Module 9 Prep U: Diabetes

A client newly diagnosed with diabetes mellitus asks why he needs ketone testing when the disease affects his blood glucose levels. How should the nurse respond?

"Ketones will tell us if your body is using other tissues for energy.

A 9-year-old was just diagnosed with type 1 diabetes. The parents state, "We hope our child won't have to take insulin injections." How should the nurse respond?

"The pancreas doesn't produce insulin in Type 1 diabetes, so it is likely that insulin injections will be necessary."

A client is receiving insulin lispro at 7:30 AM. The nurse ensures that the client has breakfast by which time?

0745

A client with diabetes mellitus has a blood glucose level of 40 mg/dL. Which rapidly absorbed carbohydrate would be most effective?

1/2 cup fruit juice or regular soft drink

A patient who is 6 months' pregnant was evaluated for gestational diabetes mellitus. The doctor considered prescribing insulin based on the serum glucose result of:

138 mg/dL, 2 hours postprandial.

The nurse educates a client newly diagnosed with diabetes regarding diet and energy requirements. The nurse knows that 1 gram of fat will provide _____ kcal of energy.

9

Which statement is true regarding gestational diabetes?

A glucose challenge test should be performed between 24 and 28 weeks.

Which client would be considered to be exhibiting manifestations of "prediabetes"?

A middle-aged overweight adult with a fasting plasma glucose level of 122 with follow-up OGTT of 189 mg/dL (10.49 mmol/L).

A client with diabetes is receiving an oral antidiabetic agent that acts to help the tissues use available insulin more efficiently. Which of the following agents would the nurse expect to administer?

Metformin

The results of a 44-year-old obese man's recent diagnostic workup have culminated in a new diagnosis of type 2 diabetes. Which pathophysiologic process underlies the client's new diagnosis?

Beta cell exhaustion due to long-standing insulin resistance

Diabetics are hospitalized for a number of reasons. What is the most common complication of diabetes requiring hospitalization?

Foot problems

Which would a nurse identify as an example of a sulfonylurea?

Glyburide

Which assessment finding of a client constitutes a criterion for a diagnosis of metabolic syndrome?

Has a high blood pressure that is consistently in the range of 140/90 mm Hg or greater

When the nurse inspects the feet of a diabetic, a tack is found sticking in the sole of one foot. The client denies feeling anything unusual in the foot. Which is the best rationale for this finding?

High blood sugar decreases blood circulation to nerves.

An older adult patient is in the hospital being treated for sepsis related to a urinary tract infection. The patient has started to have an altered sense of awareness, profound dehydration, and hypotension. What does the nurse suspect the patient is experiencing?

Hyperglycemic hyperosmolar syndrome

The nurse is teaching a client with gestational diabetes about complications that can occur either following birth or during the birth for the infant. Which statement by the mother indicates that further teaching is needed by the nurse?

If my blood sugars are elevated, my baby's lungs will mature faster, which is good.

The client who is managing diabetes through diet and insulin control asks the nurse why exercise is important. Which is the best response by the nurse to support adding exercise to the daily routine?

Increases ability for glucose to get into the cell and lowers blood sugar

When describing the effects of incretins on blood glucose control to a group of students, which would an instructor include?

Increases insulin release

A nurse at a health care facility is assigned to administer insulin to the patient. Which intervention should the nurse perform before administering each insulin dose?

Inspect the previous injection site for inflammation

A client with diabetes asks the nurse for advice in controlling between-meal blood glucose levels. Which of these might the nurse suggest as a long-acting insulin to provide a consistent basal level?

Insulin glargine

A nurse explains to a client that she will administer his first insulin dose in his abdomen. How does absorption at the abdominal site compare with absorption at other sites?

Insulin is absorbed more rapidly at abdominal injection sites than at other sites.

The nurse knows that metabolic abnormalities that lead to type 2 diabetes include which physiologic problems? Select all that apply.

Insulin resistance Beta cell failure Hepatic glycogenolysis

What should be included in the teaching plan for a child with type 1 diabetes who is going home on insulin therapy?

It is absolutely normal for the growing child to require an increase in insulin; this does not mean his/her condition is getting worse.

The nurse who has admitted a client with diabetic ketoacidosis should look for what assessment findings that are consistent with this diagnosis? (Select all that apply.)

Ketones in the urine Flushed, dry skin

A pregnant woman diagnosed with diabetes should be instructed to perform which action?

Notify the primary care provider if unable to eat because of nausea and vomiting

A nurse is teaching a diabetic support group about the causes of type 1 diabetes. The teaching is determined to be effective when the group is able to attribute which factor as a cause of type 1 diabetes?

Presence of autoantibodies against islet cells

A woman in her 28th week of pregnancy tests positive for gestational diabetes mellitus and begins to follow a nutritional plan at home. What result at the follow-up visit indicates a successful outcome?

Random blood glucose 85 mg/dL (4.72 mmol/L)

The nurse is administering an insulin drip to a patient in ketoacidosis. What insulin does the nurse know is the only one that can be used intravenously?

Regular

Research has identified a cycle of insulin-induced posthypoglycemic episodes. What is this phenomenon called?

Somogyi effect

The nurse is teaching a client with diabetes about the signs and symptoms of hypoglycemia. The client asks, "Why will I get headache, disturbed behavior, coma, and seizures if it's my pancreas that's impaired?" Which response is the best explanation?

The brain relies on blood glucose as its main energy source.

A male client, aged 42 years, is diagnosed with diabetes mellitus. He visits the gym regularly and is a vegetarian. Which of the following factors is important when assessing the client?

The client's consumption of carbohydrates

A 42-year-old male client is prescribed glargine insulin for management of his type 2 diabetes mellitus. The nurse caring for the client develops a teaching plan regarding glargine insulin therapy. Which statement made by the client indicates that the client needs additional teaching?

The medication will peak in 3 hours.

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:

The pancreatic hormone glucagon will stimulate the liver to release stored glucose

A client with type 2 diabetes asks the nurse why he can't have a pancreatic transplant. Which of the following would the nurse include as a possible reason?

Underlying problem of insulin resistance

An obese adult has recently been diagnosed with type 2 diabetes. The nurse knows that the most likely treatment plan for this client will include which topics?

Weight loss, glucose monitoring, and oral antihyperglycemic medications

A client with a new diagnosis of type 2 diabetes mellitus states, "I am really worried that I might need to take injections. Is there something I can do to avoid that?" What is the best response by the nurse?

You could regulate your diet, exercise regularly, and lose weight

A nurse should recognize that which laboratory result would be most consistent with a diagnosis of diabetes mellitus?

a fasting blood glucose greater than 126 mg/dl

A nurse is to see a child. Assessment reveals the chief complaints of urinating "a lot" and being "really thirsty." The nurse interprets these symptoms as being associated with which condition?

diabetes insipidus

A G2P1 woman with type 1 diabetes is determined to be at 8 weeks' gestation by her health care provider. The nurse should point out which factor will help the client maintain glycemic control?

exercise

A client with diabetes mellitus is receiving an oral antidiabetic agent. The nurse observes for which condition when caring for this client?

hypoglycemia

After teaching a client with type 1 diabetes who is scheduled to undergo an islet cell transplant, which client statement indicates successful teaching?

might need insulin later on but probably not as much or as often.

A 40-year-old woman comes to the clinic reporting having missed her period for two months. A pregnancy test is positive. What is she and her fetus at increased risk for?

placental abnormalities

The nurse is assessing a 5-year-old child whose parent reports the child has been vomiting lately, has no appetite, and has had an extreme thirst. Laboratory work for diabetes is being completed. Which symptom would differentiate between type 1 diabetes from type 2 diabetes?

recent weight loss

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?

weakness, sweating, and decreased mentation.