ch 33 diabetes

A client diagnosed with type 2 diabetes has been instructed about managing his condition with diet. The nurse determines further teaching is necessary when the client states: "I must avoid all candies and cookies, but can eat unlimited amounts of pasta and breads." "I can drink 8 to 10 glasses of water daily without concern for calories." "I need to limit the amount of foods that I eat that contain trans fats." "I need to avoid adding salt to my foods."

"I must avoid all candies and cookies, but can eat unlimited amounts of pasta and breads."

When caring for the client with diabetic ketoacidosis, the nurse recognizes that fatty acids and ketones may be used for energy by most organs. Which organ does the nurse recognize is reliant on glucose as the major energy source? Heart Lungs Spleen Brain

Brain

A client with diabetes mellitus has sudden onset of slurred speech, incoordination, and cool, clammy skin. What will the nurse do first?

Check blood glucose (Because other conditions can also cause these symptoms, the blood glucose level should be checked first. Then glucose should be given.)

A woman in her 28th week of pregnancy develops gestational diabetes mellitus and has persistent elevated blood glucose when using the diet plan. What medications are appropriate? Select all that apply. Acarbose Glyburide Insulin Metformin Sitagliptin

Glyburide Insulin

A nurse educator is conducting a course for newly diagnosed diabetes clients. Which statement by a participant should the nurse follow up first? "I've started eating four or five smaller meals each day instead of three larger meals." "My doctor suggested checking my blood sugars twice a day, but I've started doing it before each meal and at bedtime." "I've had a little sore on the sole of my foot for a few days, but I'm sure it will eventually heal." "I know that we're supposed to get our eyes checked regularly, but my extended health insurance doesn't cover it."

"I've had a little sore on the sole of my foot for a few days, but I'm sure it will eventually heal."

A nurse is evaluating clients for the risk of developing type 2 diabetes. Which client has the highest risk for developing this metabolic disorder? A middle aged obese adult with a sedentary lifestyle A young child whose grandmother has type 2 diabetes An adult who has an active lifestyle and small waist-hip ratio An older adult with a history of gestational diabetes

A middle aged obese adult with a sedentary lifestyle

A 60 year-old man has long managed his type 1 diabetes effectively with a combination of vigilant blood sugar monitoring, subcutaneous insulin administration, and conscientious eating habits. This morning, however, his wife has noted that he appears pale and clammy and appears to be in a stupor, though he is responsive. She suspects that he has made an error in his insulin administration and that he is experiencing a hypoglycemic episode. Which action should be the wife's first choice?

Administration of 15 to 20 g of glucose in a concentrated carbohydrate source. (Glucagon or D50 would be indicated if the client is unconscious or unable to swallow.)

The nurse and nursing student are caring for a client undergoing a severe stressor with release of epinephrine into the bloodstream. The nurse teaches the student that epinephrine will cause which effect on blood glucose levels? Blood glucose will elevate. Hypoglycemia will occur. An unusable form of glucose will be released. Gluconeogenesis will occur.

Blood glucose will elevate.

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 aspart Insulin glargine Insulin glulisine Regular insulin

Insulin glargine (Glargine is a long-acting peakless insulin that provides consistent basal levels over a 20- to 24-hour period) Regular insulin has a duration of 5 to 7 hours. Aspart and glulisine have the most rapid onset and shortest duration of action, making them optimal for postprandial glucose control.

A client admitted to the hospital with elevated blood glucose is diagnosed with type 1 diabetes mellitus. What characteristics commonly differentiate type 1 diabetes mellitus from type 2 diabetes mellitus? Select all that apply. Onset before age 20 Insulin not needed for management Abrupt onset of symptoms HgbA1C 7.5% (.07) Autoimmune beta cell damage

Onset before age 20 Autoimmune beta cell damage Abrupt onset of symptoms

The nurse knows that increased blood glucose levels will pull water out of cells and result in which fluid/electrolyte manifestations? Select all that apply. Polyphagia Polydysplasia Polydipsia Fatigue Polyuria

Polydipsia (excessive thirst) Polyuria (excessive urination)

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

Somogyi effect

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? Injectable insulin, nutrition management, and adequate hydration Weight loss, glucose monitoring, and oral antihyperglycemic medications Continuous subcutaneous insulin infusion (CSII) and nutrition management Daily monitoring for urine ketones and weight loss measures.

Weight loss, glucose monitoring, and oral antihyperglycemic medications

Which criterion about insulin would prompt a diagnosis of type 1 diabetes? Large amounts of insulin secreted Small amounts of insulin secreted Insulin not efficiently used Complete failure of insulin secretion

Complete failure of insulin secretion

A client with pancreatitis is admitted with weight loss, nausea, and vomiting. To maintain nutrition, the physician orders parenteral nutrition to be started. Knowing that a major side effect of parenteral nutrition is a hyperosmolar hyperglycemic state, the nurse should assess the client for which clinical manifestations?

Dry lips, excess urine output, and seizures.

A client tells the health care provider that he has been very compliant over the last 2 months in the management of his diabetes. The best diagnostic indicator that would support the client's response would be:

Glycosylated hemoglobin, hemoglobin A1C (HbA1C)

A man is brought into the emergency department by paramedics who state that the client passed out on the street. The man smells of alcohol, and when roused says he has not eaten since yesterday. He is wearing a medic alert bracelet that says he is a diabetic. What would the nurse suspect as a diagnosis?

Hypoglycemia

The nurse screening for diabetes mellitus at a health fair obtains these results. Which client should be referred to a primary health care provider for further evaluation? Random blood glucose 195 mg/dL (10.82 mmol/L) Hemoglogin A1C 6.0% (.06) Urine ketones 0 Fasting blood glucose 89 mg/dL (4.94 mmol/L)

Random blood glucose 195 mg/dL (10.82 mmol/L)

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? Glycosylated hemoglobin 7.2% (.07) Gained 5 lb in one week 1% ketones present in urine Random blood glucose 85 mg/dL (4.72 mmol/L)

Random blood glucose 85 mg/dL (4.72 mmol/L) The goals of the nutritional plan for gestational diabetes mellitus (GDM) include normal glucose levels, no ketosis, proper weight gain for the pregnancy, and adequate nutrition for fetal health.

A woman with a diagnosis of type 2 diabetes has been ordered a hemoglobin A1C test for the first time by her primary care provider. The woman states, "I don't see why you want to test my blood cells when it's sugar that's the problem." What aspect of physiology will underlie the care provider's response to the client? Insulin is a glucose receptor agonist on the hemoglobin molecule and high glucose suggests low insulin levels. The high metabolic needs of red cells and their affinity for free glucose indicate the amount of glucose that has been available over 6 to 12 weeks. The amount of glucose attached to A1C cells reflects the average blood glucose levels over the life of the cell. Hemoglobin synthesis by the bone marrow is inversely proportionate to blood glucose levels, with low A1C indicating hyperglycemia.

The amount of glucose attached to A1C cells reflects the average blood glucose levels over the life of the cell.

A client is managing diabetes with exercise and diet. The health care provider reviews the client's most recent laboratory results: fasting blood glucose level at 80 mg/dL (4.44 mmol/L) and a hemoglobin A1C of 5% (0.05). Select the response that best identifies the client. The client is at risk for developing hyperglycemia. The client is achieving normal glycemic control. The client is at risk for an insulin reaction. The client needs to modify the diet related to the low readings.

The client is achieving normal glycemic control.

A client with type 1 diabetes mellitus wishes to stop taking insulin injections. What option is appropriate? Using an insulin infusion pump Taking the herb chromium picolinate Increasing daily aerobic activity Taking metformin

Using an insulin infusion pump

The obstetrical nurse is caring for a client who has been treated for gestational diabetes. When teaching the client about the causes of gestational diabetes, the nurse should include which risk factor in the teaching? Woman who has had a child under 5 lb (2.2 kg) First birth occurring during the teenage years Woman with a family history of diabetes First pregnancy

Woman with a family history of diabetes Gestational diabetes occurs most commonly in black, Hispanic/Latino and Native American/First Nation women. It most frequently affects women with a family history of diabetes; a history of stillbirth or spontaneous abortion; women who previously gave birth to a newborn with fetal anomaly or had a previous large-for-gestational-age infant; those who are obese; those of advanced maternal age; or those who have had five or more pregnancies.