EXAM 6 USE THIS: Chapter 37 Care of Patients with Diabetes and Hypoglycemia

A 28-year-old primigravida with gestational diabetes visits the clinic at 16 weeks' gestation. Which statement indicates she understands the health teaching regarding her insulin needs during pregnancy?

"Changes in my hormones will make my body more resistant to insulin, so I will need more insulin as my pregnancy goes on."

A patient newly diagnosed with diabetes is given diet instructions. What should the nurse do to effectively motivate the patient to comply with dietary recommendations?

Emphasize good food choices Apply diet prescriptions to patient preferred foods Focus on the benefits of diet compliance Involve meal preparers in diet teaching

The nurse is supervising and nursing student who is performing foot care for a diabetic patient. The nurse would intervene if the student:

Places a protective cover between a heating pad and feet and uses the lowest setting

Ketoacidosis

The accumulation of ketone bodies in the blood because of incomplete metabolism of fats, resulting in metabolic acidosis

In discussing diabetes mellitus with a patient, it is important to base the discussion on the fact that diabetes mellitus:

can often be controlled by diet and regular exercise.

Which statement generally describes individuals diagnosed with type 1 diabetes mellitus?

They usually have a lack of insulin.

The nurse is caring for a patient suspected of having ketoacidosis. Which manifestation(s) is/are characteristic with early ketoacidosis? (select all that apply.) a. Fruity breath b. Polyuria c. Nausea d. Thirst e. Sunken eyes

ANS: A. Fruity breath B. Polyuria D. Thirst

The nursing assistant informs the nurse that the diabetic patient's blood glucose reading is 750 mg/dL. What is the nurse's priority action?

Assess the patient for responsiveness and ketoacidosis

A patient who works as a personal trainer is diagnosed with insulin-dependent diabetes. What should the nurse teach regarding self administration of regular insulin?

Use the abdomen as an insulin injection site

The nursing assistant tells you that a known diabetic patient has a blood glucose level of 60 mg/dL. What symptoms would the nurse be most likely to observe with this glucose level?

Confusion, tremulousness, pallor, sweating, and ketoacidosis

A 50 y.o. woman was recently diagnosed with type 2 diabetes mellitus and desires to start a healthy lifestyle to control her disease. What is the initial recommendation that the nurse should make?

Ensure Adequate Glucose Control

During a routine checkup, the healthcare provider tells the diabetic patient that tests results reveal microalbuminuria. Which long-term complication is specific to this test result?

Nephropathy

A patient recently diagnosed as having hypoglycemia says, "Hypoglycemia! I can't live with that. My neighbor, Joseph, had that and he acted crazy!" Which response by the nurse is most appropriate?

"Hypoglycemia has been successfully treated by diet modifications."

A patient newly diagnosed with diabetes is learning to administer his injections of NPH and regular insulin. Which statement indicates that the patient understands the nurse's teaching regarding proper insulin administration?

"I will draw up the regular insulin before the NPH."

Which teaching technique would be most useful for the older diabetic patient?

-Set a time for the teaching session that is agreeable to the patient -Allow time for the patient to jot down important points -Repeat key concepts frequently; if the patient doesn't understand, try rephrasing the concept

A 30 y.o. woman is admitted for urinary tract infection. A urinalysis reveals presence of ketones, glucose, and nitrates. Which question would the nurse ask to further assess possible diabetes mellitus?

Have you been thirstier than usual? DO you find you urinate more now?

Which laboratory test is best used to determine level of compliancy in the patient with diabetes mellitus?

Hb A1c

A patient with diabetes phones the clinic stating, "I have a terrible cold and I don't know what to do about taking my insulin." Regarding her insulin needs, what should be included in the information given to this patient?

Infections cause alterations and increase insulin needs, so she should check her blood glucose levels and urine ketones at least every 4 hours.

Diabetic Nephropathy

A disorder of the peripheral nerves that is associated with diabetes mellitus and is characterized by sexual impotence in the male, neurogenic bladder, and pain or loss of feeling in the lower extremities

Which statement(s) explain(s) a reason for weight loss in type 1 diabetics? (select all that apply.) a. Loss of body fluid b. Insulin intolerance c. Metabolization of body fats d. Stress of disease e. Altered diet

ANS: A. Loss of body fluid, C. Metabolization of body fats

Which genetic factor(s) increase(s) the risk of a person developing diabetes mellitus (DM)? (select all that apply.) a. Number of relatives with DM b. Body mass index (BMI) c. Sedentary lifestyle d. Genetic closeness of relatives with DM e. Race

ANS: A. Number of relatives with DM, D. Genetic closeness of relatives with DM, E. Race

Which requirement(s) is/are part of the criteria for "tight control" of hyperglycemia? (select all that apply.) a. Perform glucose testing twice daily. b. Administer insulin injections three times a day based on glucometer readings. c. Maintain fasting glucose within normal limits. d. Maintain normal weight for height and age. e. Maintain cholesterol within normal limits.

ANS: B. Administer insulin injections three times a day based on glucometer readings., C. Maintain fasting glucose within normal limits. D. Maintain normal weight for height and age. E. Maintain cholesterol within normal limits.

The nurse watches a patient perform an insulin injection. Which observation(s) indicate(s) that the patient needs additional instruction? (select all that apply.) a. The patient uses a 90-degree angle to administer the injection. b. The patient cleans the injection site with alcohol before the injection. c. The patient rubs the injection site after administration of the insulin injection. d. The patient draws up the cloudy insulin and then the clear insulin. e. The patient shakes the insulin bottle before administration.

ANS: C. The patient rubs the injection site after administration of the insulin injection. D. The patient draws up the cloudy insulin and then the clear insulin. E. The patient shakes the insulin bottle before administration.

The nurse is counseling an overweight, noncompliant, 30-year-old female with type 2 diabetes. Which change is most important for the nurse to suggest? a. Begin an exercise program and lose weight. b. Obtain annual eye examinations. c. Keep a food diary. d. Inspect feet daily.

ANS: A All of these changes are important, but exercise and weight loss are priority changes. In the type 2 diabetic, weight reduction and increased physical activity can restore blood glucose to normal levels and maintained it—hence the importance of diet and exercise in the management of type 2 diabetes.

A preoperative nurse assesses a client who has type 1 diabetes mellitus prior to a surgical procedure. The client's blood glucose level is 160 mg/dL. Which action should the nurse take? a. Document the finding in the client's chart. b. Administer a bolus of regular insulin IV. c. Call the surgeon to cancel the procedure. d. Draw blood gases to assess the metabolic state.

ANS: A Clients who have type 1 diabetes and are having surgery have been found to have fewer complications, lower rates of infection, and better wound healing if blood glucose levels are maintained at between 140 and 180 mg/dL throughout the perioperative period. The nurse should document the finding and proceed with other operative care. The need for a bolus of insulin, canceling the procedure, or drawing arterial blood gases is not required. DIF: Applying/Application REF: 1322

Which goal is the primary objective of a diabetic diet? a. Adequate nutrition with weight control b. Exclusion of all sweets c. Increased fat intake for greater energy d. Elimination of all fast foods

ANS: A Currently, the diabetic diet is much less stringent than diets of years past. The primary goal of the current diabetic diet includes adequate nutrition with weight and cholesterol control.

Which laboratory values are consistent with a patient in ketoacidosis? a. Blood urea nitrogen (BUN) of 35 mg/dL b. Carbon dioxide (CO2) of 40 mEq/L c. pH of 7.54 d. Blood glucose of 70 mg/dL

ANS: A Diabetic ketoacidosis results when the body attempts to metabolize protein and fats, which results in high BUN readings. The CO2 should be normal or low depending on the effectiveness of Kussmaul respirations. The arterial pH will be low, and there will be high glucose, which the diabetic patient cannot use.

The nurse notes that the HbA1c level of an assigned patient demonstrated a drop from 9.4% to 5.4%. What can the nurse infer from these findings? a. The patient's blood glucose control has improved over the last several months. b. The patient has been less compliant with the prescribed treatment regimen. c. The patient is experiencing a reduction in insulin sensitivity. d. The patient has less need for insulin.

ANS: A HbA1c is a diagnostic assessment used to review blood glucose levels retrospectively. A reduction in the value indicates improved glucose control by the patient. There is no evidence of insulin sensitivity. The need for insulin is not decreased in this patient.

A nurse teaches a client who is diagnosed with diabetes mellitus. Which statement should the nurse include in this client's plan of care to delay the onset of microvascular and macrovascular complications? a. "Maintain tight glycemic control and prevent hyperglycemia." b. "Restrict your fluid intake to no more than 2 liters a day." c. "Prevent hypoglycemia by eating a bedtime snack." d. "Limit your intake of protein to prevent ketoacidosis."

ANS: A Hyperglycemia is a critical factor in the pathogenesis of long-term diabetic complications. Maintaining tight glycemic control will help delay the onset of complications. Restricting fluid intake is not part of the treatment plan for clients with diabetes. Preventing hypoglycemia and ketosis, although important, are not as important as maintaining daily glycemic control. DIF: Applying/Application REF: 1301

A nurse cares for a client with diabetes mellitus who is visually impaired. The client asks, "Can I ask my niece to prefill my syringes and then store them for later use when I need them?" How should the nurse respond? a. "Yes. Prefilled syringes can be stored for 3 weeks in the refrigerator in a vertical position with the needle pointing up." b. "Yes. Syringes can be filled with insulin and stored for a month in a location that is protected from light." c. "Insulin reacts with plastic, so prefilled syringes are okay, but you will need to use glass syringes." d. "No. Insulin syringes cannot be prefilled and stored for any length of time outside of the container."

ANS: A Insulin is relatively stable when stored in a cool, dry place away from light. When refrigerated, prefilled plastic syringes are stable for up to 3 weeks. They should be stored in the refrigerator in the vertical position with the needle pointing up to prevent suspended insulin particles from clogging the needle. DIF: Remembering/Knowledge REF: 1316

An emergency department nurse assesses a client with ketoacidosis. Which clinical manifestation should the nurse correlate with this condition? a. Increased rate and depth of respiration b. Extremity tremors followed by seizure activity c. Oral temperature of 102° F (38.9° C) d. Severe orthostatic hypotension

ANS: A Ketoacidosis decreases the pH of the blood, stimulating the respiratory control areas of the brain to buffer the effects of increasing acidosis. The rate and depth of respiration are increased (Kussmaul respirations) in an attempt to excrete more acids by exhalation. Tremors, elevated temperature, and orthostatic hypotension are not associated with ketoacidosis. DIF: Applying/Application REF: 1333

The nurse is reviewing the patient's prescribed insulin regimen. The nurse notes that the physician has ordered a long-lasting insulin. Which medication best meets this criteria? a. Lantus b. NovoLog c. Humalog d. Regular

ANS: A Lantus is a long-lasting insulin. It may be administered only one time per day. NovoLog and Humalog are both rapid-onset insulin preparations. Regular insulin is classified as a short-acting insulin.

A long-term diabetic patient reports that he has been diagnosed with early cardiovascular disease. How does diabetes predispose the patient to cardiovascular complications? a. Hyperglycemic periods cause thickening of the basement membrane in vessels, which causes atherosclerosis. b. Hypoglycemic periods increase cortisol release, which causes hypertension. c. Insulin constricts the cardiovascular vessels, which causes congestive heart failure. d. Diabetes decrease in the body's ability to digest fats by the pancreas, which leads to increased coronary artery blockage.

ANS: A Periods of hyperglycemia cause thickening of the vessels, chiefly the basement membrane (thin layer of connective tissue under the epithelium). The vessels of the retina, renal glomeruli, peripheral nerves, muscles, and skin are affected.

A nurse cares for a client who has a family history of diabetes mellitus. The client states, "My father has type 1 diabetes mellitus. Will I develop this disease as well?" How should the nurse respond? a. "Your risk of diabetes is higher than the general population, but it may not occur." b. "No genetic risk is associated with the development of type 1 diabetes mellitus." c. "The risk for becoming a diabetic is 50% because of how it is inherited." d. "Female children do not inherit diabetes mellitus, but male children will."

ANS: A Risk for type 1 diabetes is determined by inheritance of genes coding for HLA-DR and HLA-DQ tissue types. Clients who have one parent with type 1 diabetes are at increased risk for its development. Diabetes (type 1) seems to require interaction between inherited risk and environmental factors, so not everyone with these genes develops diabetes. The other statements are not accurate. DIF: Understanding/Comprehension REF: 1307

The nurse is educating a 50-year-old patient about diabetes monitoring. Which statement reinforces the American Diabetes Association's (ADA's) recommendation? a. Obtain regularly scheduled fasting blood glucose levels. b. Strictly adhere to weight reduction diets. c. Exercise regularly in intervals lasting a minimum of 30 minutes. d. Use stress reduction techniques.

ANS: A The ADA recommends screening with a fasting blood glucose. Adherence to a weight loss plan, regular exercise, and stress reduction techniques help control diabetes but do not monitor it.

After teaching a client with diabetes mellitus to inject insulin, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching? a. "The lower abdomen is the best location because it is closest to the pancreas." b. "I can reach my thigh the best, so I will use the different areas of my thighs." c. "By rotating the sites in one area, my chance of having a reaction is decreased." d. "Changing injection sites from the thigh to the arm will change absorption rates."

ANS: A The abdominal site has the fastest rate of absorption because of blood vessels in the area, not because of its proximity to the pancreas. The other statements are accurate assessments of insulin administration. DIF: Applying/Application REF: 1314

The nurse is educating the patient about the significance of islet cell antibodies. Which statement accurately describes islet cell antibodies? a. Islet cell antibodies cause beta cells to quit producing insulin and lead to type 1 diabetes mellitus (DM). b. Islet cell antibodies protect beta cells from viral attack. c. Islet cell antibodies increase production of insulin from beta cells. d. Islet cell antibodies decrease the size of the pancreas.

ANS: A The antibodies cause beta cells to quit production of insulin.

A nurse assesses a client with diabetes mellitus and notes the client only responds to a sternal rub by moaning, has capillary blood glucose of 33 g/dL, and has an intravenous line that is infiltrated with 0.45% normal saline. Which action should the nurse take first? a. Administer 1 mg of intramuscular glucagon. b. Encourage the client to drink orange juice. c. Insert a new intravenous access line. d. Administer 25 mL dextrose 50% (D50) IV push.

ANS: A The client's blood glucose level is dangerously low. The nurse needs to administer glucagon IM immediately to increase the client's blood glucose level. The nurse should insert a new IV after administering the glucagon and can use the new IV site for future doses of D50 if the client's blood glucose level does not rise. Once the client is awake, orange juice may be administered orally along with a form of protein such as a peanut butter.

Which reason best explains why diabetics are prone to infection? a. High glucose levels provide an environment conducive to bacterial growth. b. Atherosclerotic vascular changes decrease blood supply to tissues. c.Diabetics display abnormal phagocyte function. d. Diabetics display decreased leukocyte function.

ANS: A The primary reason for increased risk of infection in diabetic patients is the hyperglycemic environment. Lesser risk factors include atherosclerotic vascular changes, abnormal phagocyte function, and decreased leukocyte function.

A nurse assesses a client who has diabetes mellitus and notes the client is awake and alert, but shaky, diaphoretic, and weak. Five minutes after administering a half-cup of orange juice, the client's clinical manifestations have not changed. Which action should the nurse take next? a. Administer another half-cup of orange juice. b. Administer a half-ampule of dextrose 50% intravenously. c. Administer 10 units of regular insulin subcutaneously. d. Administer 1 mg of glucagon intramuscularly.

ANS: A This client is experiencing mild hypoglycemia. For mild hypoglycemic manifestations, the nurse should administer oral glucose in the form of orange juice. If the symptoms do not resolve immediately, the treatment should be repeated. The client does not need intravenous dextrose, insulin, or glucagon. DIF: Applying/Application REF: 1330

A nurse provides diabetic education at a public health fair. Which disorders should the nurse include as complications of diabetes mellitus? (Select all that apply.) a. Stroke b. Kidney failure c. Blindness d. Respiratory failure e. Cirrhosis

ANS: A, B, C Complications of diabetes mellitus are caused by macrovascular and microvascular changes. Macrovascular complications include coronary artery disease, cerebrovascular disease, and peripheral vascular disease. Microvascular complications include nephropathy, retinopathy, and neuropathy. Respiratory failure and cirrhosis are not complications of diabetes mellitus. DIF: Understanding/Comprehension REF: 1303

A nurse teaches a client with diabetes mellitus about foot care. Which statements should the nurse include in this client's teaching? (Select all that apply.) a. "Do not walk around barefoot." b. "Soak your feet in a tub each evening." c. "Trim toenails straight across with a nail clipper." d. "Treat any blisters or sores with Epsom salts." e. "Wash your feet every other day."

ANS: A, C Clients who have diabetes mellitus are at high risk for wounds on the feet secondary to peripheral neuropathy and poor arterial circulation. The client should be instructed to not walk around barefoot or wear sandals with open toes. These actions place the client at higher risk for skin breakdown of the feet. The client should be instructed to trim toenails straight across with a nail clipper. Feet should be washed daily with lukewarm water and soap, but feet should not be soaked in the tub. The client should contact the provider immediately if blisters or sores appear and should not use home remedies to treat these wounds. DIF: Understanding/Comprehension REF: 1327

A nurse assesses a client who is experiencing diabetic ketoacidosis (DKA). For which manifestations should the nurse monitor the client? (Select all that apply.) a. Deep and fast respirations b. Decreased urine output c. Tachycardia d. Dependent pulmonary crackles e. Orthostatic hypotension

ANS: A, C, E DKA leads to dehydration, which is manifested by tachycardia and orthostatic hypotension. Usually clients have Kussmaul respirations, which are fast and deep. Increased urinary output (polyuria) is severe. Because of diuresis and dehydration, peripheral edema and crackles do not occur. DIF: Applying/Application REF: 1333

A nurse assesses clients at a health fair. Which clients should the nurse counsel to be tested for diabetes? (Select all that apply.) a. 56-year-old African-American male b. Female with a 30-pound weight gain during pregnancy c. Male with a history of pancreatic trauma d. 48-year-old woman with a sedentary lifestyle e. Male with a body mass index greater than 25 kg/m2 f. 28-year-old female who gave birth to a baby weighing 9.2 pounds

ANS: A, D, E, F Risk factors for type 2 diabetes include certain ethnic/racial groups (African Americans, American Indians, Hispanics), obesity and physical inactivity, and giving birth to large babies. Pancreatic trauma and a 30-pound gestational weight gain are not risk factors. DIF: Applying/Application REF: 1307

When discussing exercise programs with the diabetic, which instruction(s) is/are important for the nurse to include? (select all that apply.) a. Delay exercise until glucose controlled. b. Check glucose immediately after exercising. c. Keep a quick source of glucose readily available while exercising. d. Begin slowly and build up to 30 to 45 minutes. e. Only use the abdominal injection site for insulin.

ANS: A. Delay exercise until glucose controlled. C. Keep a quick source of glucose readily available while exercising. D. Begin slowly and build up to 30 to 45 minutes. E. Only use the abdominal injection site for insulin.

Which factor(s) may cause diabetes mellitus (DM)? (select all that apply.) a. Genetic b. Microbiologic c. Metabolic d. Allogenic e. Immunologic

ANS: A. Genetic, B.Microbiologic, C. Metabolic, E. Immunologic

The patient comes to the emergency room complaining of abdominal pain. The nurse assesses dry, hot skin, fruity breath, and deep respirations. To which problem should the nurse attribute these findings? a. An insulin reaction b. Ketoacidosis c. Rebound hyperglycemia d. Hypoglycemia

ANS: B Abdominal pain with dry, hot skin, fruity breath, and deep respirations is characteristic of ketoacidosis. Manifestations of an insulin reaction, or hypoglycemia, include tremulousness, hunger, headache, pallor, sweating, palpitations, blurred vision, and weakness. Rebound hyperglycemia, or the Somogyi effect, follows a period of hypoglycemia, often during sleep.

A nurse cares for a client who is diagnosed with acute rejection 2 months after receiving a simultaneous pancreas-kidney transplant. The client states, "I was doing so well with my new organs, and the thought of having to go back to living on hemodialysis and taking insulin is so depressing." How should the nurse respond? a. "Following the drug regimen more closely would have prevented this." b. "One acute rejection episode does not mean that you will lose the new organs." c. "Dialysis is a viable treatment option for you and may save your life." d. "Since you are on the national registry, you can receive a second transplantation."

ANS: B An episode of acute rejection does not automatically mean that the client will lose the transplant. Pharmacologic manipulation of host immune responses at this time can limit damage to the organ and allow the graft to be maintained. The other statements either belittle the client or downplay his or her concerns. The client may not be a candidate for additional organ transplantation. DIF: Applying/Application REF: 1324

A nurse is teaching a client with diabetes mellitus who asks, "Why is it necessary to maintain my blood glucose levels no lower than about 60 mg/dL?" How should the nurse respond? a. "Glucose is the only fuel used by the body to produce the energy that it needs." b. "Your brain needs a constant supply of glucose because it cannot store it." c. "Without a minimum level of glucose, your body does not make red blood cells." d. "Glucose in the blood prevents the formation of lactic acid and prevents acidosis."

ANS: B Because the brain cannot synthesize or store significant amounts of glucose, a continuous supply from the body's circulation is needed to meet the fuel demands of the central nervous system. The nurse would want to educate the client to prevent hypoglycemia. The body can use other sources of fuel, including fat and protein, and glucose is not involved in the production of red blood cells. Glucose in the blood will encourage glucose metabolism but is not directly responsible for lactic acid formation. DIF: Remembering/Knowledge REF: 1301

After teaching a client with type 2 diabetes mellitus, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching? a. "I need to have an annual appointment even if my glucose levels are in good control." b. "Since my diabetes is controlled with diet and exercise, I must be seen only if I am sick." c. "I can still develop complications even though I do not have to take insulin at this time." d. "If I have surgery or get very ill, I may have to receive insulin injections for a short time.

ANS: B Clients with diabetes need to be seen at least annually to monitor for long-term complications, including visual changes, microalbuminuria, and lipid analysis. The client may develop complications and may need insulin in the future. DIF: Applying/Application REF: 1319

A nurse reviews the medication list of a client with a 20-year history of diabetes mellitus. The client holds up the bottle of prescribed duloxetine (Cymbalta) and states, "My cousin has depression and is taking this drug. Do you think I'm depressed?" How should the nurse respond? a. "Many people with long-term diabetes become depressed after a while." b. "It's for peripheral neuropathy. Do you have burning pain in your feet or hands?" c. "This antidepressant also has anti-inflammatory properties for diabetic pain." d. "No. Many medications can be used for several different disorders."

ANS: B Damage along nerves causes peripheral neuropathy and leads to burning pain along the nerves. Many drugs, including duloxetine (Cymbalta), can be used to treat peripheral neuropathy. The nurse should assess the client for this condition and then should provide an explanation of why this drug is being used. This medication, although it is used for depression, is not being used for that reason in this case. Duloxetine does not have anti-inflammatory properties. Telling the client that many medications are used for different disorders does not provide the client with enough information to be useful. DIF: Applying/Application REF: 1328

A nurse cares for a client with diabetes mellitus who asks, "Why do I need to administer more than one injection of insulin each day?" How should the nurse respond? a. "You need to start with multiple injections until you become more proficient at self-injection." b. "A single dose of insulin each day would not match your blood insulin levels and your food intake patterns." c. "A regimen of a single dose of insulin injected each day would require that you eat fewer carbohydrates." d. "A single dose of insulin would be too large to be absorbed, predictably putting you at risk for insulin shock."

ANS: B Even when a single injection of insulin contains a combined dose of different-acting insulin types, the timing of the actions and the timing of food intake may not match well enough to prevent wide variations in blood glucose levels. One dose of insulin would not be appropriate even if the client decreased carbohydrate intake. Additional injections are not required to allow the client practice with injections, nor will one dose increase the client's risk of insulin shock. DIF: Applying/Application REF: 1314

The nurse is discussing insulin administration with an assigned patient. The patient reports that she prefers to use only certain sites for insulin injections and questions the need to rotate sites. What response by the nurse is most appropriate? a. "Rotating injection sites helps reduce your risk of infection." b. "Rotating injection sites helps enhance insulin absorption." c. "Unsightly fatty tumors can develop when you do not adequately rotate injection sites." d. "Rotating injection sites decreases your risk of an insulin reaction."

ANS: B Insulin injections are rotated within one body area to enhance absorption. Patients are given charts showing the places on the arms, legs, buttocks, and abdomen where insulin can be injected.

A nurse teaches a client with type 2 diabetes mellitus who is prescribed glipizide (Glucotrol). Which statement should the nurse include in this client's teaching? a. "Change positions slowly when you get out of bed." b. "Avoid taking nonsteroidal anti-inflammatory drugs (NSAIDs)." c. "If you miss a dose of this drug, you can double the next dose." d. "Discontinue the medication if you develop a urinary infection."

ANS: B NSAIDs potentiate the hypoglycemic effects of sulfonylurea agents. Glipizide is a sulfonylurea. The other statements are not applicable to glipizide. DIF: Applying/Application REF: 1310

nurse cares for a client who has diabetes mellitus. The nurse administers 6 units of regular insulin and 10 units of NPH insulin at 0700. At which time should the nurse assess the client for potential problems related to the NPH insulin? a. 0800 b. 1600 c. 2000 d. 2300

ANS: B Neutral protamine Hagedorn (NPH) is an intermediate-acting insulin with an onset of 1.5 hours, peak of 4 to 12 hours, and duration of action of 22 hours. Checking the client at 0800 would be too soon. Checking the client at 2000 and 2300 would be too late. The nurse should check the client at 1600. DIF: Applying/Application REF: 1314

The nurse is caring for a patient with ketosis. Which statement indicates that the patient correctly understands the phenomenon? a. "I took too much insulin to decrease my body's glucose levels." b. "The condition resulted when my body tried to break down and use my stores of fats." c. "My blood glucose went over 150 mg/dL and caused this condition." d. "I exercised too much reduced my blood glucose level too dramatically."

ANS: B People with type 1 diabetes are more prone to a serious complication, ketosis, associated with an excess production of ketone bodies, leading to ketoacidosis (metabolic acidosis). When the glucose level gets too high, the body attempts to metabolize fats for energy, and the result is a buildup of ketone bodies.

A patient recently diagnosed with type 1 diabetes mellitus (DM) asks why she is experiencing increased thirst. Which explanation is most appropriate? a. Diabetes results in a lack of protein absorption that decreases amino acids and causes increased thirst. b. High glucose levels in the blood pull cellular water into circulating volume and increase thirst. c. Thirst results from the body's increased loss of fluids from frequent urination. d. Diabetes causes large amount of fluid to shut to the pancreas, which dehydrates the body.

ANS: B Polydipsia is stimulated by cellular dehydration from the hyperglycemia pulling intracellular fluid into the circulating volume.

A nurse assesses a client with diabetes mellitus. Which clinical manifestation should alert the nurse to decreased kidney function in this client? a. Urine specific gravity of 1.033 b. Presence of protein in the urine c. Elevated capillary blood glucose level d. Presence of ketone bodies in the urine

ANS: B Renal dysfunction often occurs in the client with diabetes. Proteinuria is a result of renal dysfunction. Specific gravity is elevated with dehydration. Elevated capillary blood glucose levels and ketones in the urine are consistent with diabetes mellitus but are not specific to renal function. DIF: Applying/Application REF: 1328

A nurse develops a dietary plan for a client with diabetes mellitus and new-onset microalbuminuria. Which component of the client's diet should the nurse decrease? a. Carbohydrates b. Proteins c. Fats d. Total calories

ANS: B Restriction of dietary protein to 0.8 g/kg of body weight per day is recommended for clients with microalbuminuria to delay progression to renal failure. The client's diet does not need to be decreased in carbohydrates, fats, or total calories. DIF: Remembering/Knowledge REF: 1329

A nurse teaches a client about self-monitoring of blood glucose levels. Which statement should the nurse include in this client's teaching to prevent bloodborne infections? a. "Wash your hands after completing each test." b. "Do not share your monitoring equipment." c. "Blot excess blood from the strip with a cotton ball." d. "Use gloves when monitoring your blood glucose."

ANS: B Small particles of blood can adhere to the monitoring device, and infection can be transported from one user to another. Hepatitis B in particular can survive in a dried state for about a week. The client should be taught to avoid sharing any equipment, including the lancet holder. The client should be taught to wash his or her hands before testing. The client would not need to blot excess blood away from the strip or wear gloves. DIF: Applying/Application REF: 1318

A patient asks the nurse if stress can be a potential cause of type 2 diabetes. Which response is most appropriate for the nurse to make? a. "Stress decreases the number of alpha cells in the pancreas, and increases the workload on the beta cells." b. "Periods of stress cause increases in glycogen production by the adrenal cortex." c. "Stress is directly associated with decreased insulin tolerance." d. "The inhibition of beta cells to glucose is increased in periods of stress."

ANS: B Stress stimulates the adrenal cortex to release glucocorticoids, which can cause hyperglycemia.

A nurse reviews the chart and new prescriptions for a client with diabetic ketoacidosis: Vital Signs and Assessment Laboratory Results Medications Blood pressure: 90/62 mm Hg Pulse: 120 beats/min Respiratory rate: 28 breaths/min Urine output: 20 mL/hr via catheter Serum potassium: 2.6 mEq/L Potassium chloride 40 mEq IV bolus STAT Increase IV fluid to 100 mL/hr Which action should the nurse take? a. Administer the potassium and then consult with the provider about the fluid order. b. Increase the intravenous rate and then consult with the provider about the potassium prescription. c. Administer the potassium first before increasing the infusion flow rate. d. Increase the intravenous flow rate before administering the potassium.

ANS: B The client is acutely ill and is severely dehydrated and hypokalemic. The client requires more IV fluids and potassium. However, potassium should not be infused unless the urine output is at least 30 mL/hr. The nurse should first increase the IV rate and then consult with the provider about the potassium. DIF: Applying/Application REF: 1333

A nurse reviews laboratory results for a client with diabetes mellitus who is prescribed an intensified insulin regimen: • Fasting blood glucose: 75 mg/dL • Postprandial blood glucose: 200 mg/dL • Hemoglobin A1c level: 5.5% How should the nurse interpret these laboratory findings? a. Increased risk for developing ketoacidosis b. Good control of blood glucose c. Increased risk for developing hyperglycemia d. Signs of insulin resistance

ANS: B The client is maintaining blood glucose levels within the defined ranges for goals in an intensified regimen. Because the client's glycemic control is good, he or she is not at higher risk for ketoacidosis or hyperglycemia and is not showing signs of insulin resistance. DIF: Applying/Application REF: 1314

A nurse cares for a client who is prescribed pioglitazone (Actos). After 6 months of therapy, the client reports that his urine has become darker since starting the medication. Which action should the nurse take? a. Assess for pain or burning with urination. b. Review the client's liver function study results. c. Instruct the client to increase water intake. d. Test a sample of urine for occult blood.

ANS: B Thiazolidinediones (including pioglitazone) can affect liver function; liver function should be assessed at the start of therapy and at regular intervals while the client continues to take these drugs. Dark urine is one indicator of liver impairment because bilirubin is increased in the blood and is excreted in the urine. The nurse should check the client's most recent liver function studies. The nurse does not need to assess for pain or burning with urination and does not need to check the urine for occult blood. The client does not need to be told to increase water intake. DIF: Applying/Application REF: 1312

A nurse teaches a client with diabetes mellitus about sick day management. Which statement should the nurse include in this client's teaching? a. "When ill, avoid eating or drinking to reduce vomiting and diarrhea." b. "Monitor your blood glucose levels at least every 4 hours while sick." c. "If vomiting, do not use insulin or take your oral antidiabetic agent." d. "Try to continue your prescribed exercise regimen even if you are sick."

ANS: B When ill, the client should monitor his or her blood glucose at least every 4 hours. The client should continue taking the medication regimen while ill. The client should continue to eat and drink as tolerated but should not exercise while sick. DIF: Applying/Application REF: 1335

A nurse assesses a client who has diabetes mellitus. Which arterial blood gas values should the nurse identify as potential ketoacidosis in this client? a. pH 7.38, HCO3- 22 mEq/L, PCO2 38 mm Hg, PO2 98 mm Hg b. pH 7.28, HCO3- 18 mEq/L, PCO2 28 mm Hg, PO2 98 mm Hg c. pH 7.48, HCO3- 28 mEq/L, PCO2 38 mm Hg, PO2 98 mm Hg d. pH 7.32, HCO3- 22 mEq/L, PCO2 58 mm Hg, PO2 88 mm Hg

ANS: B When the lungs can no longer offset acidosis, the pH decreases to below normal. A client who has diabetic ketoacidosis would present with arterial blood gas values that show primary metabolic acidosis with decreased bicarbonate levels and a compensatory respiratory alkalosis with decreased carbon dioxide levels. DIF: Applying/Application REF: 1333

A nurse assesses a client who is being treated for hyperglycemic-hyperosmolar state (HHS). Which clinical manifestation indicates to the nurse that the therapy needs to be adjusted? a. Serum potassium level has increased. b. Blood osmolarity has decreased. c. Glasgow Coma Scale score is unchanged. d. Urine remains negative for ketone bodies.

ANS: C A slow but steady improvement in central nervous system functioning is the best indicator of therapy effectiveness for HHS. Lack of improvement in the level of consciousness may indicate inadequate rates of fluid replacement. The Glasgow Coma Scale assesses the client's state of consciousness against criteria of a scale including best eye, verbal, and motor responses. An increase in serum potassium, decreased blood osmolality, and urine negative for ketone bodies do not indicate adequacy of treatment. DIF: Applying/Application REF: 1330

A nurse assesses a client who has a 15-year history of diabetes and notes decreased tactile sensation in both feet. Which action should the nurse take first? a. Document the finding in the client's chart. b. Assess tactile sensation in the client's hands. c. Examine the client's feet for signs of injury. d. Notify the health care provider.

ANS: C Diabetic neuropathy is common when the disease is of long duration. The client is at great risk for injury in any area with decreased sensation because he or she is less able to feel injurious events. Feet are common locations for neuropathy and injury, so the nurse should inspect them for any signs of injury. After assessment, the nurse should document findings in the client's chart. Testing sensory perception in the hands may or may not be needed. The health care provider can be notified after assessment and documentation have been completed. DIF: Applying/Application REF: 1321

The nurse is educating a patient with gestational diabetes. Which statement indicates that the patient needs additional teaching? a "Gestational diabetes happens because of the hormonal changes of pregnancy." b."I should exercise regularly and lose weight to reduce my risk of becoming a diabetic." c."This problem goes away completely once I give birth." d. "The baby will have to be monitored for hypoglycemia during my pregnancy."

ANS: C Giving birth does not automatically resolve gestational diabetes. Of the women who have gestational diabetes, 5% to 10% go on to develop type 2 diabetes.

The nurse is caring for an older adult patient who is diabetic. The nurse cautions against the technique of "tight control" of hyperglycemia. Which statement explains why this management method is not recommended? a. Older adults may not accurately test and administer sliding-scale insulin. b. Older adults possess lower risk for hyperglycemia. c. Older adults may experience cardiovascular problems from hypoglycemia. d. Older adults possess an unstable metabolic rate.

ANS: C One complication of the "tight control" method includes hypoglycemia. Older adults experience hypoglycemia more quickly than do younger people, and older adults are more prone to hypoglycemic episodes.

After teaching a client who is newly diagnosed with type 2 diabetes mellitus, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching? a. "I should increase my intake of vegetables with higher amounts of dietary fiber." b. "My intake of saturated fats should be no more than 10% of my total calorie intake." c. "I should decrease my intake of protein and eliminate carbohydrates from my diet." d. "My intake of water is not restricted by my treatment plan or medication regimen."

ANS: C The client should not completely eliminate carbohydrates from the diet, and should reduce protein if microalbuminuria is present. The client should increase dietary intake of complex carbohydrates, including vegetables, and decrease intake of fat. Water does not need to be restricted unless kidney failure is present. DIF: Applying/Application REF: 1322

At 4:45 p.m., a nurse assesses a client with diabetes mellitus who is recovering from an abdominal hysterectomy 2 days ago. The nurse notes that the client is confused and diaphoretic. The nurse reviews the assessment data provided in the chart below: Capillary Blood Glucose Testing (AC/HS) Dietary Intake At 0630: 95 At 1130: 70 At 1630: 47 Breakfast: 10% eaten - client states she is not hungry Lunch: 5% eaten - client is nauseous; vomits once After reviewing the client's assessment data, which action is appropriate at this time? a. Assess the client's oxygen saturation level and administer oxygen. b. Reorient the client and apply a cool washcloth to the client's forehead. c. Administer dextrose 50% intravenously and reassess the client. d. Provide a glass of orange juice and encourage the client to eat dinner.

ANS: C The client's symptoms are related to hypoglycemia. Since the client has not been tolerating food, the nurse should administer dextrose intravenously. The client's oxygen level could be checked, but based on the information provided, this is not the priority. The client will not be reoriented until the glucose level rises. DIF: Applying/Application REF: 1334

A nurse assesses a client with diabetes mellitus 3 hours after a surgical procedure and notes the client's breath has a "fruity" odor. Which action should the nurse take? a. Encourage the client to use an incentive spirometer. b. Increase the client's intravenous fluid flow rate. c. Consult the provider to test for ketoacidosis. d. Perform meticulous pulmonary hygiene care.

ANS: C The stress of surgery increases the action of counterregulatory hormones and suppresses the action of insulin, predisposing the client to ketoacidosis and metabolic acidosis. One manifestation of ketoacidosis is a "fruity" odor to the breath. Documentation should occur after all assessments have been completed. Using an incentive spirometer, increasing IV fluids, and performing pulmonary hygiene will not address this client's problem. DIF: Applying/Application REF: 1330

The nurse is caring for a patient with type 1 diabetes who is diaphoretic and clammy. The patient complains of hunger but denies pain. The nurse performs a bedside blood glucose check. What should the nurse do next? a. Administer insulin as scheduled. b. Notify the charge nurse. c. Give 6 ounces of orange juice. d. Document the findings.

ANS: C These findings are consistent with hypoglycemia; manifestations of hypoglycemia include tremulousness, hunger, headache, pallor, sweating, palpitations, blurred vision, and weakness. Management includes providing a source of quick-acting carbohydrate/glucose such as orange juice. The nurse should withhold the patient's scheduled insulin

A nurse teaches a client with diabetes mellitus who is experiencing numbness and reduced sensation. Which statement should the nurse include in this client's teaching to prevent injury? a. "Examine your feet using a mirror every day." b. "Rotate your insulin injection sites every week." c. "Check your blood glucose level before each meal." d. "Use a bath thermometer to test the water temperature."

ANS: D Clients with diminished sensory perception can easily experience a burn injury when bathwater is too hot. Instead of checking the temperature of the water by feeling it, they should use a thermometer. Examining the feet daily does not prevent injury, although daily foot examinations are important to find problems so they can be addressed. Rotating insulin and checking blood glucose levels will not prevent injury. DIF: Applying/Application REF: 1327

When teaching a client recently diagnosed with type 1 diabetes mellitus, the client states, "I will never be able to stick myself with a needle." How should the nurse respond? a. "I can give your injections to you while you are here in the hospital." b. "Everyone gets used to giving themselves injections. It really does not hurt." c. "Your disease will not be managed properly if you refuse to administer the shots." d. "Tell me what it is about the injections that are concerning you."

ANS: D Devote as much teaching time as possible to insulin injection and blood glucose monitoring. Clients with newly diagnosed diabetes are often fearful of giving themselves injections. If the client is worried about giving the injections, it is best to try to find out what specifically is causing the concern, so it can be addressed. Giving the injections for the client does not promote self-care ability. Telling the client that others give themselves injections may cause the client to feel bad. Stating that you don't know another way to manage the disease is dismissive of the client's concerns. DIF: Applying/Application REF: 1338

A nurse assesses clients who are at risk for diabetes mellitus. Which client is at greatest risk? a. A 29-year-old Caucasian b. A 32-year-old African-American c. A 44-year-old Asian d. A 48-year-old American Indian

ANS: D Diabetes is a particular problem among African Americans, Hispanics, and American Indians. The incidence of diabetes increases in all races and ethnic groups with age. Being both an American Indian and middle-aged places this client at highest risk. DIF: Understanding/Comprehension REF: 1307

After teaching a young adult client who is newly diagnosed with type 1 diabetes mellitus, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the need for eye examinations? a. "At my age, I should continue seeing the ophthalmologist as I usually do." b. "I will see the eye doctor when I have a vision problem and yearly after age 40." c. "My vision will change quickly. I should see the ophthalmologist twice a year." d. "Diabetes can cause blindness, so I should see the ophthalmologist yearly."

ANS: D Diabetic retinopathy is a leading cause of blindness in North America. All clients with diabetes, regardless of age, should be examined by an ophthalmologist (rather than an optometrist or optician) at diagnosis and at least yearly thereafter. DIF: Applying/Application REF: 1303

A patient with type 1 diabetes mellitus (DM) is preparing for a moderate 30-minute exercise period. Which action best indicates that the patient understands condition management? a. The patient reduces insulin use during days when exercise periods are planned. b. The patient administers insulin after exercise rather than before exercise. c. The patient eats a high-carbohydrate snack before the exercise period. d. The patient consumes a simple carbohydrate snack after 30 minutes of activity.

ANS: D During moderate exercise (such as brisk walking, bowling, or vacuuming), 5 g of simple carbohydrate should be consumed at the end of 30 minutes and at 30-minute intervals during the continued activity. (A food example with 5 g of simple carbohydrate is 1 tsp honey.)

After teaching a client who has diabetes mellitus and proliferative retinopathy, nephropathy, and peripheral neuropathy, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the teaching? a. "I have so many complications; exercising is not recommended." b. "I will exercise more frequently because I have so many complications." c. "I used to run for exercise; I will start training for a marathon." d. "I should look into swimming or water aerobics to get my exercise."

ANS: D Exercise is not contraindicated for this client, although modifications based on existing pathology are necessary to prevent further injury. Swimming or water aerobics will give the client exercise without the worry of having the correct shoes or developing a foot injury. The client should not exercise too vigorously. DIF: Applying/Application REF: 1318

A nurse reviews the medication list of a client recovering from a computed tomography (CT) scan with IV contrast to rule out small bowel obstruction. Which medication should alert the nurse to contact the provider and withhold the prescribed dose? a. Pioglitazone (Actos) b. Glimepiride (Amaryl) c. Glipizide (Glucotrol) d. Metformin (Glucophage)

ANS: D Glucophage should not be administered when the kidneys are attempting to excrete IV contrast from the body. This combination would place the client at high risk for kidney failure. The nurse should hold the metformin dose and contact the provider. The other medications are safe to administer after receiving IV contrast. DIF: Applying/Application REF: 1310

A nurse teaches a client who is prescribed an insulin pump. Which statement should the nurse include in this client's discharge education? a. "Test your urine daily for ketones." b. "Use only buffered insulin in your pump." c. "Store the insulin in the freezer until you need it." d. "Change the needle every 3 days."

ANS: D Having the same needle remain in place through the skin for longer than 3 days drastically increases the risk for infection in or through the delivery system. Having an insulin pump does not require the client to test for ketones in the urine. Insulin should not be frozen. Insulin is not buffered. DIF: Applying/Application REF: 1315

A nurse reviews laboratory results for a client with diabetes mellitus who presents with polyuria, lethargy, and a blood glucose of 560 mg/dL. Which laboratory result should the nurse correlate with the client's polyuria? a. Serum sodium: 163 mEq/L b. Serum creatinine: 1.6 mg/dL c. Presence of urine ketone bodies d. Serum osmolarity: 375 mOsm/kg

ANS: D Hyperglycemia causes hyperosmolarity of extracellular fluid. This leads to polyuria from an osmotic diuresis. The client's serum osmolarity is high. The client's sodium would be expected to be high owing to dehydration. Serum creatinine and urine ketone bodies are not related to the polyuria. DIF: Applying/Application REF: 1302

The nurse is explaining the underlying pathophysiology of type 1 diabetes to a newly diagnosed patient. Which information accurately explains why the type 1 diabetic does not produce adequate insulin? a. A pituitary disorder inhibits beta cells. b. An allergic response alters beta cell responses to hyperglycemia. c. Alpha cells proliferated in the islets of Langerhans. d. The body's immune system destroyed beta cells.

ANS: D In type 1 diabetes mellitus (DM), the beta cells on the islets of Langerhans are destroyed by an autoimmune reaction.

A nurse reviews the laboratory results of a client who is receiving intravenous insulin. Which should alert the nurse to intervene immediately? a. Serum chloride level of 98 mmol/L b. Serum calcium level of 8.8 mg/dL c. Serum sodium level of 132 mmol/L d. Serum potassium level of 2.5 mmol/L

ANS: D Insulin activates the sodium-potassium ATPase pump, increasing the movement of potassium from the extracellular fluid into the intracellular fluid, resulting in hypokalemia. In hyperglycemia, hypokalemia can also result from excessive urine loss of potassium. The chloride level is normal. The calcium and sodium levels are slightly low, but this would not be related to hyperglycemia and insulin administration. DIF: Applying/Application REF: 1325

A nurse teaches a client with type 1 diabetes mellitus. Which statement should the nurse include in this client's teaching to decrease the client's insulin needs? a. "Limit your fluid intake to 2 liters a day." b. "Animal organ meat is high in insulin." c. "Limit your carbohydrate intake to 80 grams a day." d. "Walk at a moderate pace for 1 mile daily."

ANS: D Moderate exercise such as walking helps regulate blood glucose levels on a daily basis and results in lowered insulin requirements for clients with type 1 diabetes mellitus. Restricting fluids and eating organ meats will not reduce insulin needs. People with diabetes need at least 130 grams of carbohydrates each day. DIF: Applying/Application REF: 1338

After teaching a client with type 2 diabetes mellitus who is prescribed nateglinide (Starlix), the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the prescribed therapy? a. "I'll take this medicine during each of my meals." b. "I must take this medicine in the morning when I wake." c. "I will take this medicine before I go to bed." d. "I will take this medicine immediately before I eat

ANS: D Nateglinide is an insulin secretagogue that is designed to increase meal-related insulin secretion. It should be taken immediately before each meal. The medication should not be taken without eating as it will decrease the client's blood glucose levels. The medication should be taken before meals instead of during meals. DIF: Applying/Application REF: 1312

A nurse assesses a client with diabetes mellitus who self-administers subcutaneous insulin. The nurse notes a spongy, swelling area at the site the client uses most frequently for insulin injection. Which action should the nurse take? a. Apply ice to the site to reduce inflammation. b. Consult the provider for a new administration route. c. Assess the client for other signs of cellulitis. d. Instruct the client to rotate sites for insulin injection.

ANS: D The client's tissue has been damaged from continuous use of the same site. The client should be educated to rotate sites. The damaged tissue is not caused by cellulitis or any type infection, and applying ice may cause more damage to the tissue. Insulin can only be administered subcutaneously and intravenously. It would not be appropriate or practical to change the administration route. DIF: Applying/Application REF: 1339

A nurse cares for a client experiencing diabetic ketoacidosis who presents with Kussmaul respirations. Which action should the nurse take? a. Administration of oxygen via face mask b. Intravenous administration of 10% glucose c. Implementation of seizure precautions d. Administration of intravenous insulin

ANS: D The rapid, deep respiratory efforts of Kussmaul respirations are the body's attempt to reduce the acids produced by using fat rather than glucose for fuel. Only the administration of insulin will reduce this type of respiration by assisting glucose to move into cells and to be used for fuel instead of fat. The client who is in ketoacidosis may not experience any respiratory impairment and therefore does not need additional oxygen. Giving the client glucose would be contraindicated. The client does not require seizure precautions. DIF: Applying/Application REF: 1333

Type 2 diabetes cases compose approximately what percentage of all known cases of diabetes? a. 70% b. 75% c. 80% d. 95%

ANS: D Type 2 diabetics comprise 90% to 95% of all known cases.

A nurse cares for a client who has type 1 diabetes mellitus. The client asks, "Is it okay for me to have an occasional glass of wine?" How should the nurse respond? a. "Drinking any wine or alcohol will increase your insulin requirements." b. "Because of poor kidney function, people with diabetes should avoid alcohol." c. "You should not drink alcohol because it will make you hungry and overeat." d. "One glass of wine is okay with a meal and is counted as two fat exchanges."

ANS: D Under normal circumstances, blood glucose levels will not be affected by moderate use of alcohol when diabetes is well controlled. Because alcohol can induce hypoglycemia, it should be ingested with or shortly after a meal. One alcoholic beverage is substituted for two fat exchanges when caloric intake is calculated. Kidney function is not impacted by alcohol intake. Alcohol is not associated with increased hunger or overeating. DIF: Applying/Application REF: 1320

The nurse is explaining the underlying pathophysiology of type 1 diabetes to a newly diagnosed patient. Which information accurately explains why the type 1 diabetic does not produce adequate insulin? A) A pituitary disorder inhibits beta cells. B) An allergic response alters beta cell responses to hyperglycemia. C) Alpha cells proliferated in the islets of Langerhans. D) The body's immune system destroyed beta cells

ANS: D In type 1 diabetes mellitus (DM), the beta cells on the islets of Langerhans are destroyed by an autoimmune reaction

The nurse is caring for a patient who struggles to maintain glycemic control at night and during early morning hours. Which statement correctly explains the reason for this problem? a. Counterregulatory hormones produce hyperglycemia. b. Hyperglycemia of dawn phenomenon does not react to insulin. c. Hypoglycemia quickly follows the dawn phenomenon. d. Food intake fails to change hyperglycemia of dawn phenomenon.

NS: A Dawn phenomenon is produced in the morning by the circadian release of growth hormones, epinephrine, and glucagon during the night. Rebound hyperglycemia, also known as the Somogyi effect, follows a period of hypoglycemia, often during sleep. When hypoglycemia occurs, the body secretes glucagon, epinephrine, growth hormone, and cortisol to counteract the effects of low blood sugar.

A nurse collaborates with the interdisciplinary team to develop a plan of care for a client who is newly diagnosed with diabetes mellitus. Which team members should the nurse include in this interdisciplinary team meeting? (Select all that apply.) a. Registered dietitian b. Clinical pharmacist c. Occupational therapist d. Health care provider e. Speech-language pathologist

NS: A, B, D When planning care for a client newly diagnosed with diabetes mellitus, the nurse should collaborate with a registered dietitian, clinical pharmacist, and health care provider. The focus of treatment for a newly diagnosed client would be nutrition, medication therapy, and education. The nurse could also consult with a diabetic educator. There is no need for occupational therapy or speech therapy at this time. DIF: Applying/Application REF: 1327

A patient has just been diagnosed with diabetes and is admitted for insulin regulation. He asks the nurse, "Why do I need to be stuck so many times a day?" Which statement best explains the rationale for the frequent checks of his blood glucose level?

Blood glucose levels are checked so that your insulin doses can be adjusted."

The nursing assistant tells you that a patient with diabetes has a blood glucose level of 60 mg/dL. What symptoms would the nurse be most likely to observe with this glucose level? A) Confusion, tremulousness, pallor, sweating, and weakness B) Dry, flushed skin and mild irritability C) Deep, rapid breathing and abdominal pain D) Incoherent moaning, combativeness, and seizure activity

Correct Answer: A Confusion, tremulousness, pallor, sweating, and weakness are the most likely symptoms. Incoherent moaning, combativeness, and seizure activity might occur if the nurse fails to intervene quickly. Dry, flushed skin is symptomatic of hyperglycemia. Irritability could be present to high or low glucose levels. Deep rapid breathing and abdominal pain are signs of hyperglycemia.

During a routine checkup, the health care provider tells a patient with diabetes that test results reveal albuminuria. Which long-term complication is specific to this test result? A) Metabolic syndrome B) Nephropathy C) Retinopathy D) Peripheral vascular disease

Correct Answer: B Albuminuria indicates that protein is passing into the urine because the filtering mechanism of the kidney has sustained damage from filtering blood with elevated glucose. The other complications are likely to be simultaneously occurring over time because of the damage to blood vessels and other organs.

A nurse determines the fingerstick blood glucose reading for a patient with diabetes is 750 mg/dL. What is the nurse's priority action? A) Immediately notify the RN and the health care provider. B) Assess the vital signs of the patient. C) Check the record to verify whether the patient has type 1 or type 2 diabetes. D) Administer prescribed sliding scale insulin.

Correct Answer: B The patient should be assessed immediately for responsiveness and additional signs and symptoms. Notifying the RN and the physician after the patient has been assessed are appropriate actions. Checking the record to verify type 1 or type 2 diabetes is not incorrect, but hopefully the nurse would know this information from shift report. Administering the insulin should not happen until further assessment is completed.

The home health nurse is visiting an older adult patient who has successfully managed her type 2 diabetes for years. During the visit, the nurse notes that the patient has severe arthritis; poor vision; and several dry, red areas on the lower extremities. What is the priority patient problem? A) Potential for noncompliance due to social circumstances. B) Potential for ineffective self-health management due to aging. C) Potential for infection due to poor peripheral perfusion. D) Potential for disturbed sensory perception due to degenerative changes.

Correct Answer: B This patient has had type 2 diabetes for years, but now changes related to aging place the patient at risk for ineffective self-health management. Risk for noncompliance is an inappropriate diagnosis. Patient does not have a history of noncompliance but now needs interventions related to aging to maximize self-care. Patient does have risk for infection and problems with sensory input; however, again, the nurse should use interventions that address the problems of aging, so that the patient can continue self-care.

A 50-year-old woman was recently diagnosed with type 2 diabetes mellitus and desires to start a healthy lifestyle to control her disease. What is the initial recommendation that the nurse should make? A) Engage in brisk walking. B) Lose 10 to 15 pounds. C) Maintain adequate glucose control. D) Develop an exercise schedule.

Correct Answer: C Once the patient has learned how to manage and monitor her glucose level, she can begin to balance her diet with exercise and gradually lose some weight.

A 30-year-old woman is admitted for urinary tract infection with sepsis. A urinalysis reveals presence of ketones, glucose, and nitrates. Which question would the nurse ask to further assess possible diabetes mellitus? A) "Have you noticed an extra roundness to your face?" B) "Have you had more gas or abdominal bloating?" C) "Have you been thirstier than usual? Do you find you urinate more now?" D) "Have you experienced any pain or discomfort with urination?"

Correct Answer: C Polydipsia, polyuria, and polyphagia (thirst, urinary frequency, and hunger, respectively) are signs of diabetes. A round moon face is characteristic of Cushing disease. Abdominal bloating is more associated with thyroid problems. Asking about pain with urination is appropriate to assess for urinary tract infection (UTI). There is an increased risk for UTI with diabetes, but asking about occurrence or frequency of UTIs is a better question to assess for possible diabetes.

A patient who works as a personal trainer is diagnosed with insulin-dependent diabetes. What should the nurse teach regarding self-administration of regular insulin? A) If you have a strenuous workout, skip your insulin for the day. B) Inject the insulin before moderate exercise. C) Exercise during the insulin peak of action. D) Use the abdomen as an insulin injection site.

Correct Answer: D The abdomen is a good site for insulin injection as absorption is steady, rapid, and not affected by exercise. Do not encourage the patient to skip insulin doses. Diabetics must learn to balance their nutrition, exercise, and insulin doses. Instruct the patient to eat a light snack before exercising. Depending on the type of insulin and the onset of action, injecting the insulin before exercise may cause a hypoglycemic reaction. Exercising during the peak of insulin will increase the chances of hypoglycemia.

A patient newly diagnosed with diabetes is given diet instructions. What should the nurse do to effectively motivate the patient to comply with dietary recommendations? (Select all that apply.) A) Emphasize good food choices. B) Apply diet prescriptions to patient-preferred foods. C) Instill guilt to self-regulate when "cheating" occurs. D) Focus on the benefits of diet compliance. E) Involve meal preparers in diet teaching.

Correct Answers: A, B, D, E These options are good strategies. Fear and guilt create a situation where the patient will be reluctant to tell the truth to others. There will be times when the patient will not follow the diet (e.g., it may be very difficult during the holidays); however, the patient should be able to admit the deviation from the plan and then get back on schedule.

Which teaching technique(s) would be most useful for an older adult patient with diabetes? (Select all that apply.) A) Set a time for the teaching session that is agreeable to the patient. B) Invite the patient to join a teaching session for patients newly diagnosed with diabetes. C) Allow time for the patient to jot down important points. D) Use bold-type printed materials with a white type on a dark blue or black background. E) Keep the sessions at a limit of 1 to 2 hours and give frequent breaks. F) Teach all necessary information in one session. G) Repeat key concepts frequently; if the patient does not understand, try rephrasing the concept.

Correct Answers: A, C, G Setting a specific time, allowing additional time to write down information, and repeating key concepts are good strategies. Group learning may work for some older patients, but generally it is more advisable to have less distraction and more time for individualized attention. Use dark type on white backgrounds for optimal visual clarity. Attempting to cover all material in long sessions is not ideal, even if you give the patient frequent breaks.

The nurse answers the call light for a patient with diabetes. The patient states she feels shaky and weak. The nurse notes pallor and moist skin. List in priority order the actions of the nurse. A) Give patient 6 oz of juice. B) Document interventions. C) Check fingerstick glucose. D) Assess level of consciousness.

Correct Answers: D, C, A, B The level of consciousness determines the glucose intervention. If the patient is not able to swallow, injectable forms of glucose will be utilized. If the patient is unconscious, treatment should be initiated immediately, not taking time for checking the blood glucose level. For the conscious patient, fingerstick glucose should be done and treatment given and actions documented. Fifteen minutes after treatment, the glucose should be rechecked.

A patient who is undergoing surgery will have an intravenous solution to which insulin will be added. Which of these types of insulin must be used?

Regular

A patient with diabetes mellitus has been maintained on metformin (Glucophage) for regulation of her blood glucose levels. What should be included in this patient's teaching?

Report changes in voiding patterns.

A patient with diabetes asks her nurse why she should use a diaphragm for contraception instead of birth control pills. The best explanation for the patient is that:

a diaphragm is noninvasive and will not affect her blood glucose levels.

A patient with diabetes is taking Lantus insulin. The nurse is aware that this insulin will most likely be administered:

at night

A patient with diabetes experiences the Somogyi effect. To prevent this complication, the nurse should instruct the patient to:

eat a protein and carbohydrate snack before retiring.

A patient presents in the emergency room with polydipsia, polyuria, and polyphagia related to his diabetes. The nurse should expect these symptoms are related to:

hyperglycemia.

A patient is diagnosed as having diabetes mellitus and is started on 22 units of NPH insulin and an 1800-calorie American Diabetic Association (ADA) diet. While the LPN/LVN is teaching the patient that she should have a mid-afternoon snack, the patient asks why that is necessary. The nurse should reply that:

it helps prevent a hypoglycemic reaction.

The nurse explains that the three cardinal signs of type 1 diabetes mellitus (DM) are __________, __________, and __________.

polydipsia, polyphagia, polyuria

A patient with type 1 diabetes mellitus plays tennis and asks if she will be able to continue with that sport. The LPN/LVN should tell her that:

she can play tennis, but she will need to eat more before she plays.

When teaching a patient with type 1 diabetes about home care, the LPN/LVN assures her that she can recognize the early signs of diabetic ketoacidosis, which are:

thirst, dry mucous membranes, and dry skin.