Exam 3 Study Questions 345 Glucose Regulation

A client is receiving total parenteral nutrition. The nurse assesses for which client response that indicates hyperglycemia?

A fruity odor to the breath. Hyperglycemia is indicated by a fruity odor to the breath.

A client with type 2 diabetes, who is taking an oral hypoglycemic agent, is to have a serum glucose test early in the morning. The client asks the nurse, "What do I have to do to prepare for this test?" Which statement by the nurse reflects accurate information?

"Do not ingest anything before the test." Fasting before the test is indicated for accurate and reliable results; food before the test will increase serum glucose levels through metabolism of the nutrients. Food should not be ingested before the test; food will increase the serum glucose level, negating accuracy of the test.

An infant of a diabetic mother is admitted to the neonatal intensive care unit. What is the priority nursing intervention for this infant?

Obtaining heel blood to test the glucose level. Hypoglycemia may be present because of the sudden withdrawal of maternal glucose and increased fetal insulin production, which continues after birth.

A 9-year-old child who has had type 1 diabetes for several years is brought to the emergency department of a community hospital. The child is exhibiting deep, rapid respirations; flushed, dry cheeks; abdominal pain with nausea; and increased thirst. What blood pH and glucose level does the nurse expect the laboratory tests to reveal?

A pH of 7.20 and blood glucose level of 460 mg/dL (25.5 mmol/L) are expected values in ketoacidosis

A client with type 2 diabetes is taking one oral hypoglycemic tablet daily. The client asks whether an extra tablet should be taken before exercise. What is the best response by the nurse?

"No, but you should observe for signs of hypoglycemia while exercising." Exercise improves glucose metabolism; with exercise there is a risk of developing hypoglycemia, not hyperglycemia.

A 9-year-old child with type 1 diabetes is hospitalized for insulin dosage regulation. A nurse observes the child sneaking food and trying to talk family members into bringing candy. What action should the nurse take when the child complains of feeling hypoglycemic?

A check of the blood glucose level will confirm whether the child is hypoglycemic.

A nurse is formulating a teaching plan for a client recently diagnosed with type 2 diabetes. What interventions should the nurse include to decrease the risk of complications? Select all that apply.

Clients with diabetes often have peripheral neuropathies and are unaware of discomfort or pain in the feet; the feet should be examined every night for signs of trauma. Well-fitting shoes prevent pressure and rubbing that can cause tissue damage and the development of ulcers. Daily exercise increases the uptake of glucose by the muscles and improves insulin use. Powdering the feet after showering may cause a pastelike residue between the toes that may macerate the skin and promote bacterial and fungal growth.

Four hours after surgery, the blood glucose level of a client who has type 1 diabetes is elevated. What intervention should the nurse implement?

Give supplemental doses of regular insulin. The blood glucose level needs to be reduced; regular insulin begins to act in 30 to 60 minutes. The client has type 1, not type 2, diabetes, and an oral hypoglycemic will not be effective.

A client had a gastric bypass procedure to treat morbid obesity. After surgery the client reports weakness, sweating, palpitations, and dizziness after eating. What should the nurse encourage the client to do?

Divide the daily caloric intake into six smaller meals. The client's clinical manifestations are related to the dumping syndrome from the gastric bypass procedure.

The most appropriate method for a nurse to evaluate the effects of the maternal blood glucose level in the infant of a diabetic mother is by performing a heel stick blood test on the newborn. What specifically does this test determine?

Glycosylated hemoglobin level.Obtaining a blood glucose level is a simple, cost-effective method of testing newborns for suspected hypoglycemia.

A school-aged child with type 1 diabetes is admitted to the pediatric unit in ketoacidosis. What sign of ketoacidosis does the nurse expect to identify when assessing the child?

Hyperpnea. Deep, rapid breathing (hyperpnea) is an attempt by the respiratory system to eliminate excess carbon dioxide

A nurse is caring for a client with type 1 diabetes who is experiencing a fluid imbalance. Which fluid shift associated with diabetes should the nurse take into consideration when assessing this client?

Intracellular to intravascular as a result of hyperosmolarity. The osmotic effect of hyperglycemia pulls fluid from the cells, resulting in cellular dehydration. Hyperglycemia pulls fluid from the interstitial compartment to the intravascular compartment.

A nurse working in the diabetes clinic is evaluating a client's success with managing the medical regimen. What is the best indication that a client with type 1 diabetes is successfully managing the disease?

Stabilization of the serum glucose. A combination of diet, exercise, and medication is necessary to control the disease; the interaction of these therapies is reflected by the serum glucose level.

The nurse is teaching a client newly diagnosed with diabetes about the importance of glucose monitoring. Which blood glucose levels should the nurse identify as hypoglycemia?

68 mg/dL (3.8 mmol/L). Normal blood glucose level for an adult is 72-108 mg/dL (4-6 mmol/L).

A primary healthcare provider prescribes a low-sodium, high-potassium diet for a client with Cushing syndrome. Which explanation should the nurse provide to the client about the need to follow this diet?

"Excessive aldosterone and cortisone cause retention of sodium and loss of potassium." Clients with Cushing syndrome must limit their intake of salt and increase their intake of potassium. The kidneys are retaining sodium and excreting potassium. An excessive secretion of adrenocortical hormones in Cushing syndrome, not increased or high sodium intake, is the problem.

A nurse is teaching the parents of an 8-year-old child with recently diagnosed type 1 diabetes about their child's care. What significant complication associated with type 1 diabetes should the nurse include in the teaching plan?

Ketoacidosis. Ketoacidosis is a complication of type 1 diabetes

At 4:30 pm, a client who is receiving NPH insulin every morning states, "I feel very nervous." The nurse observes that the client's skin is moist and cool. What is the nurse's most accurate interpretation of what the client is likely experiencing?

Hypoglycemia. The time of the client's response corresponds to the expected peak action (4 to 12 hours after administration) of the intermediate-acting insulin that was administered in the morning; this can result in hypoglycemia. Hypoglycemia triggers the sympathetic nervous system; epinephrine causes diaphoresis and nervousness.

The clinical findings of a client with diabetes mellitus show decreased glucose tolerance. Which complication is anticipated in the client?

Frequent yeast infections. Decreased glucose tolerance may cause frequent yeast infections, but it is not associated with the risk of cystitis, thin and dry skin, and decreased bone density.

A school-aged child is receiving 45 units of intermediate-acting insulin at 7:00 AM and 7:00 PM. What will the nurse tell the parents regarding a bedtime snack?

Provide a bedtime snack to prevent hypoglycemia during the night. Intermediate-acting insulin peaks in 4 to 12 hours; a bedtime snack will prevent hypoglycemia during the night.

A nurse is teaching a client with type 1 diabetes about assessing for signs and symptoms of hypoglycemia as a result of excessive insulin. What response should the nurse instruct the client to monitor in addition to nervousness and hunger?

Sweating. When serum glucose decreases, the sympathetic nervous system is stimulated, resulting in a surge of epinephrine and norepinephrine.