PrepU - diabetes
A nurse is providing client education to a 13-year-old girl who was just diagnosed with type 1 diabetes mellitus. Which statement by the client will alert the nurse that special instructions regarding insulin are necessary?
"I am on the middle school track team." Explanation: Because the client is on the track team, she will have increased exercise at various times that will require increased insulin and special instructions related to hypoglycemia that may come hours after she has ceased exercising. Walking two blocks every day and walking up stairs would not be considered increased physical exercise and would not be a factor. Wanting to have her mother administer the insulin is not uncommon for this age client, and the nurse would normally instruct both the mother and the daughter in the administration of the drug.
A young man has been diagnosed with type 2 diabetes and has been prescribed glyburide. Which statement suggests that the nurse should perform further health education?
"I'll plan to take my glyburide each night before I go to bed." Explanation: Glyburide is normally taken in the morning, before breakfast. No drug cures diabetes; the goal of therapy is the maintenance of safe blood glucose levels. The client should check before taking other drugs and should indeed be aware of the risk of hypoglycemia.
A 59-year-old man with type 2 diabetes is prescribed metformin. When the client returns to the clinic, he reports that he has lost 8 pounds in a month. How should the nurse respond?
"Please continue taking the medication and monitoring your weight. This is an expected outcome of this drug therapy." Explanation: The nurse should advise the client to continue therapy as prescribed because weight loss is a beneficial adverse effect for type 2 diabetics. The client need not seek a decrease in dosage or change in medication, nor would discontinuation of the drug be warranted.
A 54-year-old male client is diagnosed with chronic renal failure and hyperglycemia. He asks if he can be prescribed sulfonylurea because it works well for his friend. If he were to be given sulfonylurea, this client's renal impairment may lead to what effect?
Accumulation and hypoglycemia Explanation: Sulfonylureas and their metabolites are excreted mainly by the kidneys; renal impairment may lead to accumulation and hypoglycemia. They should be used cautiously, with close monitoring of renal function, in clients with mild to moderate renal impairment and are contraindicated in severe renal impairment.
A nurse is caring for a 48-year-old woman who has been hospitalized after injecting the wrong type of insulin. Which sign of hypoglycemia will the nurse be careful to observe for?
Blurred vision Explanation: Blurred or double vision (diplopia), fatigue, trembling, irritability, headache, nausea, numbness, muscle weakness, hunger, tachycardia, sweating, and nervousness are signs of a hypoglycemic reaction. Fruity breath can be an indication of ketoacidosis, and flushing of the face is a sign of hyperglycemia. Dry skin is unrelated to hypoglycemia.
The nurse is preparing to administer a mixture of 12 units regular insulin and 45 units NPH insulin to a client with a blood sugar of 378 mg/dL. After the nurse draws the medication into the syringe, what is the nurse's next action?
Check the dosage with another nurse. Explanation: After preparing the syringe with insulin, the nurse should then have the medication and dosage checked by a second nurse to make sure that it is correct. It is not necessary to recheck the client's blood sugar again. It is important to know when the client will be eating again; make sure that it is within the next 30 minutes. However, this is not the nurse's next step. Then the nurse will administer the insulin to the client.
When learning about type 1 diabetes, what would the student nurses learn is a distinguishing characteristic of this disease?
Exogenous insulin is required for life. Explanation: Type 1 diabetes results from an autoimmune disorder that destroys pancreatic beta cells. Insulin is the only effective treatment for type 1 diabetes because pancreatic beta cells are unable to secrete endogenous insulin and metabolism is severely impaired. In type I diabetes, blood glucose levels cannot be controlled with diet, oral agents cannot control the disease process, and it does not always start in childhood.
Clients with type 2 diabetes have nonfunctioning beta pancreatic cells.
False Explanation: Type 2 diabetes reflects an inability to produce enough insulin as needed or a change in insulin receptor sensitivity.
A nurse is caring for a patient who has developed a hypoglycemic reaction. Which intervention should the nurse perform if swallowing and gag reflexes are present in the patient?
Give oral fluids or candy. Explanation: The nurse should administer oral fluids or candy to the hypoglycemic patient with swallowing and gag reflexes. If the patient is unconscious the nurse should administer glucose or glucagon parenterally. The nurse should administer insulin through an insulin pump to special categories of diabetic patients, such as pregnant women with diabetes and renal transplantation. Oral antidiabetic drugs are administered to patients with type 2 diabetes.
When administering insulin, what would be most appropriate?
Insert the needle at a 45-degree angle for injection. Explanation: The vial should be gently rotated and vigorous shaking is to be avoided to ensure uniform suspension of the insulin. Typically the area is pinched to allow access to the loose connective tissue layer. The needle is inserted at a 45-degree angle for subcutaneous administration. Gentle pressure should be applied at the injection site.
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. Explanation: The nurse should check the previous injection site before administering each insulin dose. The injection sites should be rotated to prevent lipodystrophy. Prefilled syringes should not be kept horizontally; they should be kept in a vertical or oblique position to avoid plugging the needle. The nurse checks for symptoms of myalgia or malaise when administration of metformin leads to lactic acidosis. Insulin should be kept at room temperature for administration. Insulin is refrigerated if it needs to be stored for up to three months for later use.
As a diabetic educator, the nurse is teaching a newly diagnosed diabetic client about aspects of the disease process. What would the nurse tell the client about the body's control of glucose?
It is related to fat and protein metabolism Explanation: The body's control of glucose is intricately related to fat and protein metabolism, balancing energy conservation with energy consumption to maintain homeostasis in a variety of situations. Our body stores glucose for use in times of stress.
A client prescribed metformin is scheduled to undergo diagnostic testing with the administration of parenteral radiographic contrast media containing iodine. What fact should direct the nurse's plan of care for this client?
Metformin should be discontinued at least 48 hours before and after diagnostic tests that use contrast medias. Explanation: Metformin should be discontinued at least 48 hours before diagnostic tests are performed with these materials and should not be resumed for at least 48 hours after the tests are done and tests indicate renal function is normal. By altering the metformin therapy, none of the other options are required.
A client prescribed metformin is scheduled to undergo diagnostic testing with the administration of parenteral radiographic contrast media containing iodine. What fact should direct the nurse's plan of care for this client?
Metformin should be discontinued at least 48 hours before and after diagnostic tests that use contrast medias. Explanation: Metformin should be discontinued at least 48 hours before diagnostic tests are performed with these materials and should not be resumed for at least 48 hours after the tests are done and tests indicate renal function is normal. By altering the metformin therapy, none of the other options are required.
The nurse is caring for a client taking bromocriptine (Cycloset). What is an advantage of this medication?
Reduces risk of heart attack or stroke Explanation: Bromocriptine-therapy clients had improved HbA1c levels, showing better glycemic control, and were less likely to have a heart attack or stroke or to die of heart disease. All drugs have adverse effects. Taking the medication four times a day and the need for long-term studies are not advantages of the drug.
A client is admitted to the intensive care unit with diabetic ketoacidosis. The nurse knows that the client will be placed on an intravenous insulin drip. The only type of insulin that can be administered intravenously is:
Regular. Explanation: In general, regular insulin, a short-acting insulin, is used with major surgery or surgery requiring general anesthesia. IV administration of insulin is preferred because it provides more predictable absorption than subcutaneous injections. Only regular insulin is administered IV.
A client was diagnosed with type 2 diabetes several months ago and has presented for a scheduled follow-up appointment. Which stated behavior most clearly indicates that the client has established effective health maintenance?
The client frequently checks his/her blood glucose levels. Explanation: Vigilant blood glucose monitoring is imperative in the management of diabetes. This shows effective health maintenance even more clearly than exercising. Dietary modifications must be undertaken with care in people with diabetes to avoid health consequences. Explaining pathophysiology does not necessarily show effective health maintenance.
An insulin-dependent diabetic male client is having trouble with hypoglycemia late in the morning. During the health history, the nurse becomes aware of the most likely cause. What would cause the late morning hypoglycemia?
The client jogs two miles in the morning before he goes to work. Explanation: Physical exercise, such as jogging, changes insulin requirements and may result in a delayed hypoglycemic reaction. The fact that he likes to nap before dinner and has an early lunch is unrelated to his hypoglycemia. The client eating oatmeal early in the morning would help stabilize his blood sugars until later in the morning, but the jogging would have a dramatic effect.
A nurse is preparing to administer an insulin that is clear. Which insulin would the nurse most likely administer?
humulin R Explanation: Regular insulin (Humulin R) is clear, whereas intermediate-acting (Humulin N and Humulin L) and long-acting (Humulin U) insulins are cloudy.
A 35-year-old client has begun the administration of glyburide for treatment of diabetes mellitus type 2. The nurse caring for this client provides education regarding this medication. Which statement would NOT be an appropriate instruction for this client?
The medication should have a fixed dose which cannot be manipulated. Explanation: Manipulating the dosing of glyburide can often reduce the unpleasant reactions. The primary adverse effect associated with glyburide (and the other sulfonylureas) is hypoglycemia. Concomitant alcohol use increases the rate of glyburide metabolism and may cause a disulfiram-like reaction. Administer glyburide before breakfast or the first main meal of the day in order to stimulate insulin production. It is important to caution clients to avoid taking OTC medications and herbal or dietary supplements without first consulting the prescriber
The nurse is caring for a client with renal dysfunction who requires an oral antidiabetic agent. What drug will the nurse expect to see ordered?
Tolbutamide Explanation: Tolbutamide is preferred for clients with renal dysfunction, who may not be able to excrete chlorpropamide, because it is more easily cleared from the body. Tolbutamide, chlorpropamide, and tolazamide are all first-generation sulfonylureas, but tolazamide is used less frequently and is usually tried after the first two drugs have been shown to be ineffective. Chlorpromazine (Thorazine) is an antipsychotic agent.
The pathophysiology class is studying diabetes. A student asks the instructor what is considered a sign of a hypoglycemic reaction. The instructor's response would be:
diaphoresis. Explanation: Diaphoresis and cool, clammy skin are signs of hypoglycemia. A fruity breath is seen with ketoacidosis. Flushing of the face is associated with hyperglycemia.
The nurse is caring for a client who is taking glyburide as treatment for type 2 diabetes mellitus. The health care provider has added a corticosteroid to this client's medication regimen for treatment of a severe allergic reaction. The nurse knows that this drug combination may cause what adverse effect on this client?
hyperglycemia Explanation: Corticosteroids increase insulin needs, so the client may develop hyperglycemia.