TTC NUR205: MedSurgII PrepU Chapter 30 (Diabetes Mellitus)

Which instruction about insulin administration should a nurse give to a client?

"Always follow the same order when drawing the different insulins into the syringe."

During a routine medical evaluation, a client is found to have a random blood glucose level of 210 mg/dL. Which client statement(s) made by the client are concerning to the nurse? Select all that apply.

"At times my vision is blurry." "I have to void nearly every hour." "I cannot seem to quench my thirst." "I have lost 10 pounds without even trying."

A client is taking glyburide (DiaBeta), 1.25 mg P.O. daily, to treat type 2 diabetes. Which statement indicates the need for further client teaching about managing this disease?

"I skip lunch when I don't feel hungry."

A client is evaluated for type 1 diabetes. Which client comment correlates best with this disorder?

"I'm thirsty all the time. I just can't get enough to drink."

A nurse prepares teaching for a client with newly-diagnosed diabetes. Which statements about the role of insulin will the nurse include in the teaching? Select all that apply.

"Insulin permits entry of glucose into the cells of the body." "Insulin promotes synthesis of proteins in various body tissues." "Insulin promotes the storage of fat in adipose tissue."

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." The nurse should tell the client that ketones are a byproduct of fat metabolism and that ketone testing can determine whether the body is breaking down fat to use for energy.

A client has just been diagnosed with type 1 diabetes. When teaching the client and family how diet and exercise affect insulin requirements, the nurse should include which guideline?

"You'll need less insulin when you exercise or reduce your food intake."

A 16-year-old client newly diagnosed with type 1 diabetes has a very low body weight despite eating regular meals. The client is upset because friends frequently state, "You look anorexic." Which statement by the nurse would be the best response to help this client understand the cause of weight loss due to this condition?

"Your body is using protein and fat for energy instead of glucose."

Which of the following is a characteristic of diabetic ketoacidosis (DKA)? Select all that apply.

-Elevated blood urea nitrogen (BUN) and creatinine -Rapid onset -More common in type 1 diabetes

The nurse is administering lispro insulin. Based on the onset of action, how long before breakfast should the nurse administer the injection?

10 to 15 minutes

When the dawn phenomenon occurs, the patient has relatively normal blood glucose until approximate what time of day?

3 AM During the dawn phenomenon, the patient has a relatively normal blood glucose level until about 3 AM, when the level begins to rise.

Glycosylated hemoglobin reflects blood glucose concentrations over which period of time?

3 months

What is the duration of regular insulin?

4 to 6 hours

The nurse expects that a type 1 diabetic patient may receive what percentage of his or her usual morning dose of insulin preoperatively?

50% to 60%

When administering insulin to a client with type 1 diabetes, which of the following would be most important for the nurse to keep in mind?

Accuracy of the dosage

A child is brought into the emergency department with vomiting, drowsiness, and blowing respirations. The child's parent reports that the symptoms have been progressing throughout the day. The nurse suspects diabetic ketoacidosis (DKA). Which action should the nurse take first in the management of DKA?

Begin fluid replacements.

A nurse expects to note an elevated serum glucose level in a client with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which other laboratory finding should the nurse anticipate?

Below-normal serum potassium level

Which of the following is an age-related change that may affect diabetes? Select all that apply.

Decreased renal function Taste changes Decreased vision

An obese Hispanic client, age 65, is diagnosed with type 2 diabetes. Which statement about diabetes mellitus is true?

Diabetes mellitus is more common in Hispanics and Blacks than in Whites.

The nurse is caring for a client receiving insulin isophane suspension (NPH) at breakfast. What is an important dietary consideration for the nurse to keep in mind?

Encourage midday snack. Because NPH is an intermediate-acting insulin that peaks in approximately 4 to 10 hours, a midday snack should be included in daily calorie intake to avoid hypoglycemia.

A diabetes nurse is discussing lifestyle measures that a patient with a recent diagnosis of type 1 diabetes can use to manage his disease. When discussing the benefits of exercise with this patient, the nurse should recommend that he:

Exercise a similar amount at a similar time each day

A nurse practitioner ordered blood work for a 65-year-old man who is hypertensive and obese. Which of the following results is consistent with a diagnosis of prediabetes?

Fasting plasma glucose of 128 mg/dL

A nurse is inspecting the feet of a client with diabetes and finds a tack 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. Diabetic neuropathy results from poor glucose control and decreased blood circulation to nerve tissues. The lack of sensitivity increases the potential for soft tissue injury without awareness.

Which is the best nursing explanation for the symptom of polyuria in a client with diabetes mellitus?

High sugar pulls fluid into the bloodstream, which results in more urine production.

When the nurse is caring for a patient with type 1 diabetes, what clinical manifestation would be a priority to closely monitor?

Hypoglycemia

Which combination of adverse effects should a nurse monitor for when administering IV insulin to a client with diabetic ketoacidosis?

Hypokalemia and hypoglycemia Hypoglycemia might occur if too much insulin is administered. Hypokalemia, not hyperkalemia, might occur because I.V. insulin forces potassium into cells, thereby lowering the plasma level of potassium

For a client with hyperglycemia, which assessment finding best supports a nursing diagnosis of Deficient fluid volume?

Increased urine osmolarity

A nurse is assessing a client who is receiving total parenteral nutrition (TPN). Which finding suggests that the client has developed hyperglycemia?

Increased urine output

The nurse is describing the action of insulin in the body to a client newly diagnosed with type 1 diabetes. Which of the following would the nurse explain as being the primary action?

It carries glucose into body cells.

A patient is diagnosed with type 1 diabetes. What clinical characteristics does the nurse expect to see in this patient? Select all that apply.

Ketosis-prone Little or no endogenous insulin Younger than 30 years of age

A patient with a diagnosis of type 2 diabetes has been vigilant about glycemic control since being diagnosed and has committed to increasing her knowledge about the disease. To reduce her risk of developing diabetic nephropathy in the future, this patient should combine glycemic control with what other preventative measure?

Maintenance of healthy blood pressure and prompt treatment of hypertension

During a period of heavy work and family pressures, an adult male patient with type 1 diabetes has become ill with influenza. This combination of psychological and physiological stress has culminated in ketoacidosis. The nurse who is now providing this patient's care should be aware that the presence of ketones in the blood result from:

Metabolism of fat

A group of students are reviewing the various types of drugs that are used to treat diabetes mellitus. The students demonstrate understanding of the material when they identify which of the following as an example of an alpha-glucosidase inhibitor?

Miglitol

A nurse obtains a fingerstick glucose level of 45 mg/dl on a client newly diagnosed with diabetes mellitus. The client is alert and oriented, and the client's skin is warm and dry. How should the nurse intervene?

Obtain a repeat fingerstick glucose level. The nurse should recheck the fingerstick glucose level to verify the original result because the client isn't exhibiting signs of hypoglycemia.

Which of the following factors should the nurse take into consideration when planning meals and selecting the type and dosage of insulin or oral hypoglycemic agent for an elderly patient with diabetes mellitus?

Patient's eating and sleeping habits

A 30-year-old type 1 diabetic has been admitted to the critical care unit with a diagnosis of diabetic ketoacidosis following a drinking binge over the course of a weekend. The nurse should anticipate that this patient will require what immediate intervention?

Rapid administration of intravenous normal saline

A 78-year-old patient with type 2 diabetes is brought to the emergency department by his daughter. The patient is found to have a blood glucose level of 623 mg/dL. The patient's daughter reports that the patient recently had a gastrointestinal virus and has been confused for the last 3 hours. A diagnosis of hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is made. What nursing action would be the priority?

Replacing fluids and electrolytes

A client with a tentative diagnosis of hyperosmolar hyperglycemic nonketotic syndrome (HHNS) has a history of type 2 diabetes that is being controlled with an oral diabetic agent, tolazamide. Which laboratory test is the most important for confirming this disorder?

Serum osmolarity

After taking glipizide (Glucotrol) for 9 months, a client experiences secondary failure. What should the nurse expect the physician to do?

Switch the client to a different oral antidiabetic agent.

Insulin is a hormone secreted by the Islets of Langerhans and is essential for the metabolism of carbohydrates, fats, and protein. The nurse understands the physiologic importance of gluconeogenesis, which refers to the:

Synthesis of glucose from noncarbohydrate sources.

Which of the following factors would a nurse identify as a most likely cause of diabetic ketoacidosis (DKA) in a client with diabetes?

The client has eaten and has not taken or received insulin.

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 nurse is preparing to administer two types of insulin to a client with diabetes mellitus. What is the correct procedure for preparing this medication?

The short-acting insulin is withdrawn before the intermediate-acting insulin.

A client with diabetes mellitus develops sinusitis and otitis media accompanied by a temperature of 100.8° F (38.2° C). What effect do these findings have on his need for insulin?

They increase the need for insulin. Insulin requirements increase in response to growth, pregnancy, increased food intake, stress, surgery, infection, illness, increased insulin antibodies, and some medications.

The nurse understands that a client with diabetes mellitus is at greater risk for developing which of the following complications?

Urinary tract infections Elevated levels of blood glucose and glycosuria supports bacterial growth and places the diabetic at greater risk for urinary tract, skin, and vaginal infections.

Which factor is the focus of nutrition intervention for clients with type 2 diabetes?

weight loss

Health teaching for a patient with diabetes who is prescribed Humulin N, an intermediate NPH insulin, would include which of the following advice?

"You should take your insulin after breakfast and after dinner." NPH (Humulin N) insulin is an intermediate-acting insulin that has an onset of 2 to 4 hours, a peak effectiveness of 4 to 12 hours, and a duration of 16 to 20 hours.

A nurse is teaching a client with diabetes mellitus about self-management of his condition. The nurse should instruct the client to administer 1 unit of insulin for every:

15 g of carbohydrates.

The nurse has cared for four patients with type 1 diabetes over the past few shifts. Based upon components of managing diabetes, which patient will likely have the greatest success in maintaining tight glucose control of his or her type 1 diabetes?

A patient who adheres to a meal plan and meal schedule.

A client with diabetic ketoacidosis has been brought into the ED. Which intervention is not a goal in the initial medical treatment of diabetic ketoacidosis?

Administer glucose.

A client is admitted with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which laboratory finding should the nurse expect in this client?

Blood glucose level 1,100 mg/dl

A patient with a recent diagnosis of type 2 diabetes has been prescribed metformin (Glucophage) 500 mg PO t.i.d. The nurse who is providing this patient's care should recognize that this medication helps the patient achieve stable blood glucose levels by:

Facilitating the action of insulin on peripheral receptor sites

Which of the following insulins are used for basal dosage?

Glargine (Lantus)

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 suspects that a patient with diabetes has developed proliferative retinopathy. The nurse confirms this by the presence of which of the following diagnostic signs?

Neovascularization into the vitreous humor

A client with diabetes mellitus has a prescription for 5 units of U-100 regular insulin and 25 units of U-100 isophane insulin suspension (NPH) to be taken before breakfast. At about 4:30 p.m., the client experiences headache, sweating, tremor, pallor, and nervousness. What is the most probable cause of these signs and symptoms?

Serum glucose level of 52 mg/dl

A client with status asthmaticus requires endotracheal intubation and mechanical ventilation. Twenty-four hours after intubation, the client is started on the insulin infusion protocol. The nurse must monitor the client's blood glucose levels hourly and watch for which early signs and symptoms associated with hypoglycemia?

Sweating, tremors, and tachycardia

Which intervention is essential when performing dressing changes on a client with a diabetic foot ulcer?

Using sterile technique during the dressing change

A client has been recently diagnosed with type 2 diabetes, and reports continued weight loss despite increased hunger and food consumption. This condition is called:

polyphagia

A nurse is assigned to care for a postoperative client with diabetes mellitus. During the assessment interview, the client reports that he's impotent and says he's concerned about the effect on his marriage. In planning this client's care, the most appropriate intervention would be to:

suggest referral to a sex counselor or other appropriate professional.

A nurse is preparing a continuous insulin infusion for a child with diabetic ketoacidosis and a blood glucose level of 800 mg/dl. Which solution is the most appropriate at the beginning of therapy?

100 units of regular insulin in normal saline solution Continuous insulin infusions use only short-acting regular insulin.

A client with long-standing type 1 diabetes is admitted to the hospital with unstable angina pectoris. After the client's condition stabilizes, the nurse evaluates the diabetes management regimen. The nurse learns that the client sees the physician every 4 weeks, injects insulin after breakfast and dinner, and measures blood glucose before breakfast and at bedtime. Consequently, the nurse should formulate a nursing diagnosis of:

Deficient knowledge (treatment regimen). The client should inject insulin before, not after, breakfast and dinner — 30 minutes before breakfast for the a.m. dose and 30 minutes before dinner for the p.m. dose.

Which of the following would be considered a "free" item from the exchange list?

Diet soda Free items include unsweetened iced tea, diet soda, and ice water with lemon.

A client who was diagnosed with type 1 diabetes 14 years ago is admitted to the medical-surgical unit with abdominal pain. On admission, the client's blood glucose level is 470 mg/dl. Which finding is most likely to accompany this blood glucose level?

Rapid, thready pulse This client's abnormally high blood glucose level indicates hyperglycemia, which typically causes polyuria, polyphagia, and polydipsia. Because polyuria leads to fluid loss, the nurse should expect to assess signs of deficient fluid volume, such as a rapid, thready pulse;

A nurse is educating a client about the benefits of fruit versus fruit juice in the diabetic diet. The client states, "What difference does it make if you drink the juice or eat the fruit? It is all the same." What are the best responses by the nurse? Select all that apply.

-Eating the fruit instead of drinking juice decreases the glycemic index by slowing absorption." -"The fruit has less sugar than the juice."

A patient newly diagnosed with type 2 diabetes is attending a nutrition class specifically designed for type 2 diabetics. What general guideline would it be important to teach the patients at this class?

Calorie intake should support a reasonable body weight.

A nurse is preparing a client with type 1 diabetes for discharge. The client can care for himself; however, he's had a problem with unstable blood glucose levels in the past. Based on the client's history, he should be referred to which health care worker?

Dietitian

A 44-year-old woman was diagnosed with type 2 diabetes 4 months ago and has presented for a follow-up appointment. Together with the patient, the nurse is reviewing her diet, meal planning, and nutrition. It is becoming apparent that the patient's eating habits are not conducive to preventing fluctuations in blood glucose levels. The patient acknowledges this fact, stating, "I went over all of this with the dietitian, and I know that it's important, but no one seems to realize how hard it is to put it all into practice." The nurse should identify what nursing diagnosis in the planning of this patient's subsequent care?

Hopelessness related to inability to implement an appropriate diet

A hospitalized, insulin-dependent patient with diabetes has been experiencing morning hyperglycemia. The patient will be awakened once or twice during the night to test blood glucose levels. The health care provider suspects that the cause is related to the Somogyi effect. Which of the following indicators support this diagnosis? Select all that apply.

Increase in blood glucose from 3:00 AM until breakfast Decrease in blood sugar to a hypoglycemic level between 2:00 to 3:00 AM Normal bedtime blood glucose The Somogyi effect is nocturnal hypoglycemia followed by rebound hyperglycemia in the morning

A health care provider prescribes short-acting insulin for a patient, instructing the patient to take the insulin 20 to 30 minutes before a meal. The nurse explains to the patient that Humulin-R taken at 6:30 AM will reach peak effectiveness by:

8:30 AM. Short-acting insulin reaches its peak effectiveness 2 to 3 hours after administration

A nurse is teaching a client recovering from diabetic ketoacidosis (DKA) about management of "sick days." The client asks the nurse why it is important to monitor the urine for ketones. Which statement is the nurse's best response?

"Ketones accumulate in the blood and urine when fat breaks down in the absence of insulin. Ketones signal an insulin deficiency that will cause the body to start breaking down stored fat for energy."

A client with type 1 diabetes is scheduled to receive 30 units of 70/30 insulin. There is no 70/30 insulin available. As a substitution, the nurse may give the client:

9 units regular insulin and 21 units neutral protamine Hagedorn (NPH). A 70/30 insulin preparation is 70% NPH and 30% regular insulin.

During a follow-up visit 3 months after a new diagnosis of type 2 diabetes, a client reports exercising and following a reduced-calorie diet. Assessment reveals that the client has only lost 1 pound and did not bring the glucose-monitoring record. Which value should the nurse measure?

Glycosylated hemoglobin level

Laboratory studies indicate a client's blood glucose level is 185 mg/dl. Two hours have passed since the client ate breakfast. Which test would yield the most conclusive diagnostic information about the client's glucose use?

Serum glycosylated hemoglobin (Hb A1c) Hb A1c is the most reliable indicator of glucose use because it reflects blood glucose levels for the prior 3 months.

The nurse is preparing an educational session about foot care for clients with diabetes. Which information will the nurse include in the education? Select all that apply.

Check the inside of shoes before putting them on. Check the bottom of the feet with a mirror every day.

A nurse knows to assess a patient with type 1 diabetes for postprandial hyperglycemia. The nurse knows that glycosuria is present when the serum glucose level exceeds:

180 mg/dL Glycosuria occurs when the renal threshold for sugar exceeds 180 mg/dL. Glycosuria leads to an excessive loss of water and electrolytes (osmotic diuresis).

The nurse is reviewing the initial laboratory test results of a client diagnosed with DKA. Which of the following would the nurse expect to find?

Blood pH of 6.9 With DKA, blood glucose levels are elevated to 300 to 1000 mg/dL or more. Urine contains glucose and ketones. The blood pH ranges from 6.8 to 7.3.

A client with diabetic ketoacidosis was admitted to the intensive care unit 4 hours ago and has these laboratory results: blood glucose level 450 mg/dl, serum potassium level 2.5 mEq/L, serum sodium level 140 mEq/L, and urine specific gravity 1.025. The client has two IV lines in place with normal saline solution infusing through both. Over the past 4 hours, his total urine output has been 50 ml. Which physician order should the nurse question?

Change the second IV solution to dextrose 5% in water. the client should receive normal saline solution through the second IV site until his blood glucose level reaches 250 mg/dl.

A hospital patient has been ordered a sliding scale of Humulin R for the duration of her admission. The patient's medication administration record specifies the first administration time of the day at 08:00 and the nurse knows that breakfast trays typically arrive on the unit between 07:45 and 07:50. When should the nurse administer the patient's insulin?

07:30 Short-acting insulin, called regular insulin and marked "R" on the vial, is an unmodified clear solution that usually is administered 20 to 30 minutes before a meal.