions is diagnostic of diabetes. A fasting blood sugar result of 100 mg/dL or more and an AIC of 6 on two separate occasions is diagnostic of diabetes.
A fasting blood sugar result of 126 mg/dL or more on two separate occasions is diagnostic of diabetes. Explanation: Chapter 42: Antidiabetic Drugs - Page 490
To prevent episodes of hypoglycemia,the client should be taught that the following OTC drug may interact with insulin: Acetaminophen An antacid A salicylate preparation A vitamin with Iron
A salicylate preparation
A client is admitted with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which laboratory finding should the nurse expect in this client? Arterial pH 7.25 Plasma bicarbonate 12 mEq/L Blood urea nitrogen (BUN) 15 mg/dl Blood glucose level 1,100 mg/dl
Blood glucose level 1,100 mg/dl Explanation: HHNS occurs most frequently in older clients. It can occur in clients with either type 1 or type 2 diabetes mellitus but occurs most commonly in those with type 2. The blood glucose level rises to above 600 mg/dl in response to illness or infection. As the blood glucose level rises, the body attempts to rid itself of the excess glucose by producing urine. Initially, the client produces large quantities of urine. If fluid intake isn't increased at this time, the client becomes dehydrated, causing BUN levels to rise. Arterial pH and plasma bicarbonate levels typically remain within normal limits.
A nurse is caring for a patient with Type 2 diabetes mellitus and is admitted with hyperglycemic-hyperosmolar nonketotic syndrome (HHNS). Which of the following laboratory findings would he expect to find? Blood glucose of 432 mg/dL and serum pH of 7.32 Blood glucose of 846 mg/dL and serum pH of 7.40 Blood glucose of 555 mg/dL and serum pH of 7.04 Blood glucose of 600 mg/dL and serum pH of 6.94
Blood glucose of 846 mg/dL and serum pH of 7.40
A client's blood glucose level is 45 mg/dl. The nurse should be alert for which signs and symptoms? Coma, anxiety, confusion, headache, and cool, moist skin Kussmaul respirations, dry skin, hypotension, and bradycardia Polyuria, polydipsia, polyphagia, and weight loss Polyuria, polydipsia, hypotension, and hypernatremia
Coma, anxiety, confusion, headache, and cool, moist skin Explanation: Signs and symptoms of hypoglycemia (indicated by a blood glucose level of 45 mg/dl) include anxiety, restlessness, headache, irritability, confusion, diaphoresis, cool skin, tremors, coma, and seizures. Kussmaul respirations, dry skin, hypotension, and bradycardia are signs of diabetic ketoacidosis. Excessive thirst, hunger, hypotension, and hypernatremia are symptoms of diabetes insipidus. Polyuria, polydipsia, polyphagia, and weight loss are classic signs and symptoms of diabetes mellitus.
NPH is an example of which type of insulin? Intermediate-acting Short-acting Long-acting Rapid-acting
Intermediate-acting Explanation: NPH is an intermediate-acting insulin.
The nurse is describing the action of insulin in the body to a client newly diagnosed with type 1 diabetes. Which of the following would the nurse explain as being the primary action? It stimulates the pancreatic beta cells. It enhances the transport of glucose across the cell membrane. It aids in the process of gluconeogenesis. It decreases the intestinal absorption of glucose.
It enhances the transport of glucose across the cell membrane. Explanation: Insulin carries glucose into body cells as their preferred source of energy. Besides, it promotes the liver's storage of glucose as glycogen and inhibits the breakdown of glycogen back into glucose. Insulin does not aid in gluconeogenesis but inhibits the breakdown of glycogen back into glucose.
A patient who is diagnosed with type 1 diabetes would be expected to: Be restricted to an American Diabetic Association diet. Have no damage to the islet cells of the pancreas. Receive daily doses of a hypoglycemic agent. Need exogenous insulin.
Need exogenous insulin. Explanation: Type 1 diabetes is characterized by the destruction of pancreatic beta cells that require exogenous insulin.
An older adult patient that has type 2 diabetes comes to the emergency department with second-degree burns to the bottom of both feet and states, "I didn't feel too hot but my feet must have been too close to the heater." What does the nurse understand is most likely the reason for the decrease in temperature sensation? A faulty heater Peripheral neuropathy Autonomic neuropathy Sudomotor neuropathy
Peripheral neuropathy Explanation: As the neuropathy progresses, the feet become numb. In addition, a decrease in proprioception (awareness of posture and movement of the body and of position and weight of objects in relation to the body) and a decreased sensation of light touch may lead to an unsteady gait. Decreased sensations of pain and temperature place patients with neuropathy at increased risk for injury and undetected foot infections.
A client newly diagnosed with type 1 diabetes asks the nurse why injection site rotation is important. What is the nurse's best response? Prevent muscle destruction. Avoid infection. Minimize discomfort. Promote absorption.
Promote absorption. Explanation: Subcutaneous injection sites require rotation to avoid breakdown and/or buildup of subcutaneous fat, either of which can interfere with insulin absorption in the tissue. Infection and discomfort are risks involved with injection site but not the primary reason for rotation of sites. Insulin is not injected into the muscle.
A patient with type 1 diabetes has just been admitted to the critical care unit (CCU) for diabetic ketoacidosis. The nurse should prioritize what assessment/treatment? Assessing the patient for signs and symptoms of venous thromboembolism Restoring and maintaining the patient's fluid balance Monitoring the patient for dysrhythmias Assessing the patient's past 24-hour dietary intake
Restoring and maintaining the patient's fluid balance
A male client with a tentative diagnosis of hyperosmolar hyperglycemic nonketotic syndrome (HHNS) has a history of type 2 diabetes that is being controlled with an oral diabetic agent, tolazamide (Tolinase). Which of the following is the most important laboratory test for confirming this disorder? Arterial blood gas (ABG) values Serum osmolarity Serum sodium level Serum potassium level
Serum osmolarity Explanation: Serum osmolarity is the most important test for confirming HHNS; it's also used to guide treatment strategies and determine evaluation criteria. A client with HHNS typically has a serum osmolarity of more than 350 mOsm/L. Serum potassium, serum sodium, and ABG values are also measured, but they aren't as important as serum osmolarity for confirming a diagnosis of HHNS. A client with HHNS typically has hypernatremia and osmotic diuresis. ABG values reveal acidosis, and the potassium level is variable.
Match the following: TZD Hormone released from cells that line the ileum and colon Two human pancreas needed Should check liver function tests every 2 months during the first year Usual candidate type 1 diabetic with renal failure
Should check liver function tests every 2 months during the first year
A nurse educator been invited to local seniors center to discuss health-maintaining strategies for older adults. The nurse addresses the subject of diabetes mellitus, its symptoms, and consequences. What should the educator teach the participants about type 1 diabetes? New cases of diabetes will be split roughly evenly between type 1 and type 2. The participants are unlikely to develop a new onset of type 1 diabetes. Type 1 diabetes always develops before the age of 20. New cases of diabetes are highly uncommon in older adults.
The participants are unlikely to develop a new onset of type 1 diabetes. Explanation: Type 1 diabetes usually (but not always) develops in people younger than 20. In older adults, an onset of type 2 is far more common. A significant number of older adults develops type 2 diabetes.
A client with diabetes mellitus develops sinusitis and otitis media accompanied by a temperature of 100.8° F (38.2° C). What effect do these findings have on his need for insulin? They decrease the need for insulin. They cause wide fluctuations in the need for insulin. They increase the need for insulin. They have no effect.
They increase the need for insulin. Explanation: Insulin requirements increase in response to growth, pregnancy, increased food intake, stress, surgery, infection, illness, increased insulin antibodies, and some medications. Insulin requirements are decreased by hypothyroidism, decreased food intake, exercise, and some medications.
In general, obesity is defined as 20% above ideal body weight or a BMI equal to or greater than 30. False True
True
Which intervention is essential when performing dressing changes on a client with a diabetic foot ulcer? Debriding the wound three times per day Applying a heating pad Cleaning the wound with a povidone-iodine solution Using sterile technique during the dressing change
Using sterile technique during the dressing change Explanation: The nurse should perform the dressing changes using sterile technique to prevent infection. Applying heat should be avoided in a client with diabetes mellitus because of the risk o ... (more) The nurse should perform the dressing changes using sterile technique to prevent infection. Applying heat should be avoided in a client with diabetes mellitus because of the risk of injury. Cleaning the wound with povidone-iodine solution and debriding the wound with each dressing change prevents the development of granulation tissue, which is essential in the wound healing process
The nurse answers the call light of a client with diabetes. The client has a mild tremor and slight diaphoresis. He is fully oriented. What is the FIRST action the nurse should take? check the client's blood glucose level with a glucometer call the lab for a stat glucose level give him 4 ounces of orange juice with one packet of sugar call the RN to administer IV Dextrose
check the client's blood glucose level with a glucometer
A client with a history of type 1 diabetes is demonstrating fast, deep, labored breathing and has fruity odored breath. What could be the cause of the client's current serious condition? hepatic disorder All options are correct. hyperosmolar hyperglycemic nonketotic syndrome ketoacidosis
ketoacidosis Explanation: Kussmaul respirations (fast, deep, labored breathing) are common in ketoacidosis. Acetone, which is volatile, can be detected on the breath by its characteristic fruity odor. If treatment is not initiated, the outcome of ketoacidosis is circulatory collapse, renal shutdown, and death. Ketoacidosis is more common in people with diabetes who no longer produce insulin, such as those with type 1 diabetes. People with type 2 diabetes are more likely to develop hyperosmolar hyperglycemic nonketotic syndrome because with limited insulin, they can use enough glucose to prevent ketosis but not enough to maintain a normal blood glucose level.
A nurse is developing a teaching plan for a client with diabetes mellitus. A client with diabetes mellitus should: walk barefoot at least once each day. wash and inspect the feet daily. cut the toenails by rounding edges. use commercial preparations to remove corns.
wash and inspect the feet daily. Explanation: A client with diabetes mellitus should wash and inspect his feet daily and should wear nonconstrictive shoes. Corns should be treated by a podiatrist — not with commercial preparations. Nails should be filed straight across. Clients with diabetes mellitus should never walk barefoot.
