Textbook/Saunders Questions

"A nurse performs a physical assessment on a client with type 2 diabetes mellitus. Findings include a fasting blood glucose of 70 mg/dL, temp of 101 F, pulse of 82 bpm, respirations of 20, and blood pressure of 118/68. Which finding would be of most concern to the nurse? "1. Pulse 2. Respiration 3. Temperature 4. Blood pressure"

3) temp. An elevated temperature may indicate infection. Infection is a leading cause of hyperglycemic hyperosmolar nonketotic syndrome or diabetic ketoacidosis. The other findings noted in the question are within normal limits.

The nurse is caring for a client hospitalized for heart failure exacerbation and suspects that the client may be entering a state of shock. The nurse knows that which intervention is a priority for this client? A. Administration of digoxin B. Administration of whole blood C. Administration of IV fluids D. Administration of packed red blood cells

A. Administration of digoxin The client in this question is likely experiencing cardiogenic shock secondary to heart failure. It is important to know that if the shock state is cardiogenic in nature, the infusion of volume expanding fluids may result in pulmonary edema; therefore restoration of cardiac function is the priority for this type of shock.

The nurse is assessing a client with septic shock. What assessment data indicate a progression of shock? Select all that apply A. BP change from 86/50 to 100/40 mm Hg B. Heart rate change from 98 to 76 bpm C. Cool and clammy skin D. Petechiae along the gumline E. Urine output 45 mL/hour

A. BP change from 86/50 to 100/40 C. Cool and clammy skin D. Petechiae along the gumline

The nurse is caring for a client experiencing acute lower gastrointestinal bleeding. In developing the plan of care, which priority problem should the nurse assign to this client? A. Deficient fluid volume related to acute blood loss B. Risk for aspiration related to acute bleeding in the G.I. tract C. Risk for infection related to acute disease process and medications D. In balance nutrition, less than body requirements, related to lack of nutrients and increased metabolism

A. Deficient fluid volume related to acute blood loss

Which physiological processes directly prevent severe hypoglycemia in a healthy adult without diabetes who is NPO for 12 hours? Select all that apply A. Gluconeogenesis B. Glycogenesis C. Glycogenolysis D. Ketogenesis E. Lipogenesis F. Lipolysis

A. Gluconeogenesis C. Glycogenolysis

The nurse is caring for a patient in the initial stage of hypovolemic shock. What assessment data will the nurse anticipate? A. Heart rate 118 bpm 2. 2+ pedal pulses 3. Bilateral fine crackles in lung bases 4. BP change from 100/60 to 100/40 mm Hg

A. Heart rate 118 bpm

A client with diabetes mellitus is taking Humulin NPH insulin and regular insulin every morning. The nurse should provide which instructions to the client? Select all that apply A. Hypoglycemia may be experienced before dinner time B. The insulin dose should be decreased if illness occurs C. The insulin should be administered at room temperature D. The insulin vial needs to be shaken vigorously to break up the precipitates E. The NPH insulin should be drawn into the syringe first, then the regular insulin

A. Hypoglycemia may be experienced before dinner time C. The insulin should be administered at room temperature

The home health nurse visits a client with a diagnosis of type 1 diabetes mellitus. The client reports a history of vomiting and diarrhea and tells the nurse that no food has been consumed for the last 24 hours. Which additional statement by the client indicates a need for further teaching? A. I need to stop my insulin B. I need to increase my fluid intake C. I need to monitor my blood glucose every 3 to 4 hours D. I need to call my primary healthcare provider because of these symptoms

A. I need to stop my insulin

A client in the progressive stage of hypovolemic shock has all of the following signs, symptoms, or changes. Which signs will the nurse attribute to ongoing compensatory mechanisms? Select all that apply. A. Increasing pallor B. Increasing thirst C. Increasing confusion D. Increasing heart rate E. Increasing respiratory rate F. Decreasing systolic blood pressure G. Decreasing blood pH H. Decreasing urine output

A. Increasing pallor B. Increasing thirst D. Increasing heart rate E. Increasing respiratory rate H. Decreasing urine output

The nurse is admitting a client who is diagnosed with syndrome of an appropriate antidiuretic hormone secretion (SIADH) and has a serum sodium of 118 mEq/L. Which primary healthcare providers prescription should the nurse anticipate receiving? Select all that apply A. Initiate an infusion of 3% NaCl B. Administer intervenous furosemide C. Restrict fluids to 800 mL over 24 hours D. Elevate the head of the bed to a high Fowlers E. Administer a vasopressin antagonist as prescribed

A. Initiate an infusion of 3% NaCl C. Restrict fluids to 800 mL over 24 hours E. Administer a vasopressin antagonist as prescribed Clients with SIADH experience excess secretion of antidiuretic hormone, which leads to excess intravascular volume, a declining serum osmolarity, and dilutional hyponatremia. Management is directed at correcting the hyponatremia and preventing cerebral edema. Hypertonic saline is prescribed when the hyponatremia is severe, less than 120 mEq/L. An IV infusion of 3% saline is hypertonic. Hypertonic saline must be infuse slowly as prescribed and an infusion pump must be used. Fluid restriction is A useful strategy and act correct in dilutional hyponatremia. Vasopressin is an 80 H; visa present antagonist are used to treat SIADH. Furosemide maybe used to treat extravascular volume and dilutional hyponatremia an SIADH, but it is only safe to use of the serum sodium is at least 125 mEq/L. When Furosemide is used, potassium supplementation should also occur occur and serum potassium level should be monitored. To promote venous return, the head of the bed should not be raised more than 10° for the client. Maximizing venous return helps avoid stimulating stretch receptors in a heart of signal the pituitary that more ADH is needed.

Which precaution is a priority for the nurse to teach a client prescribed semaglutide to prevent harm? A. Only take this drug once weekly B. Report any vision changes immediately C. Do not mix in the same syringe with insulin D. This drug can only be given by a healthcare professional

A. Only take this drug once weekly

The nurse is monitoring a client newly diagnosed with diabetes mellitus first signs of complications. Which sign or symptom, is frequently exhibited in the client, indicates that the client is at risk for chronic complications of diabetes if the blood glucose is not adequately managed? A. Polyuria B. Diaphoresis C. Pedal edema D. Decrease respiratory rate

A. Polyuria

The nurse is monitoring a client who is diagnosed with type 1 diabetes mellitus and is being treated with NPH and regular insulin. Which manifestations would alert the nurse to the presence of a hypoglycemic reaction? Select all that apply A. Tremors B. Anorexia C. Irritability D. Nervousness E. Hot, dry skin F. Muscle cramps

A. Tremors C. Irritability D. Nervousness

The nurse is teaching a client with diabetes mellitus how to mix regular insulin and NPH insulin in the same syringe. Which action, if performed by the client, indicates the need for further teaching? A. Withdraws the NPH first B. Withdrawals the regular insulin first C. Inject air into NPH insulin vial first D. Injects an amount of air equal to the desired dose of insulin into each vial

A. Withdrawals the NPH insulin first

The primary healthcare provider prescribes exenatide for a client with type 1 diabetes mellitus Who takes insulin. The nurse should plan to take which most appropriate intervention? A. Withhold the medication and call the primary healthcare provider, questioning the prescription for the client B. Teach the client about the signs and symptoms of hypoglycemia and hyperglycemia C. Monitor the client for gastrointestinal side effects after administering the medication D. Withdraw the insulin from the prefilled pen into an insulin syringe to prepare for administration.

A. Withhold the medication and call the PCP, questioning the prescription for the client Exenatide is an incretin mimetic used for type 2 and not recommended her clients taking insulin. Hence the nurse should withhold medication and question the PCP regarding this prescription. Although options B and C are correct statements about the medication, in this situation the medication should not be administered. The medication is packaged in prefilled pens ready for injection without the need for drawing it up into another syringe

A client with a diagnosis of diabetic ketoacidosis (DKA) it's been treated in the emergency department. Which finding support this diagnosis? Select all that apply A. Increase in pH B. Comatose state C. Deep, rapid breathing D. Decreased urine output E. Elevated blood glucose level

B. Comatose state C. Deep rapid breathing E. Elevated blood glucose level

Which hormones help prevent hypoglycemia? Select all that apply A. Aldosterone B. Cortisol C. Epinephrine D. Growth hormone E. Glucagon F. Insulin G. Norepinephrine H. Proinsulin

B. Cortisol C. Epinephrine D. Growth hormone E. Glucagon G. Norepinephrine Rationale: Cortisol decreases glucose uptake by cells and increases liver production and release of glucose. Epinephrine and norepinephrine rapidly increase liver glycogen breakdown and release of glucose into circulation. Growth hormone also rapidly increases liver glycogen breakdown and increases release of glucose into circulation. Glucagon is the major hormone preventing hypoglycemia. It is produced and secreted by alpha cells of the pancreatic islets as soon as blood glucose levels begin to drop below normal. Aldosterone is an adrenal hormone that affects water and mineral metabolism, not glucose metabolism. Insulin decreases blood glucose levels and can cause hypoglycemia. Proinsulin is an inactive compound that does not directly affect blood glucose levels until it is metabolized into insulin.

Which Health promotion activities will the nurse recommend to prevent harm in a client with type 2 diabetes? Select all that apply A. Avoid all dietary carbohydrates and fat B. Have your eyes and vision assessed by an ophthalmologist each year C. Reduce your intake of animal fat and increase your intake of plant sterols D. Be sure to take your anti-diabetic drug right before you engage in any type of exercise E. Keep your feet warm and cold weather by using either a hot water bottle or a heating pad F. Avoid for damage from shoe rubbing by going barefoot or wearing flip-flops when you are at home

B. Have your eyes and vision assessed by an ophthalmologist each year C. Reduce your intake of animal fat and an increase your intake of plant sterols

The nurse teaches a client who is newly diagnosed with diabetes insipidus about the prescribed intranasal desmopressin. Which statement by the client indicates understanding? Select all that apply A. This medication will turn my urine an orange B. I should decrease my oral fluids when I start this medication C. The amount of urine I make should increase if this medication is working D. I need to follow a low fat diet to avoid pancreatitis when taking with medication E. I should report headache and drowsiness to my doctor since these symptoms could be related to my desmopressin

B. I should decrease my oral fluids when I start this medication E. I should report headache and drowsiness to my doctors and the symptoms could be related to my desmopressin And diabetes insipidus there is a deficiency and antidiuretic hormone (ADH), resulting in large urinary losses. Desmopressin is an anti-diuretic hormone that enhances resorption of water in the kidney. Clients and diabetes insipidus drink high volumes of fluid (polydipsia) as a compensatory mechanism to counteract urinary losses and maintaining food balance. Once desmopressin is started, oral fluid should be decreased to prevent water intoxication. Therefore clients with diabetes insipidus should decrease in oral fluid intake when they start desmopressin. Headache and drowsiness are signs of water intoxication in the patient taking desmopressin and should be reported to the primary healthcare provider.

For making rounds the nurse finds a client with a type one diabetes mellitus pale, sweaty, and slightly confused; the client can swallow. The client blood glucose level check is 48 mg/dL. What is the nurse best first action to prevent harm? A. Call the pharmacy and order a stat dose of glucagon B. Immediately give the client 30 g of glucose orally C. Start an IV and administer a small amount of concentrated dextrose solution D. Recheck the blood glucose level and call the rapid response team

B. Immediately give the client 30 g of glucose orally

The nurse is preparing a plan of care for a client with diabetes mellitus who has hyperglycemia. The nurse places priority on which client problem? A. Lack of knowledge B. Inadequate fluid volume C. Compromised family coping D. Inadequate consumption of nutrients

B. Inadequate fluid volume

Glimepiride is prescribed for a client with diabetes mellitus. The nurse instruct the client that which food items are most acceptable to consumed while taking this medication? Select all that apply A. Alcohol B. Red meats C. Whole grain cereal D. Low-calorie desserts E. Carbonated beverages

B. Red meats C. Whole grain cereal E. Carbonated beverages When alcohol is combined with this drug a disulfiram like reaction may occur. This syndrome includes flushing, palpitations, and nausea. Alcohol can also potentiates the hypoglycemic effects of the medication. Low-calorie desserts should also be avoided. Even though the calorie content may be low, carbohydrate content is most likely high and can affect the blood glucose.

The home care nurse visit the client recently diagnosed with diabetes mellitus Who is taking Humulin NPH insulin daily. The client asked the nurse how to store the unopened vials of insulin. The nurse should tell the client to take a which action? A. Freeze the insulin B. Refrigerate the insulin C. Store the insulin in a dark, dry place D. Keep the insulin at room temperature

B. Refrigerate the insulin

The nurse teaches a client with diabetes mellitus about differentiating between hypoglycemia and ketoacidosis. The client demonstrates an understanding of the teaching by stating that a form of glucose should be taken if which symptoms develop? Select all that apply A. Polyuria B. Shakiness C. Palpations D. Blurred vision E. Lightheadedness F. Fruity breath odor

B. Shakiness C. Palpations E. Lightheadedness

A client at risk for shock secondary to pneumonia develops restlessness and agitated and confused. Urinary output has decreased in the blood pressure is 92/68 mmHg. The nurse suspects which stage of shock based on this data.? A. Stage one B. Stage two C. Stage three D. Stage four

B. Stage two Shock is categorized by four stages. Stage 1 is characterized by restlessness, increase heart rate, core and pale skin, and agitation. Stage 2 is characterized by cardiac output that is less than 4-6 L per minute, systolic blood pressure less than 100 mmHg, decrease urinary output, confusion, and cerebral perfusion pressure that is less than 70 mmHg. Stage 3 is characterized by Edema, excessively low blood pressure, dysrhythmias, and weak three pulses. Stage 4 is characterized as unresponsiveness to vasopressors, profound hypertension, slowed heart rate, and multiple organ failure. Most often the client will not survive.

The nurse is providing instructions to the client newly diagnosed with diabetes mellitus who has been prescribed pramlintide. Which instruction should the nurse include in the discharge teaching? A. Inject the Pramlintide at the same time you take your other medications B. Take your prescribed pills one hour before or two hours after the injection C. Be sure to take the Pramlintide with food so you don't upset your stomach D. Make sure you take your Primlintide immediately after you eat so you don't experience low blood sugar

B. Take your prescribed pills one hour before or two hours after the injection Pramlintide is used for clients with the types of one and two diabetes who use insulin. It is administered subcutaneously before meals to lower blood glucose levels after meals. Leading to less fluctuation during the day and better long-term glucose control. Because Pramlintide delays gastric emptying, the prescribed oral medication should be taking one hour before or two hours after an injection; therefore instructing the client to take his or her pills one hour before or two hours after the injection is correct

A client with type 1 diabetes mellitus Who takes NPH daily in the morning calls nurse to report recurrent episodes of hypoglycemia with exercising. Which statement by the client indicates an adequate understanding of the peak action of NPH insulin and exercise? A. I should not exercise since I am taking insulin B. The best time for me to exercise is after breakfast C. The best time for me to exercise is mid to late afternoon D. NPH is a basal insulin, so I should exercise in the evening

B. The best time for me to exercise is after breakfast

The nurse is teaching a clients family regarding the diagnosis of septic shock. Which teaching will the nurse include? Select all that apply A. The blood cultures will tell us for sure if your loved one has septic shock B. The clients change in behavior and lethargy may be associated with septic shock C. Antibiotics, as prescribed, will be started within an hour to treat the sepsis D. An insulin drip has been started to keep the clients glucose as low as possible E. Septic shock is easily treated with multiple antibiotics

B. The clients change in behavior and lethargy may be associated with septic sharp C. Antibiotics as prescribed will be started within an hour to treat the sepsis

A client with diabetes who now has chronic albuminuria ask the nurse how this change will affect his health. How will the nurse answer this question? A. "You will need to limit your intake of dietary albumin and other proteins to reduce the albuminuria" B. " This change indicates beginning kidney problems and requires good blood glucose control to prevent more damage" C. "Your risk for developing urinary track infections is greatly increased, requiring the need to take antibiotics for prevention" D. "From now on you need to limit your food intake to choose 1 L daily and completely avoid caffeine to protect your kidneys"

B. This change indicates beginning kidney problems that requires good blood glucose control to prevent more damage

How old a nurse modify insulin injection techniques for a client who is 5'10 and weighs 106 pounds (48.1kg) A. Use a 6-mm needle and inject at a 90° angle B. Use a 6-mm needle and inject at a 45° angle C. Use a 12-mm needle and inject at a 90° angle D. Use a 12-mm needle and inject at a 45° angle

B. Use a 6 mm needle and inject it at a 45° angle

A client with diabetes mellitus demonstrate acute anxiety when admitted to the hospital for the treatment of hyperglycemia. Which is the appropriate intervention to decrease the clients anxiety? A. Administer a sedative B. Convey empathy, trust, and respect towards the client C. Ignore the signs and symptoms of anxiety, anticipating that they will soon disappear D. Make sure that the client is familiar with the correct medical terms to promote understanding of what is happening

C. Convey empathy, trust and respect towards the client

Which precaution is a priority for the nurse to teach a client prescribed pramlintide to prevent harm? A. Only take this drug once weekly B. Do not drink alcohol when taking this drug C. Do not mix in the same syringe with insulin D. Report any genital itching to your primary healthcare provider

C. Do not mix in the same syringe with insulin This is not like any of the other GLP-1 -tides, it's a different class of drug called amlyin analogs and is only available as a subcutaneous formula which cannot be mixed with insulin because the pH is not compatible

The family of a client receiving a blood transfusion report with distress to the nurse that although the blood bag hanging has the clients name on it, the bag label says B negative and the clients blood type is B positive. What is the nurses priority action? A. Alert the blood bank and rapid response team about a potential error B. Thank the family for being alert and preventing a serious complication C. Explain that a person who is Rh positive can receive Rh negative blood D. Immediately go and stop the infusion but keep the IV line open with normal saline

C. Explain that a person who is Rh positive can receive Rh negative blood.

The nurse is providing discharge teaching for a client newly diagnosed with type 2 diabetes mellitus Who has been prescribed metformin. Which client statement indicates the need for further teaching? A. It is OK if I skip meals once in a while B. I need to let my doctor know if I get unusually tired C. I need to constantly watch for signs of low blood sugar D. I will be sure not to drink alcohol excessively while on this medication

C. I need to constantly watch for signs of low blood sugar When used alone, Metformin lowers blood glucose after meal and take as well as fasting blood glucose levels. Metformin does not stimulate insulin release and therefore for poses a little risk for hypoglycemia. For this reason Metformin is well suited for clients who skip meals. Unusual somnolence as well as hyperventilation, myalgia , malaise or early signs of lactic acidosis, a toxic effect associated with Metformin

A client is admitted to a hospital with a diagnosis of diabetic ketoacidosis. The initial blood glucose level is 950 mg/dL. A continuous intravenous (IV) infusion of short acting insulin as initiated, along with IV rehydration with normal saline . The serum glucose level is now decreased to 240 mg/dL. The nurse with the next prepared to administer which medication? A. An ampule of 50% dextrose B. NPH insulin subcutaneously C. IV fluids containing dextrose D. phenytoin for the prevention of seizures

C. IV fluids containing dextrose

A client is brought to the emergency department in an unresponsive state, and the diagnosis of hyperosmolar hyperglycemic syndrome is made. The nurse would immediately prepare to initiate which anticipated primary healthcare providers prescription? A. Endotracheal intubation B. 100 units of NPH insulin C. Intervenous infusion of normal saline D. Intervenous infusion of sodium bicarbonate

C. Intravenous infusion of normal saline

The nurse is reviewing the laboratory profile of a client with hypovolemic shock. What laboratory value with the nurse anticipate? A. pH 7.51 B. PaO2 106 mm Hg C. Pac02 49 mm Hg D. Lactate 0.4 mmol/L

C. PaC02 49 mm Hg

Which clinical findings are consistent with sepsis diagnostic criteria? Select all that apply A. Urine output of 50 mL/hr B. Hypoactive bowel sounds C. Temperature of 102°F D. Heart rate of 96 bpm E. Mean arterial pressure 65 mm Hg F. Systolic blood pressure 110 mmHg

C. Temperature of 102°F D. Heart rate of 96 bpm E. Mean arterial pressure 65 mmHg Sepsis diagnostic criteria with regard to signs and symptoms include the following: fever (temperature higher than 100.9°F , or hypothermia (toward temperature lower than 97°F) , tachycardia, tachypnea, systolic blood pressure less than or equal to 100 mmHg or arterial hypertension, MAP less than 70 mmHg, altered mental status, edema or positive fluid balance, oliguria, ileus (absent bowel sounds) and decreased capillary refill or mottling of skin

Which urine characteristics indicate to the nurse of the client being managed for diabetes insipidus is responding appropriately to interventions? A. Urine output volume increased; urine specific gravity increased B. Urine output volume increased; urine specific gravity decreased C. Urine output volume decreased; urine specific gravity increased D. Urine output volume decreased; urine specific gravity decreased

C. Urine output volume decreased; urine specific gravity increased

The nurse is caring for a client admitted to the emergency department with diabetic ketoacidosis. In the acute phase, the nurse plans for which priority intervention? A. Correct the acidosis B. Administer 5% dextrose intravenously C. Apply a monitor for an electrocardiogram D. Administer short duration insulin intravenously

D. Administer short duration insulin intravenously

The nurse is caring for a client with hypovolemic shock was bleeding from a traumatic injury to the upper chest wall. What is the priority nursing action? A. Insert a large bore IV catheter B. Administer supplemental oxygen C. Elevate the clients feet, keeping the head flat D. Apply direct pressure to the area of overt bleeding

D. Apply direct pressure to the area of overt bleeding

One preparing to administer a prescribed subcutaneous dose of NPH insulin from an open while taken for me medication drawer to a client with diabetes, the nurse notes the solution is cloudy. What action will the nurse performed to ensure client safety? A. Warm the vial a bowl of warm water until it reaches normal body temperature B. Return the vial to the pharmacy and open a fresh vial of NPH insulin C. Roll the vial between the hands until the insulin is clear D. Check the expiration date and draw up the insulin dose

D. Check the expiration date and draw up the insulin dose

Packed red blood cells have been prescribed her a female client with anemia who has a hemoglobin level of 7.6 g/dL and hematocrit of 30%. The nurse takes the clients temperature before hanging the blood transfusion and records 100.6°F orally. Which action should the nurse take? A. Begin the transfusion as prescribed B. Administer an antihistamine and begin the transfusion C. Administer 2 tablets of acetaminophen and begin the transfusion D. Delay hanging the blood to notify the primary healthcare provider

D. Delay hanging the blood and notify the primary healthcare provider If the client has a temperature higher than 100°F the unit of blood should not be hung until the primary care provider is notified and has the opportunity to give further prescriptions. The PCP likely will prescribe the blood it be administered regardless of the temperature, or main strength the nurse to administer a prescribed acetaminophen and wait until the temperature has decreased before administration. This decision is not within the nurses scope of practice to make.

The nurse provides instructions to a client newly diagnosed with type one diabetes mellitus. The nurse recognizes accurate understanding of measures to prevent diabetic ketoacidosis when the client makes which statement? A. I will stop taking my insulin if I am too sick to eat B. I will decrease my insulin dose during times of illness C. I will adjust my insulin dose according to the level of glucose in my urine D. I will notify my primary healthcare provider if my blood glucose level is higher than 250 mg/dL

D. I will notify my primary healthcare provider if my blood glucose level is higher than 250 mg/dL

Client in shock develops a central venous pressure of 2 mm Hg and mean arterial pressure (MAP) of 60 mmHg. Which prescribed intervention should the nurse implement first? A. Increase the rate of oxygen flow B. Obtain arterial blood gas results C. Insert an indwelling urinary catheter D. Increase the rate of intravenous fluids

D. Increase the rate of intravenous fluids

An external insulin pump is prescribed for a client with diabetes mellitus and the client asks the nurse about the functioning of the pump. The nurse bases the response on the information that the pump: a) is timed to release programmed doses of regular or NPH insulin into the bloodstream at specific intervals b) continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels c) is surgically attached to the pancreas and infuses regular insulin into the pancreas, which in turn releases the insulin into the bloodstream d) gives a small continuously dose of regular insulin subcutaneously, and the client can self-administer a bolus with an additional dose form the pump before each meal

D. It administers a small continuous dose of short duration insulin subcutaneously. The client can solve administer an additional bolus dose from the pump before each meal

The nurse is caring for a client with hypovolemic shock. Which new assessment finding indicates to the nurse that interventions are currently effective? A. Oxygen saturation remains unchanged B. Core body temperature has increased to 99°F C. The client correctly states the month and year D. Serum lactate and serum potassium levels are declining

D. Serum lactate and serum potassium levels are declining

The nurse reviewing the preadmission testing laboratory values for 62-year-old client scheduled for a total knee replacement fines and A-1 C value of 6.2%. How will the nurse interpret this finding? A. The clients A-1 C is completely normal B. The client has type one diabetes mellitus C. The client has type two diabetes mellitus D. The client has pre-diabetes mellitus

D. The client has pre-diabetes mellitus